Form 78016 "Certificate of Title Bond" - Mississippi

What Is Form 78016?

This is a legal form that was released by the Mississippi Department of Revenue - a government authority operating within Mississippi. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2017;
  • The latest edition provided by the Mississippi Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 78016 by clicking the link below or browse more documents and templates provided by the Mississippi Department of Revenue.

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Download Form 78016 "Certificate of Title Bond" - Mississippi

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Form 78-016-10-1-1-000 Rev(09/17)
Mississippi
CERTIFICATE OF TITLE BOND
$
Bond No.
KNOW ALL MEN BY THESE PRESENTS: That we,
of
, Mississippi, as Principal, and
of
, a corporation incorporated under the Laws of the State of
, as Surety, are held and firmly bound unto the State of Mississippi, as Obligee, in
the sum of $
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 made application to the Department of Revenue of the State of Mississippi for a
Certificate of Title on a certain vehicle described to with:
MODEL
MAKE & YEAR
IDENTIFICATION NUMBER
TYPE BODY
NUMBER CYLINDERS
NEW OR USED
And under the provisions of the Mississippi Code, Section 63-21-23, (Senate Bill 1688, Laws of 1968) or any
amendments thereto known as the Mississippi Motor Vehicle Title Act; The Department of Revenue is requiring this
bond before issuing the applied for Certificate of Title.
Said bond shall run and be in full force and effect for a period of three (3) years from and after the effective
date as shown here below and no liability shall accrue after the expiration of the three (3) year period.
THE CONDITIONS OF THIS OBLIGATION ARE SUCH, that if the Principal shall indemnify any prior owner
and lienholder and any subsequent purchaser of said vehicle or person acquiring any security interest in it, and
their respective successors in interest, against any expense, loss or damage, including reasonable attorney's fees
by reason of the issuance of the Certificate of Title for said vehicle or on account of any defect in or undisclosed
security interest upon the right, title, and interest of the applicant in and to said vehicle, then this obligation shall be
void, otherwise, it shall remain in full force and effect. This bond will not be accepted by the Department of
Revenue if it is not filed within thirty (30) days of its effective date.
EFFECTIVE THIS THE
DAY OF
, 20
.
Insurance Co. Name
Principal's Signature
Agent's Signature
Surety
By:
Attorney-in-Fact
Mailing Address
City
State
Zip Code
Phone Number
P. O. Box 1383,
Jackson, MS 39215
Motor Vehicle Services
www.dor.ms.gov
Phone 601-923-7200
Fax 601-923-7224
Form 78-016-10-1-1-000 Rev(09/17)
Mississippi
CERTIFICATE OF TITLE BOND
$
Bond No.
KNOW ALL MEN BY THESE PRESENTS: That we,
of
, Mississippi, as Principal, and
of
, a corporation incorporated under the Laws of the State of
, as Surety, are held and firmly bound unto the State of Mississippi, as Obligee, in
the sum of $
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 made application to the Department of Revenue of the State of Mississippi for a
Certificate of Title on a certain vehicle described to with:
MODEL
MAKE & YEAR
IDENTIFICATION NUMBER
TYPE BODY
NUMBER CYLINDERS
NEW OR USED
And under the provisions of the Mississippi Code, Section 63-21-23, (Senate Bill 1688, Laws of 1968) or any
amendments thereto known as the Mississippi Motor Vehicle Title Act; The Department of Revenue is requiring this
bond before issuing the applied for Certificate of Title.
Said bond shall run and be in full force and effect for a period of three (3) years from and after the effective
date as shown here below and no liability shall accrue after the expiration of the three (3) year period.
THE CONDITIONS OF THIS OBLIGATION ARE SUCH, that if the Principal shall indemnify any prior owner
and lienholder and any subsequent purchaser of said vehicle or person acquiring any security interest in it, and
their respective successors in interest, against any expense, loss or damage, including reasonable attorney's fees
by reason of the issuance of the Certificate of Title for said vehicle or on account of any defect in or undisclosed
security interest upon the right, title, and interest of the applicant in and to said vehicle, then this obligation shall be
void, otherwise, it shall remain in full force and effect. This bond will not be accepted by the Department of
Revenue if it is not filed within thirty (30) days of its effective date.
EFFECTIVE THIS THE
DAY OF
, 20
.
Insurance Co. Name
Principal's Signature
Agent's Signature
Surety
By:
Attorney-in-Fact
Mailing Address
City
State
Zip Code
Phone Number
P. O. Box 1383,
Jackson, MS 39215
Motor Vehicle Services
www.dor.ms.gov
Phone 601-923-7200
Fax 601-923-7224