Form 78-905-10 - Bond Of Designated Agent (For Motor Vehicle Dealers Only)
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1Form 78-905-10
MISSISSIPPI DEPARTMENT OF REVENUE
P.O. BOX 1033
JACKSON, MS 39215
BOND OF DESIGNATED AGENT
(FOR MOTOR VEHICLE DEALERS ONLY)
STATE OF MISSISSIPPI
BOND NUMBER _____________________
KNOW ALL MEN BY THESE PRESENTS, THAT WE
_______________________________________________________________, of _____________________________, Mississippi
As principal, and ________________________________________________________________________________ a corporation
incorporated under the Laws of the State of ___________________________________, as Surety, are held firmly bound into the
State of Mississippi, as Obligee, in the sum of Fifteen Thousand ($15,000.00) dollars, for the payment of which we bind ourselves, our
heirs, executors, administrators, successors, and assigns, jointly, and severally, firmly by these presents
Whereas, the Principal has been duly appointed a “Designated Agent” as provided for in Section 6, Senate Bill 1688, Laws of 1968
known as the Mississippi Motor Vehicle Title Act, and such “Designated Agent” is required to furnish this bond.
THE CONDITION OF THIS OBLIGATION IS SUCH, that if the aforesaid Principal shall well and faithfully perform his duties as such
“Designated Agent” then, this obligation shall be void, otherwise to remain in full force and effect.
THE PARTIES HERETO mutually agree that the Surety may cancel this bond by giving thirty (30) days notice in writing to the
Department of Revenue of the State of Mississippi. Such cancellation shall be effective only as to acts committed by the Principal as
such “Designated Agent” after the expiration of said thirty (30) day period.
SIGNED, SEALED AND DELIVERED, this the _______________________ day of ________________________, 20___________ .
___________________________________________
_________________________________________
AGENT
PRINCIPAL
___________________________________________
_________________________________________
INSURANCE COMPANY NAME
OWNER, AGENT OR OFFICER
___________________________________________
_________________________________________
MAILING ADDRESS
SURETY
___________________________________________
BY: ______________________________________
CITY
ST
ZIP
ATTORNEY-IN-FACT
___________________________________________
PHONE NUMBER
AFFIX SEAL HERE:
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