Surety Bail Bond Application and Agreement

Transcription

1 Surety Bail Bond Application and Agreement Agent Referred By: Defendant:Male/Female Defendant s Full Name AKA Scars/Marks/Tattoos Social Sec No. - - Date of Birth / /19 Race Height Weight Eye Color Hair Place of Birth DL# State Exp Address Apt# City/Town State Zip Code ( )Own Rent( ) Landlord/Lives with How long at current address years/months Lease Expires Previous Address Apt# City/Town State Zip Home Phone ( ) - Cell Phone( ) - Facebook OCCUPATION Present Occupation(s) Employer Address City, State Zip Phone#( ) - Ext How Long Supervisor Previous Occupation(s) Employer Address City/town Zip Phone#( ) - Ext How Long Supervisor SPOUSE Spouse Full Name Maiden Name Date of Birth / /19 Social Sec. No DL# Occupation(s) Employer Address City/town Zip Phone#( ) - Ext How Long AUTO Auto Year Make Model Color Tag# State Amount Owed$ LienHolder InsuranceCompany

2 REFRENCES Family/Friends Address,City,State Phone Mother Father Children Children Sibling Sibling M-law/F-law Gr.Mother Gr. Father Aunt Uncle Friends Friends Friends Attorney Address Phone # ( ) - / 2015 Sign Print Date

3 AMERICAN SURETY COMPANY DEFENDANT P.O. BOX INDIANAPOLIS, INDIANA AGENT Power No I, the undersigned, do hereby apply to you to act as my surety in the amount$ Cause No. In the Court of wherein I am Execution Date Charged with Contact Date And I agree to the following terms and conditions prescribed by the State Insurance Department. Address Date Time Relationship TERMS AND CONDITIONS The following terms and conditions are an integral part of this application for appearance bond No. Date for which AMERICAN SURETY COMPANY or its Agents shall receive a premium in the amount of Dollars ($ ) and the parties agree that said appearance bond is conditioned upon full compliance of all said terms and conditions and is a part of said bond and application thereof. 1. AMERICAN SURETY COMPANY, as surety, shall have control and jurisdiction over the Defendant during the terms foe which the bond is executed and shall have the right to apprehend, arrest and surrender the Defendant to the proper officials at any time as provided by law. 2. In the event surrender of Defendant is made prior to the time set for Defendant s appearances and for reason other then as enumerated below in paragraph 3, then Defendant shall be entitled to a refund of the bond premium. 3. It is understood and agreed that the happening of any one of the following events shall constitute a breach of Defendant s obligation to AMERICAN SURETY COMPANY hereunder, and AMERICAN SURETY COMPANY shall have the right to forthwith apprehend, arrest, and surrender Defendant, and Defendant shall have no right to any refund of premium whatsoever. Said event shall constitute a breach of Defendant s obligations hereunder are. (A) If Defendant shall depart the jurisdiction of the court without written consent of the court and AMERICAN SURETY COMPANY, or its Agent (B) If Defendant shall move from one address to another without notifying AMERICAN SURETY COMPANY, or its Agent in writing prior to said move. (C) If Defendant shall commit any act which shall constitute reasonable evidence of Defendants intention to cause a forfeiture of said bond. (D) If Defendant is arrested and incarcerated for any offence other than a minor traffic violation. (E) If Defendant shall make any material false statement in the application. The Defendant herby affirms that the foregoing declarations made and answers given are the truth without reservation and are made for the purpose of including 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, employer, bankers, the Federal Social Security Administration, The Internal Revenue Service, 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 person or organization having information concerning the Defendants whereabouts to give such information to AMERICAN SURETY COMPANY and its assigns and/or duly authorize 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 authorizes representatives. In addition, if the Defendant escapes from custody of AMERICAN SURETY COMPANY and is subsequently captured in the 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 proceeding and further consents to the application of such force may be necessary to effect such return. Signed and delivered the day of, 20 AGENT WITNESS HERE DEFENDANT SIGN HERE X (SIGNATURE OF AGENT) (SIGNATURE OF DEFENDANT) MAILING ADDRESS

