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Form 72-440-01-1-1-000 (Rev. 6/01)

STATE TAX COMMISSION

Bond Number______________

JACKSON, MISSISSIPPI

RIDER

(SALES, USE, INCOME, FRANCHISE, WITHHOLDING, AND

SPECIAL FUEL [DIESEL FUEL] TAX BOND)

This Rider is attached to and becomes a part of a certain performance and/or payment bond executed by _____________

_______________________________________________________________________________________ as Principal,

(Name and Address)

in favor of _______________________________________________________________________________ as Obligee,

(Name and Address)

and covering a contract dated ___________________________________________, 20 ________, for the construction of

_________________________________________________________________________________________________

(Name Project and Describe)

_________________________________________________________________________________________________

WHEREAS, under the provisions of Section 27-65-21, Mississippi Code of 1972 as amended, the said Principal is required

to and has furnished the attached bond guaranteeing payment of all taxes, damages, interest and penalties which may

accrue to the State of Mississippi under Section 27-65-1 et seq, and Section 27-67-1 et seq., and Section 27-7-1 et seq.,

and Section 27-13-1 et seq., and Section 27-7-301 et seq., and Section 27-55-313 et seq, Mississippi Code of 1972, and

amendments thereto, on account of entering into said contract.

NOW, THEREFORE, in addition to the obligations set forth in the attached bond, there is hereby imposed the additional

obligation by this Rider that the Contractor shall promptly make payment when due of all taxes, damages, interest and

penalties which may accrue to the State of Mississippi under Section 27-65-1 et seq., and Section 27-67-1 et seq., and

Section 27-7-1 et seq., and Section 27-13-1 et seq., and Section 27-7-301 et seq., and Section 27-55-313, Mississippi

Code of 1972, and amendments thereto, on account of the execution of the aforesaid contract.

NOTHWITHSTANDING any provision in the performance and/or payment bond, the expiration date for the sureties'

responsibilities and/or liabilities under this Rider shall be sixty (60) months from the date the final payment for the project

described herein is made, except in the existence of fraud there shall be no expiration date for this Rider.

NOTWITHSTANDING the tax information and return confidentiality provisions contained within Sections 27-65-1 et seq.,

27-67-1 et seq., 27-7-1 et seq., 27-13-1 et seq., 27-7-301 et seq., and 27-55-301 et seq., Mississippi Code of 1972, and

amendments thereto, principal hereby authorizes the State Tax Commission to release to surety any information retating to

any claim against said surety made by the State Tax Commission which is covered by this bond.

SIGNED, SEALED AND DELIVERED, This the _________ day of _________________________________, 20 ________

Filed and Approved this the _____________________ day

of ____________________________________, 20______.

_____________________________________________

Principal

_____________________________________________

Surety

_______________________________________________

By___________________________________________

Commissioner and Chairman of the STATE TAX COMMISSION

Attorney in Fact

COUNTERSIGNATURE:

By ___________________________________________

Resident Mississippi Agent

(SEAL)

______________________________________________

(Type or Print Name of Agent)

______________________________________________

(Telephone Number)

Form 72-440-01-1-1-000 - Rider (Sales, Use, Income, Franchise, Withholding, And Special Fuel [diesel Fuel] Tax Bond)

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