A corporate surety bond filed to meet the requirements of § 67-1-1801 for a stay of collection shall be in a form as follows, containing the following terms and conditions: BOND FOR STAY OF COLLECTION OF TAX ASSESSMENT RE: ________________________________(style of lawsuit)__________________ , Chancery Court for ________________ County, Tennessee, No. _________________________________________________ ________________________(name of taxpayer), a ___________(corporation, organization, or________ individual) as principal and ________(name of surety company), a corporation organized under the laws of the State of _____________________ and duly authorized by the Tennessee Commissioner of Insurance to engage in the surety insurance business in this state pursuant to Chapter 2 of Title 56 of Tennessee Code Annotated, as surety, are held and firmly bound unto the Tennessee Department of Revenue and acknowledge by this instrument their obligation to pay to said Tennessee Department of Revenue a sum not to exceed dollars ($___________ ) which is one hundred fifty percent (150%) of the amount of the tax assessment (including tax, interest and any applicable penalty) of ___________dollars ($__________) challenged by plaintiff in the above-referenced action. This instrument is prepared for the purpose of filing in the above-referenced action to stay collection of the challenged tax pending final determination of the suit. In the event the suit is withdrawn, nonsuited, or dismissed, or if final judgement thereon is rendered in favor of the Commissioner of Revenue as to all or any portion of the challenged assessment, both principal and surety hereunder shall, jointly and severally, satisfy such judgment amount in the case of final court determination, or in the case of dismissal, nonsuit, or withdrawal, the entire amount of the assessment challenged, plus interest subsequently accrued thereon, and any penalty assessed thereon. Should the principal hereunder satisfy the assessment, including interest and penalty as described above, the surety's obligations hereunder to the Tennessee Department of Revenue will be discharged. Provided that nothing herein shall be construed to require the Commissioner of Revenue to seek payment from the principal prior to seeking payment from the surety hereunder and the obligation of the principal and surety to satisfy the tax assessment (including subsequently accrued interest) or judgment amount shall be joint and several up to the amount of this instrument. This instrument shall remain in full force and effect for the benefit of the Tennessee Department of Revenue so long as any part of the challenged tax assessment or judgment amount remains outstanding and unsatisfied. TAXPAYER:____________________________________ BY:____________________________________ ____________________________________ TITLE SURETY:___________________________________ BY:___________________________________ ___________________________________ TITLE

Authority: T.C.A. §§ 67-1-1801 and 67-1-102. Administrative History: Original rule filed April 15, 1987; effective July 29, 1987. Repeal and new rule filed April 19, 1990; effective June 3, 1990.