Mississippi Contractor's Blanket Bond

Contractor's Blanket Bond
September 13, 1996
Form 72-442-14

MISSISSIPPI DEPARTMENT OF REVENUE
P.O. BOX 1033
JACKSON, MS 39215

Sales Tax Account ID:
____-____

CONTRACTOR’S BLANKET SALES, USE, INCOME, FRANCHISE, WITHHOLDING, AND
SPECIAL FUEL (DIESEL FUEL) TAX BOND

STATE OF MISSISSIPPI

BOND NUMBER

KNOW ALL MEN BY THESE PRESENTS, THAT
Trading As

Owner of Business

Address

City

As Principal, and

State

, as Surety, are held and firmly bound

unto the State of Mississippi in the just and full sum of
($

Zip

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.
WHEREAS, by the provisions of Miss. Code Ann. § 27-65-27, 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 § 27-55-501 et
seq., and amendments thereto, on any contract as defined in said statutes.
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH THAT, if the said Principal shall from
the

day of

, 20

, to

the
day of
, 20
, pay 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 § 27-55-501 et seq., and amendments thereto, then this
obligation is void, otherwise to remain in full force and effect.
NOTWITHSTANDING the tax information and return confidentiality provisions contained within Miss Code Ann. § 27-65-1 et seq., § 2767-1 et seq., 27-7-1 et seq., 27-13-1 et seq., 27-7-301 et seq., and 27-55-501 et seq., and to any claim against said surety made by the
Department of Revenue which is covered by this bond.
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.
SIGNED, SEALED AND DELIVERED, this
Filed and Approved, this

day of

, 20

day of

COMMISSIONER:

, 20
PRINCIPAL:

Countersigned by:
SURETY:

Attorney in Fact
Licensed Mississippi Agent
Type or Print Name of Agent

Telephone Number

.
.