Published on February 21, 2016
slide 1: AMERICAN SURETY COMPANY P.O. BOX 68932 · INDIANAPOLIS IN 46268 BAIL BOND APPLICATION STATEMENT OF INFORMATION REQUIRED BY RULING NO. 76 ______________________________________________________________ _________________________________________ ________________ Booking Name True Name Date of Arrest ______________________________________________________________ ___________________________ _______________ ____________ Residence Address City/State Phone How Long ______________________________________________________________ ___________________________________________________________ Full Name of Person Furnishing Information Full Name of Person Negotiating for Bail ______________________________________________________________ ___________________________________________________________ Address No. Street City State Address No. Street City State ______________________________________________________________ __________________________________________________________ Cell Phone Number E-Mail Address Cell Phone Number E-Mail Address ______________________________________________________________ __________________________________________________________ Connection With or Relation to Defendant Connection With or Relation to Defendant Phone ______________________________________________________________ ___________________________________________________________ Date Information Received Time Date of Negotiation Time ______________________________________________________________ ___________________________________________________________ Manner in Which Information Received If Bail Negotiated with Defendant How Did He Communicate with you ______________________________________________________________ ___________________________________________________________ Name of Bail Agent or Person Receiving Information Name of Bail Agent Negotiating for Bail _______________________________________________________________________________________________________________________________ If Writ Attorney Address Phone 1. Charge__________________________________________________ Court____________________________________ City________________________ 2. Case No. ________________________________________________ Court Date________________________________ Bond No. ___________________ 3. Charge__________________________________________________ Court____________________________________ City ________________________ 4. Case No. ________________________________________________ Court Date________________________________ Bond No. ___________________ 5. Charge __________________________________________________ Court ___________________________________ City ________________________ 6. Case No. ________________________________________________ Court Date _______________________________ Bond No. ___________________ 7. Previous Address __________________________________________ City ____________________________________ How Long__________________ 8. Date of Birth____________________________ Place of Birth __________________________________ Social Security Number____________________ 9. Distinguishing Marks Scars Tatoos ____________________________________________________________________ Hair Color __________________ 10. Height _____________________ Weight_____________________ Eyes_____________________ Complexion ___________________ Mustache______ 11. Employer ____________________________________________________ Occupation ________________________________ How Long_____________ 12. Address ______________________________________________________City ___________________________Phone____________ Pager No._______ 13. Arrested Before _____________________________ Offense ____________________________________ Sentence ______________________________ 14. Currently on Bond ____________________ By Whom ________________________________________________________________________________ 15. Photographed or Fingerprinted _______________________ Where ______________________________________________________________________ 16. Reference ______________________________________ Address __________________________________________________ Phone ______________ 17. Reference ______________________________________ Address __________________________________________________ Phone ______________ 18. Married Where ___________________________________________ Date ___________________ Divorce ________________ Date _________________ 19. Children ______________________________________________ Address ___________________________ School __________________ Age _______ 20. Spouse _______________________________ Occupation ___________________________ Address______________________ Phone _______________ 21. In-Laws ______________________________________________ Address ___________________________________________ Phone _______________ 22. Brother/Sister _________________________________________ Address ___________________________________________ Phone _______________ 23. Brother/Sister _________________________________________ Address ___________________________________________ Phone _______________ Notes and Comments ______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________ ASC-CA-5 Rev 03/15 Page 1 of 4 Bond Number __________________________ Amount of Bond ________________________ Booking Number ________________________ slide 2: BAIL AGREEMENT The undersigned called “First Party” makes application to _________________________________________________ called “Second Party” for execution by the American Surety Company an Indiana corporation called “Surety” of a Bail Bond or a Bail