Iowa Administrative Rules (Last Updated: December 07, 2016) |
Department 701. Revenue Department |
Chapter 10. INTEREST, PENALTY, EXCEPTIONS TO PENALTY, AND JEOPARDY ASSESSMENTS |
Section 701.10.124. Form of surety bond.
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The surety bond posted shall be in substantially the following form:
BEFORE THE IOWA STATE DEPARTMENT OF REVENUE
HOOVER STATE OFFICE BUILDING
DES MOINES, IOWA
IN THE MATTER OF
*
*
(Taxpayer’s Name, Address and
*
SURETY BOND
designate proceeding, e.g.,
*
income, sales, etc.)
*
DOCKET NO.
*
KNOW ALL PERSONS BY THESE PRESENTS:
That we ______(taxpayer)______ as principal, and ______(surety)______, as surety, of the county of ________________, and State of Iowa, are held and firmly bound unto the Iowa Department of Revenue for the use of the State of Iowa, in the sum of $ ____________ dollars, lawful money of the United States, for the payment of which sum we jointly and severally bind ourselves, our heirs, devisees, successors and assigns firmly by these presents. The condition of the foregoing obligations are, that, whereas the above-named principal has protested an assessment of tax, penalty, interest, or fees or any combination of them, made by the Iowa Department of Revenue, now if the principal _________________________ shall promptly pay the amount of the assessed tax, penalty, interest or fees found to be due upon the resolution of the contested case proceedings, then this bond shall be void, otherwise to remain in full force and effect.
Dated this ____________ day of _______________________________, __________.
_____
Principal
_____
Surety
_____
Surety
(corporate acknowledgment if surety is a corporation)
AFFIDAVIT OF PERSONAL SURETY
STATE OF IOWA
)
ss
COUNTY OF
)
I hereby swear or affirm that I am a resident of Iowa and am worth beyond my debts the amount set opposite my signature below in the column entitled, “Worth Beyond Debts,” and that I have property in the State of Iowa, liable to execution equal to the amount set opposite my signature in the column entitled “Property in Iowa Liable to Execution.”
Signature
Worth
Beyond Debts
Property in Iowa
Liable to Execution
_______________________________________________
$ _________________________________________
$ _________________________________________
Surety (type name)
_______________________________________________
$ _________________________________________
$ _________________________________________
Surety (type name)
Subscribed and sworn to before me the undersigned Notary Public this _______________ day of ____________________, __________.
(Seal) Notary Public in and
for the State of Iowa