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Form 72-440-10-8-1-000 (Rev. 7/10)

Bond Number______________

DEPARTMENT OF REVENUE

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 Miss Code Ann. § 27-65-21, 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 Miss Code Ann.§ 27-65-1 et seq, and § 27-67-1 et seq., and § 27-7-1 et seq., and § 27-13-1 et seq., and

§ 27-7-301 et seq., and § 27-55-313 et seq, 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 Miss Code Ann. § 27-65-1 et seq., and § 27-67-1 et seq., and

§ 27-7-1 et seq., and § 27-13-1 et seq., and § 27-7-301 et seq., and § 27-55-313, 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 Miss Code Ann. § 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., and amendments

thereto, principal hereby authorizes the Department of Revenue to release to surety any information relating to any claim

against said surety made by the Department of Revenue 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 DEPARTMENT OF REVENUE

Attorney in Fact

COUNTERSIGNATURE:

By ___________________________________________

(SEAL)

Licensed Mississippi Agent

______________________________________________

(Type or Print Name of Agent)

______________________________________________

(Telephone Number)

Form 72-440-10-8-1-000 - Rider (Sales, Use, Income, Franchise, Withholding, And Special Fuel [diesel Fuel] Tax Bond) Form

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