Undertaking herein referred to as “Bail Bond “ in the penal amount of _________________________________________________________ for ____________________________________________________ called “Principal” and in consideration of Second Party arranging for execution of or continuance of this Bail Bond First Party does jointly and severally agree as follows: FIRST: To pay Second Party _______________________________________________________ per annum for this Bail Bond. The premium is fully earned upon the release of Principal. The fact that Defendant may have been improperly arrested or his bail reduced or his case dismissed shall not obligate the return of any portion of said premium. This Bond is renewal each year. First Party agrees to pay to Second Party a renewal premium in the amount stated above twelve months after the date on which this Bond was executed. If said renewal premium is not paid upon written demand therefore Second Party or Surety has the right to surrender Principal as provided in the California Penal Code Section 1300 and exonerate the Bond. SECOND: To reimburse Second Party and Surety for actual expenses incurred by Second Party or Surety in connection with the arranging and/or execution of Bail bond or any renewal or substitution thereof whether or not said Principal refuses to be released after arrangements have been initiated by Second Party. THIRD: To indemnify and to at all times save harmless the Second Party or the Surety from and against any and all liability demands expenses attorney’s fees debits damages judgments all expenses or liabilities incurred as a result of searching for recapturing or returning Principal to custody incurred by Second Party or Surety or as necessary in apprehending or endeavoring to apprehend Principal including but not limited to expenses for private investigations or losses of every kind character or nature that the Second Party or the Surety shall or may at any time or for any cause sustain incur or be put to by reason of the execution or the arranging or obtaining the execution of the bail bond aforementioned or any renewal thereof or any bond issued in continuance thereof or as a substitute therefore to pay to the Second Party or the Surety immediately upon demand the penal amount of said bail bond whenever the Second Party or the Surety deems such payment necessary for protection upon any change of condition which increases the hazard which sum shall be retained and used by the Second Party or the Surety as security hereunder TO PAY THE SECOND PARTY OR THE SURETY IMMEDIATELY UPON THE DECLARATION OF FORFEITURE OF SAID BAIL BOND THE PENAL AMOUNT THEREOF. The First Party is required to pay the full amount of any forfeited bail bond within 10 days from any demand and delivery of an itemized statement which will include a statement of Bond amount and any costs incurred as a result of a declaration of forfeiture of the bail bond. Unless the demand set forth herein has been made American Surety Company shall not foreclose on any security until the Bond is actually due and payable to the court Delivery shall be by U.S. Mail to the address provided by the First Party. If the First Party does not respond or pay the demanded amount within 10 days of the mailing of the notice then American Surety Company shall have the right to proceed to immediate foreclosure on any collateral pledged to secure the Bond. FOURTH: To pay the Second Party or the Surety in the event that it is necessary for them to institute suit for a breach of this agreement a reasonable Attorney’s fees and costs to the prevailing party pursuant to the California Civil Code Section 1717. FIFTH: That an itemized statement of such above expenses sworn to by the Second Party or any officer of the Surety shall be acceptable as prima facie evidence of the fact and extent of such expenses in any and all suits hereunder. SIXTH: To pay Second Party or Surety as collateral upon demand the penal amount of Bail Bond whenever Second Party or Surety as a result of judicial action information concealed or misrepresented by the First Party or Principal or other reasonable cause any one of which was material to hazard assumed deems payment necessary to protect the Second Party or Surety hereunder. SEVENTH: To pay Second Party or Surety immediately upon entry of judgment resulting from a declaration of forfeiture of bail bond the penal amount thereof. EIGHTH: To aid Second Party or Surety in securing the release or exoneration of Second Party or Surety from all liability under Bail Bond including the surrender of Principal to Court should Second Party or Surety deem such action advisable. Such aid shall specifically include the First Party’s irrevocable consent and authorization to the Second Party Surety and their agents to at any time enter upon and search the First Party’s real property and chattel including any permanent or temporary residence vehicle vessel or aircraft. NINTH: That all money or other property which the First Party has deposited or may deposit with the Second Party or the Surety may be applied as collateral security or indemnity for the matters contained herein and to accomplish the purposes contained herein the Second party and/or Surety is authorized to lawfully sell said collateral security and at any time and without notice of legal process and in its or their sole discretion to apply the proceeds therefrom and any and all money deposited to payment of or reimbursement for the hereinabove liabilities losses costs damages and expenses. If collateral received by Second Party is in excess of the bail forfeited such excess