Form 72-440-11 - Sales, Use, Income, Franchise, Withholding, And Special Fuel (Diesel Fuel) Tax Bond

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Form 72-440-11
MISSISSIPPI DEPARTMENT OF REVENUE
P.O. BOX 1033
JACKSON, MS 39215
RIDER
SALES, USE, INCOME, FRANCHISE, WITHHOLDING, AND SPECIAL FUEL (DIESEL
FUEL) TAX BOND
STATE OF MISSISSIPPI
BOND NUMBER _____________________
This Rider is attached to and becomes a part of a certain performance and/or payment bond executed by:
_______________________________________________________________________________________________ as Principal,
Name
Address
City
State
Zip
in favor of _______________________________________________________________________________________ as Obligee,
Name
Address
City
State
Zip
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, as amended, the said Principal is required to and has furnished this
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
the Rider that the Contractor shall promptly make payment when due all taxes, damages, interest and penalties which may accrue
during that time 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 the execution of the
aforesaid contract.
NOTWITHSTANDING, 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 the 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, SELED AND DELIVERED, this ________ day of _______________, 20____.
Filed and Approved, this _______________day of ____________________________, 20______.
COMMISSIONER: ______________________________________ PRINCIPAL: ________________________________________
Countersigned by:
____________________________________________________ SURETY:
_________________________________________
Attorney in Fact
___________________________________________________________________
______________________________________________________
Licensed Mississippi Agent
__________________________________________________________________
Type or Print Name of Agent
Telephone Number

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