Form 72-901-11
MISSISSIPPI DEPARTMENT OF REVENUE
P.O. BOX 1033
JACKSON, MS 39215
SALES TAX SURETY BOND
STATE OF MISSISSIPPI
BOND NUMBER _____________________
KNOW ALL MEN BY THESE PRESENTS, THAT ___________________________________________________________
Owner of Business
_________________________________________________________________________________________________________
Trading As
Address
City
State
Zip
As Principal, and _____________________________________________________________, as Surety, are held and firmly bound
unto the State of Mississippi in the just and full sum of _________________________Dollars ($__________), for the payment of
when due of sales taxes, damages, interest and penalties which may accrue to the State of Mississippi under Miss Code Ann. §27-
65-1 et seq., and amendments thereto, for the payment of which taxes, damages, interest and penalties well and truly to be made,
we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, by these presents.
The condition of this bond is, that:
WHEREAS, by the provisions of Miss. Code Ann. §27-65-27, as amended, the Commissioner shall require of every person desiring
to engage in business with this state, who maintains no permanent place of business within this state, and of every person desiring
to engage in business of making retail sale of mobile homes, a cash bond or an approved surety bond in an amount sufficient to
cover twice the estimated tax liability for a period of three months; and the Principal herein desiring to so engage in business of:
_________________________________________________________________________________________________________
NOW THEREFORE, if the said Principal shall, from the _____________ day of ___________________________________,
20______, well and truly pay all sales taxes which may accrue to the State of Mississippi on account of said business conducted
when same shall become due and payable, then this obligation is void, otherwise to remain in full force and effect.
PROVIDED, HOWEVER, that no new liability shall accrue under this bond sixty days after receipt by the Obligee of written notice
from the Surety of its desire to cancel this bond.
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 to any claim against said surety made
by the Department of Revenue which is covered by this bond.
Witness our signature this ________ day of _______________, 20____.
ATTEST: ____________________________________________ PRINCIPAL: _______________________________________
Countersigned by:
____________________________________________________ SURETY:
_________________________________________
_________________________________________
Filed and approved this _______________day of ____________________________, 20______.