shall be returned to the depositor immediately upon the application of the collateral to the forfeiture subject to any claim of Second party and Surety for unpaid premium or the hereinabove charges. IMPORTANT: American Surety Company accepts will be responsible for and authorizes its representatives to accept only specific forms of collateral as security. THIS ACCEPTABLE COLLATERAL IS LIMITED TO: 1. CASH including cashier’s checks money orders and certified checks 2. Properly assigned SAVINGS ACCOUNTS represented by passbooks or properly assigned CERTIFICATES OF DEPOSIT 3. Properly assigned STOCKS AND BONDS 4.REAL ESTATE evidenced by properly executed mortgages deeds of trust or confession of judgment in accordance with applicable state law. IMPORTANT: Representatives are not authorized to accept and American Surety Company is not responsible for any type or form of collateral other than collateral enumerated above. Any other type or form of collateral is the sole responsibility of the Second Party. TENTH: Second Party or Surety shall not surrender principal to custody prior to the time specified in the Bail bond for the appearance of the Principal or prior to any other occasion when the presence of the principal in court is lawfully required without returning all premium paid therefore unless as a result of judicial action information concealed or misrepresented by the principal or other reasonable cause any one of which was material to the hazard assumed the hazard was substantially increased and the additional premium or charges if any for such increased hazard was not paid within a reasonable time. ELEVENTH: The obligations hereunder are joint and several and any amounts due shall bear interest at the maximum rate of interest allowed by law. The Second Party and the Surety shall not be first obliged to proceed against the Principal on Bail Bond before having recourse against the First Party or any one of them the First Party hereby expressly waiving the failure of the Principal to sign the Bail Bond and benefit of law requiring the Second Party or the Surety to make claim upon or to proceed to enforce its remedies against the Principal before making demand upon or proceeding and/or enforcing its remedies against any one or more of the First Party. TWELFTH: In making application for Bail Bond each of us warrants all statements made on this application and financial statement to be true and we agree to advise Second Party or Surety of any change including but not limited to change of address or employment of either the Principal or of any of the First Party additional charges placed against the Principal by any authority whatsoever or any other material change in circumstances or financial conditions within forty-eight 48 hours after knowledge such change shall have occurred and the First Party agrees that any failure to so notify shall be reasonable cause for the immediate surrender of he Principal. THIRTEENTH: The undersigned agree that these obligations apply to all other Bail Bonds executed for the same charge for which the above mentioned Bail Bond was executed or any charge arising out of the same transaction regardless of whether said Bail Bonds are filed before or after conviction but not in a greater amount. The undersigned waive notice of default and agree to reinstatement of any bonds after they have been forfeited. IN WHITNESS WHEREOF the First Party whose names are subscribed to the Bail Agreement executed herewith each represents I have read the Bail Agreement and I know the contents thereof that I hereby acknowledge receipt of a copy of said Bail Agreement that I am the true and lawful owner of the property whether real or personal which is set forth in the Application for Bail which Application is made a part hereof by reference as though herein fully set forth as being my property and that I own such property free and clear of all liens or encumbrances except as so noted and I further promise not to transfer or encumber any of said property until my liability on said Bail Agreement has been released. I understand the Second Party and/or Surety is permitting the said bail to remain in force upon reliance of the statements made by me and I do hereby agree that the recording of this agreement shall constitute a lien on the property in favor of the Second Party and/or Surety until all monies due under said Bail Agreement have been paid and all liability to the said Second Party and/or Surety is completely exonerated and do not set their hand this _________________________ day of ________________________ 20______. The Defendant hereby warrants that the foregoing declarations made and answers given are the truth without reservation and are made for the purpose of inducing the Surety to become surety or to procure suretyship on the bond or undertaking applied for herein with the intent and purpose that they be relied on fully. In addition the Defendant hereby authorizes and directs his relatives employers bankers the Federal Social Security Administration the Internal Revenue the state Department of Disability Insurance the United States Armed Forces the state Division of Motor Vehicles all Municipal County State and Federal Law Enforcement Agencies and any other persons or organizations having information concerning the Defendant’s whereabouts to give such information to American Surety Company and its assigns and/or authorized representatives. The Defendant understands that any information obtained will be used for the purpose of securing his or her appearance and/or apprehension for Court appearance and for the purpose