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Prepaid Gasoline Special Fuel Irrevocable Standby Letter Of Credit MF-135 - Indiana
| Prepaid Gasoline Special Fuel Irrevocable Standby Letter Of Credit Form. This is a Indiana form and can be used in Bonds And Licensing Fuel And Environmental Department Of Revenue Statewide . |
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MF-135 State Form 49169 (R2/01-06) STATE OF INDIANA DEPARTMENT OF REVENUE ____________________________________ Applicant's Name ____________________________________ Applicant's License Account Number Prepaid/Gasoline/Special Fuel Irrevocable Standby Letter Of Credit # ___________________________________________ Issuing Bank Name ___________________________________________ Address ___________________________________________ Bank FEIN# (______) ___________________________________ Phone Number ___________________________________________ Effective Date ___________________________________________ Expiration Date We, _________________________________________ , hereby issue an IRREVOCABLE STANDBY LETTER OF CREDIT for the Issuing Bank name of ______________________________________________________________________________________ , in the amount Applicant's Name and Address of $ _______________________ (________________________________________ Thousand and no/100 Dollars) which is available by the Indiana Department of Revenue draft drawn at sight of __________________________________________ bearing the clause Issuing Bank Name "drawn under ___________________________________________ Letter Credit for _______________________________________" Issuing Bank Name Applicant's Name accompanied by this Letter of Credit and the following: Statement purportedly signed by an officer of the Indiana Department of Revenue certifying that ___________________________________________ has been served a pre-warrant notice covering nonpayment of ____________________ taxes pursuant to ____________________ plus all applicable penalties and interest due the Indiana Type of Tax Indiana Code Reference Department of Revenue and has failed to provide an acceptable explanation within the time period for such protests or payment of tax. A copy of the pre-warrant notice which bears the expiration date of at least five (5) days prior to the date of the draft. Drawings may be made up to an aggregate amount but not to exceed ___________________________________________. Amount of Letter of Credit American LegalNet, Inc. www.FormsWorkflow.com Unless the Indiana Department of Revenue, Fuel Tax Section is notified in writing to the contrary by ___________________________________________, this Letter of Credit, the expiration date, and any future expiration dates shall Issuing Bank Name automatically renew each year for additional periods of one (1) year. If ___________________________________________ Issuing Bank Name elects not to renew this Letter of Credit and the expiration date thereof (or any subsequent renewal or extension hereof), _____________________________________ shall notify the Indiana Department of Revenue, Fuel Tax Section in writing by Issuing Bank Name certified mail, at least one hundred eighty (180) days prior to stated expiration date of the bank's election in that regard, in which event, the Indiana Department of Revenue, Fuel Tax Section shall have the right thereafter until the stated expiration date to draw upon ___________________________________________ in the manner above provided. Issuing Bank Name engages with the Indiana Department of Revenue, Fuel Tax Section , that all drafts Issuing Bank Name drawn under and in compliance with the terms of this letter of Credit will be duly honored upon delivery of documents as specified if presented at Issuing Bank Address on or before Expiration Date . Except so far as otherwise stated, this credit is subject to the Customs and Practice for Documentary Credits (1983 Revision), International Chamber of Commerce Publication No. 400. IN WITNESS WHEREOF, we have hereunto set our hand and seal this , 20 Issuing Bank By: Officer of Bank Title: STATE OF COUNTY Before me, the undersigned, a Notary Public within and for the County and State aforesaid, this 20 personally appeared Officer of Bank the execution of the foregoing Letter of Credit. Witness my hand and seal this date Notary Public My Commission Expires American LegalNet, Inc. www.FormsWorkflow.com day of day of , .
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