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Form Rv-F1307501 - Pledge Of Collateral To The Department Of Revenue Of The State Of Tennessee

________________

Date

The Commissioner of Revenue

State of Tennessee

Floor, Andrew Jackson Building

500 Deaderick Street

Nashville, Tennessee 37242

_________________________________ (taxpayer) has deposited funds with this financial

institution and has been issued Certificate(s) of Deposit, numbered ____________________,

____________________, which are to be deposited as collateral for a bond to insure the

payment of Tennessee taxes. It is our understanding that

_________________________________ (taxpayer) wishes to make an assignment of his right

to the aforementioned Certificate(s) of Deposit and that the Department of Revenue is

authorized by him to make demand for such Certificate(s) of Deposit upon his failure to pay

Tennessee taxes owing. By this letter, this institution approves of and recognizes the

assignment of the Certificate(s) of Deposit as a valid assignment and warrants to the

Department of Revenue of the state of Tennessee that this institution shall, upon demand from

the Department of Revenue, promptly pay the Certificate(s) of Deposit to the Department of

Revenue.

Sincerely,

___________________________

(to be signed by an officer

of the financial institution)

Form Rv-F1307501 - Pledge Of Collateral To The Department Of Revenue Of The State Of Tennessee