of securing reimbursement for any expenses incurred as a result of Defendant’s non-appearance. The Defendant hereby waives his or her rights with respect to the Privacy Act and authorizes the use of copies of this document by American Surety Company and its assigns and/or duly authorized representatives. In addition if the Defendant escapes from the custody of American Surety Company and is subsequently captured in a State of the United States other than the one in which the original charge was filed or in a foreign country the Defendant does hereby agree to return voluntarily to the State of original jurisdiction and does hereby waive extradition proceedings and further consents to the application of such force as may be necessary to effect such return. I/WE HEREBY ACKNOWLEGE THE AUTHORITY OF THE BAIL TO ARREST THE DEFENDANT AT ANY TIME AND AT ANY PLACE AND THEREFORE SPECIFICALLY AND IRREVOCABLY GRANT THE BAIL PERMISSION AND AUTHORITY TO ENTER UPON AND SEARCH ANY AND ALL REAL PROPERTY AND CHATTEL THAT IS OR REASONABLY BELIEVED BY THE BAIL TO BE UNDER MY POSSESSION CONTROL OR OCCUPANCY AT ANY TIME FOR SUCH PURPOSE. Defendant Name___________________________________ Address__________________________________________ City______________________State______ Zip_________ Cellular Phone __________________ E-Mail Address _________________Drivers License________________________ S.S. No.________________ Date of Birth _____________ Employer_____________________________________________________ Address__________________________________ City______________________ Phone____________ Defendant Signature__________________________________________________________ Home Phone______________________________ Work Phone____________________ Indemnitor Name __________________________________ Address__________________________________________ City ______________________ State______ Zip________ Cellular Phone __________________E-Mail Address _________________Drivers License ________________________ S.S. No.________________ Date of Birth _____________ Employer ____________________________________________________ Address___________________________________ City _____________________ Phone____________ Indemnitor Signature _________________________________________________________ Home Phone ______________________________ Work Phone ___________________ Indemnitor Name __________________________________ Address __________________________________________ City _____________________ State _______ Zip_______ Cellular Phone __________________E-Mail Address ________________ Drivers License ________________________ S.S. No. ________________ Date of Birth _____________ Employer _____________________________________________________ Address __________________________________ City _____________________ Phone ___________ Indemnitor Signature _________________________________________________________ Home Phone ______________________________ Work Phone ___________________ PLEASE READ CAREFULLY AND TAKE COPY ASC-CA-5 Rev 03/15 Page 2 of 4 RECEIVED COPY OF BAIL BOND AGREEMENT INITIALS_________ slide 3: FIRST INDEMNITOR’S FINANCIAL STATEMENT Every Question Must Be Answered Name______________________________________________________________ Indemnitor’s Real Property Consists of _______________________________ Street______________________________________________________________ Address________________________________________________________ City/State________________________________ Phone_____________________ Legal Description __________________________________________________________________ Lot_____________________ Block______________ Tract_______________ Business or Occupation of Indemnitor ___________________________________ As per map recorded in Bk______________ Page____________ Maps or M.R. Name of Employer___________________________________________________ Value __________________________ Encumbrances _________________ Street______________________________________________________________ Is Property Homesteaded _________________________________________ City/State_______________________________ Phone______________________ In Whose Name is Property________________________________________ Salary or Earnings ___________________________________________________ _______________________________________________________________ Stocks or Bonds _____________________________________________________ Indemnitor’s Real Property Consists of _______________________________ Other Personal Property _______________________________________________ Address ________________________________________________________ Make and Type of Indemnitor’s Auto ____________________________________ Legal Description: License No._______________________ Motor No._________________________ Lot_____________________ Block______________ Tract _______________ In Whose Name Registered ___________________________________________ As per map recorded in Bk ______________ Page____________Maps or M.R. Legal Owner or Who Holds Pink Slip____________________________________ Value __________________________ Encumbrances _________________ Value ____________________ Balance Owing _________________________ Is Property Homesteaded _________________________________________ Name of Indemnitor’s Bank ____________________________________________ In Whose Name is Property _______________________________________ Address_____________________________________________________________ Savings or Commercial ________________________________________________ How Are Checks Signed _____________________________________________ Average Balance ____________________________________________________ SECOND INDEMNITOR’S FINANCIAL STATEMENT Every Question Must Be Answered Name____________________________________________________________ Indemnitor’s Real Property Consists of _______________________________ Street_____________________________________________________________ Address________________________________________________________ City/State________________________ Phone____________________________ Legal Description __________________________________________________________________ Lot_____________________ Block______________ Tract_______________ Business or Occupation of Indemnitor __________________________________ As per map recorded in Bk______________ Page____________ Maps or M.R. Name of Employer__________________________________________________ Value __________________________ Encumbrances _________________ Street_____________________________________________________________ Is Property Homesteaded _________________________________________ City/State________________________ Phone____________________________ In Whose Name is Property________________________________________ Salary or Earnings __________________________________________________ _______________________________________________________________ Stocks or Bonds ____________________________________________________ Indemnitor’s Real Property Consists of _______________________________ Other Personal Property ______________________________________________ Address ________________________________________________________ Make and Type of Indemnitor’s Auto ___________________________________ Legal Description: License No._______________________ Motor No.________________________ Lot_____________________ Block______________ Tract _______________ In Whose Name Registered __________________________________________ As per map recorded in Bk ______________ Page____________Maps or M.R. Legal Owner or Who Holds Pink Slip__________________________________ Value __________________________ Encumbrances _________________ Value ____________________ Balance Owing ________________________ Is Property Homesteaded _________________________________________ Name of Indemnitor’s Bank __________________________________________ In Whose Name is Property _______________________________________ Address___________________________________________________________ Savings or Commercial ______________________________________________ How Are Checks Signed ____________________________________________ Average Balance __________________________________________________ ________________________________________________ and__________________________________________ the indemnitors whose names are subscribed to the bond of indemnity executed herewith each being duly sworn deposes and says for himself or herself alone and not for the other: I have read the within bail bond agreement and I know the contents thereof all the statements and representations contained in said financial statement are true of my own knowledge and I do further verily state that I am the true and lawful owner of the property whether real or personal which is set forth above as being my property and that I own such property free and clear of all liens or encumbrances except as above noted and I further promise not to transfer or encumber any of said property until my liability on said bond of indemnity has been released. I understand that the Surety herein is permitting said bail bond to remain in force upon reliance of the above statements made by me. I do hereby agree that the recording of this agreement shall constitute a lien on the above property until all monies due hereunder have been paid and all liability to the said Surety completely exonerated. ________________________________________________ ________________________________________________ _______________________________________________ Indemnitor Indemnitor Indemnitor State of ____________________________________ County of__________________________________ On ____________________ before me __________________Notary Public personally appeared ________________________________________________ DATE NAME TITLE OFFICER-E.G. “JANE DOE NOTARY PUBLIC” NAMES OF SIGNERS who proved to me on the basis of satisfactory evidence to be the persons whose names is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacityies and that by his/her/their signatures on the instrument the persons or the entity upon behalf of which the persons acted executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of ______________________________ that the foregoing paragraph is true and correct. Witness my hand and official seal. ___________________________________________________ My Commission Expires____________________________ CAPACITY CLAIMED BY SIGNER INDIVIDUAL SIGNER IS REPRESENTING CORPORATE Name of persons or Entityies OFFICER S______________________ TITLES ____________________________________ PARTNERS LIMITED GENERAL ATTORNEY-IN-FACT ____________________________________ TRUSTEES GUARDIAN/CONSERVATOR ____________________________________ OTHER:_____________________________ ASC–CA-5 Rev 03/15 Page 3 of 4 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached and not the truthfulness accuracy or validity of that document. FOR NOTARY SEAL OR STAMP slide 4: __________________________________________________________________________________________________________________________________________________ DEFENDANT’S FINANCIAL STATEMENT Every Question Must Be Answered Business or Occupation Of Defendant_____________________________________________________ Other Income of