Form   72-901-14-8-000 

                         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 
 
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 the 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____. 
 
PRINCIPAL: _____________________________________                 ATTEST: _______________________________________ 
 
SURETY:  _______________________________________                     Countersigned by:   
 
                ________________________________________                   ________________________________________________                  
 
                       Filed and approved this _______________day of ____________________________, 20______.