Change in Annual Report Filing Date

[LOGO] # STATE OF MISSISSIPPI Mississippi Insurance Department GEORGE DALE Commissioner of Insurance State Fire Marshal RONALD E. HANNA Deputy Commissioner 1804 Walter Sillers Building (39201) Post Office Box 79 Jackson, Mississippi 39205-0079 (601) 359-3569 FAX (601) 359-2474 http://www.doi.state.ms.us December 10, 1998 Bulletin No. 98-9 # BULLETIN TO ALL PROFESSIONAL BAIL AGENTS # RE: CHANGE IN ANNUAL REPORT FILING DATE Mississippi Legislature, 1998 Regular Session, amended Section 83-39-13, Mississippi Code of 1972, Annotated, to take effect and be in force from and after July 1, 1998. This law changed the Annual Report deadline to be made on a calendar basis before June 1 of each year. The required Annual Report must include financial information for the period of January 1 to December 31, 1998, and be received in our department before June 1, 1999. Failure to file this report will result in non-renewal of your privilege tax license. A revised Annual Report form is attached for your convenience. George Dale GD/be [LOGO] MISSISSIPPI INSURANCE DEPARTMENT 1804 Walter Sillers Building (39201) Post Office Box 79 Jackson, Mississippi 39205-0079 (601) 359-3569 FAX (601) 359-2474 ## ANNUAL REPORT OF PROFESSIONAL BAIL AGENTS LIMITED/PERSONAL SURETY Due June 1 each year for the period of January 1 - December 31 of previous year. Full Name: _________________________ License Number: _________________________ (First) (Middle) (Last) Residence Address: _________________________________________________________________________ (Street) (City) (State) (Zip) Mailing Address: _________________________________________________________________________ (Street) (City) (State) (Zip) Business Telephone Number: _________________________ Home Telephone Number: _________________________ : _________________________ (First) (Middle) (Last) Residence Address: _________________________________________________________________________ (Street) (City) (State) (Zip) Mailing Address: _________________________________________________________________________ (Street) (City) (State) (Zip) Business Telephone Number: _________________________ Home Telephone Number: _________________________ 1. Total amount of bonds written during this period: $_________________________ 2. Total amount of bonds outstanding at the end of this period: $_________________________ 3. Total number of bonds written during this period: _________________________ (example: 10, 25, 100, etc.) Limited Surety Agents: Name of your insurance company _________________________________________________________________________ ### PLEASE ATTACH THE FOLLOWING: A. A list of all other business activities. B. The name and address of each soliciting bail agent and/or bail enforcement agent employed or used by you. I hereby certify that the information contained herein and attached hereto is true and correct to the best of my knowledge. Date Signature of Professional Bail Agent Sworn to and subscribed this _________________________ day of _________________________, 19 _________. Notary Public Form BB-2 (Rev. 10/98)