Defendant_________________________________________ Name of Employer________________________________________________ _______________________________________________________________ Street___________________________________________________________ Stocks or Bonds__________________________________________________ City_________________________State____________Zip________________ _______________________________________________________________ Phone________________________Cell Phone ________________________ Other Personal Property____________________________________________ Salary or Earnings__________________________________________________ _______________________________________________________________ Make and Type of Name of Defendant’s Bank __________________________________________ Defendant’s Auto _______________________________________________ Address__________________________________________________________ License No. ___________________________Motor No._________________ Savings □ Commercial □ Registered Owner_______________________________________________ Average Balance ___________________________________________________ Legal Owner___________________________________________________ How Are Checks Signed ___________________________________________ Value ________________________________ Balance Owing _________ Additional Remarks:_______________________________________________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________ REAL PROPERTY OF DEFENDANT 1. 2. Street Address_____________________________________________________ Street Address_________________________________________________ Legal Description: Lot___________________ Legal Description: Lot__________________ Block_________________ Block________________ Tract___________________ Tract ________________ As per map recorded in Bk_______ Page________Maps or M.R. As per map recorded in Bk _________ Page ____________ Maps or M.R. Kind of Property __________________________________________________ Kind of Property ________________________________________________ Value _________________________ Encumbrances ___________________ Value _________________________ Encumbrances ________________ Record Owner of Property ___________________________________________ Record Owner of Property _________________________________________ _________________________________________________________________ _______________________________________________________________ _________________________________________________________________ _____________________________________________________________ ____________________________________________________________________________________________ the defendant whose name is subscribed to the bond agreement and defendant’s statement executed herewith being duly sworn deposes and says: I have read the within application for bond and I know the contents thereof: all the statements and representations contained in said application are true of my own knowledge and I do further verily state that I am the true and lawful owner of the property whether real or personal which is set forth above as being my property and that I own such property free and clear of all liens or encumbrances except as above noted and I further promise not to transfer or encumber any of said property until my liability on said bail bond agreement has been released. I understand that the Surety herein is permitting said bail bond to remain in force upon reliance of the above statements made by me. I do hereby agree that the recording of this agreement shall constitute a lien on the above property until all monies due hereunder have been paid and all liability to the said Surety completely exonerated. In addition if the Defendant escapes from the custody of American Surety Company and is subsequently captured in a State of the United States other than the one in which the original charge was filed or in a foreign country the Defendant does hereby agree to return voluntarily to the State of original jurisdiction and does hereby waive extradition proceedings and further consents to the application of such force as may be necessary to effect such return. _______________________________________________________________ DEFENDANT State of ________________________________________ County of_______________________________________ On ____________________ before me __________________Notary Public personally appeared ________________________________________________ DATE NAME TITLE OFFICER-E.G. “JANE DOE NOTARY PUBLIC” NAMES OF SIGNERS who proved to me on the basis of satisfactory evidence to be the persons whose names is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacityies and that by his/her/their signatures on the instrument the persons or the entity upon behalf of which the persons acted executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of ______________________________ that the foregoing paragraph is true and correct. Witness my hand and official seal. ___________________________________________________ My Commission Expires____________________________ CAPACITY CLAIMED BY SIGNER INDIVIDUAL SIGNER IS REPRESENTING CORPORATE Name of persons or Entityies OFFICER S______________________ TITLES ____________________________________ PARTNERS LIMITED GENERAL ATTORNEY-IN-FACT ____________________________________ TRUSTEES GUARDIAN/CONSERVATOR ____________________________________ OTHER:_____________________________ ASC-CA-5 Rev 03/15 Page 4 of 4 FOR NOTARY SEAL OR STAMP A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached and not the truthfulness accuracy or validity of that document.