701—10.124 (422,453B) Form of surety bond. 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