Form 97-506-10 - Gaming Establishment Surety Bond printable pdf download

Form 97-506-10

MISSISSIPPI DEPARTMENT OF REVENUE

GAMING ESTABLISHMENT SURETY BOND

STATE OF MISSISSIPPI

BOND NUMBER _____________________

KNOW ALL MEN BY THESE PRESENTS, THAT WE _______________________________________________________,

Of the City of ___________________________________________, County of _________________________________, State of

______________________________________ as Principal, and ____________________________________________________,

a corporation incorporated under the laws of the State of __________________________________, and duly licensed to do

business in the State of Mississippi, as Surety, are held and firmly bound unto the State of Mississippi, oblige, in the just and full

sum of _________________________Dollars ($__________), for the payment of which sum well and truly to be made and done, we

bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, by these presents, and

WHEREAS, the said Principal herein, has been licensed by the Gaming Commission to be a Gaming Establishment

Licensee under and by virtue of the provisions of the Mississippi Gaming Control Act of the State of Mississippi at _____________

_______________________________________ Street in the City of _______________________________________________

County of ______________________________________________, State of Mississippi, for a term beginning the ___________ day

of _______________________, 20_____.

NOW THEREFORE, the conditions of this obligation are such that if the Principal shall faithfully observe the provisions of

the Mississippi Gaming Control Act, Miss Code Ann §75-76-1, et. seq., all amendments thereto and Rules and Regulations issued

thereunder, and shall pay all taxes due the State of Mississippi, including but not limited to sales, income, and privilege taxes; and in

addition shall pay any and all checks returned for non-payment to the Mississippi Department of Revenue then this obligation shall

be void, otherwise to remain in full force and effect, until a release from further liabilities imposed herein is granted in writing;

PROVIDED, HOWEVER, the Surety shall so elect, this bond may be cancelled at any time by the Surety giving sixty (60) days notice

in writing addressed to and receipted therefor by the Commissioner of the Department of Revenue, and upon the giving of such

notice, this bond shall be deemed cancelled at the expiration of sixty (60) days therefrom.

Witness our hand and seal this ________ day of _______________, 20____.

PRINCIPAL: _____________________________________

By: ____________________________________________

SURETY: ______________________________________

By: ____________________________________________

(If signed by Attorney in Fact, attach copy of written authority.)

The above and foregoing bond approved this _______________day of ____________________________, 20______.

DEPARTMENT OF REVENUE

By: ____________________________________________

Applicant’s Initial: ______________________

Form 97-506-10 - Gaming Establishment Surety Bond