Iowa Admin. Code r. 701-10.124
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 * designate proceeding, e.g., * income, sales, etc.) * *
SURETY BOND
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
Iowa Admin. Code r. 701-10.124