WV/CST-283                                                                                                                                                                                                                                                                                                                           WEST VIRGINIA DEPARTMENT OF TAX AND REVENUE
(Rev. 11/99)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                            NONRESIDENT CONTRACTOR
                                                                                                                                                                                                                                                                                                                                                                                                                                                          CONSUMERS SALES AND SERVICE TAX AND USE TAX
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    CASH BOND
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  BOND NUMBER

NAME:

FEIN:

                                                                                                                     ADDRESS:

                                                                                                                                                                                                                                                                                                                                             Pursuant to W. Va. Code § 11-15-8b the above named non-resident contractor is electing to post a cash bond to
                                                                                                                     guarantee payment of the West Virginia Sales and Use Tax due with respect to the contract described below:

CONTRACT  NUMBER:

CONTRACT PARTICIPANTS:

CONTRACT DESCRIPTION:

                                                                                                                     GROSS VALUE OF CONTRACT:  $

                                                                                                                                                                                                                               The amount of the cash bond must be equal to six percent (6%) of the gross value of the contract for which the
                                                                                                                     bond is being posted.  The above named non-resident contractor hereby posts the amount of $
as cash bond with respect to the above described contract and certifies that this amount represents six percent (6%)
of the gross value of the contract and will be sufficient to cover the consumers sales and use taxes due with respect
                                                                                                                     to the above-referenced contract.

                                                                                                                                                                                                                                                                                                                                             This bond shall be effective from the                                                                                                                                                                day of                                                           ,            .

                                                                                                                                                                                                                               In witness whereof the above named non-resident contractor hereby executes this instrument this

                                                                                                                     day of                                                                                                                                                                                                                                                                                                                                                 ,                                                                       .

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           (Authorized Officer or Agent Non-Resident Contractor)

                                                                                                                     Acknowledged before me this                                                                                                                                                                                                                                                                                                                             day of                                                                                                          ,  .  My commission

                                                                                                                     expires the                                                                                                                                                                                                                                                                                                                           day of                                                                                                               ,              .

                                                                                                                     Notary Seal
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         DO NOT USE THIS SPACE
                                                                                                                                                                                                                                                                                                                                                                                                                                                            Notary Signature