4 DEFENDANT S RESPONSIBILTY 1 Defendant understands that while out on bail with DEPENDABLE BAIL BONDS, LLC. he or she MUST check in with DEPENDABLE BAIL BONDS,LLC. weekly. CALL MONDAY THROUGH FRIDAY 9AM-4PM 2 Defendant understands that He or She must sign in monthly, or upon request at the indicated office: EDISON NJ MAIN OFFICE. SIGN IN MONDAY THROUGH FRIDAY FROM 9AM-4PM 3 Defendant understands that they must provide DEPENDABLE BAIL BONDS, LLC. AND the court with their legal address so that correspondence regarding the defendant s court dates can be done through mail. Defendant must notify DEPENDABLE BAIL BONDS, LLC. and the courts if there is any change to their address or telephone number. 4 Defendant understands that they must notify DEPENDABLE BAIL BONDS, LLC. immediately regarding any change in employment, residence, court dates or legal representation. 5 Defendant understands that they MUST notify DEPENDABLE BAIL BONDS, LLC. of all court dates. This includes adjournments and new court dates given to defendant while at court. 6 Defendant understands that if they wish to request an adjournment, they must notify DEPENDABLE BAIL BONDS, LLC. prior to submitting their request to the courts. 7 Defendant understands that being arrested while out on bail is a violation of the bail agreement and that DEPENDABLE BAIL BONDS, LLC. has the right to have the bail revoked. 8 Defendant understands that they must request approval from DEPENDABLE BAIL BONDS, LLC. to leave the State of New Jersey. If request is granted, the defendant must inform the office prior to leaving the State and upon return. 9 Defendant understands that they may be responsible for payments and that the bond premium must be paid in full before the conclusion of their case. 10 If Applicable: Defendant understands that they are responsible to ensure that regular payments are being made. Payment agreement is as follows: Minimum payments are to be $ per until the balance is paid in full. 11 Defendant understands that if payments are defaulted or there is an outstanding financial balance with DEPENDABLE BAIL BONDS, LLC, the account is subject to being turned over to a third party collections agency. Defendant and indemnitor then become subject to that collection agency s fees and repercussions in addition to the balance owed to DEPENDABLE BAIL BONDS, LLC. The defendant and indemnitor will be responsible to pay the collection agency s fee, any attorney fees and/or court costs in connection with any and all legal action taken to recover payment on the account. I,, understand the previous statements and acknowledge that I have received a copy of these obligations. I also understand that these are not the only conditions that I am obligated to and that I am also obligated to the conditions of the court DEPENDABLE BAIL BONDS, LLC. and their affiliates. SIGN PRINT DATE / /2015

5 COPY OF DEFENDANT S RESPONSIBILITIES FOR THEIR RECORDS 1. Defendant understands that while out on bail with DEPENDABLE BAIL BONDS,LLC, he or she MUST check in weekly. CALL MON THROUGH FRI 9AM-4PM 2. Defendant understands that He or She must sign in monthly, or upon request at the indicated office: MAIN OFFICE. 226-RT. 1, EDISON, NJ SIGN IN MON THROUGH FRI FROM 9AM-4PM 3. Defendant understands that they must provide DEPENDABLE BAIL BONDS, LLC. AND the court with their legal address so that correspondence regarding the defendant s court dates can be done through mail. Defendant must notify DEPENDABLE BAIL BONDS, LLC. and the courts if there is any change to their address or telephone number. 4. Defendant understands that they must notify DEPENDABLE BAIL BONDS, LLC. immediately regarding any change in employment, residence, court dates or legal representation. 5. Defendant understands that they MUST notify DEPENDABLE BAIL BONDS, LLC. of all court dates. This includes adjournments and new court dates given to defendant while at court. 6. Defendant understands that if they wish to request an adjournment, they must notify DEPENDABLE BAIL BONDS, LLC. prior to submitting their request to the courts. 7. Defendant understands that being arrested while out on bail is a violation of the bail agreement and that DEPENDABLE BAIL BONDS, LLC. has the right to have the bail revoked. 8. Defendant understands that they must request approval from DEPENDABLE BAIL BONDS, LLC. to leave the State of New Jersey. If request is granted, the defendant must inform the office prior to leaving the State and upon return. 9. Defendant understands that they may be responsible for payments and that the bond premium must be paid in full before the conclusion of their case. 10. If Applicable: Defendant understands that they are responsible to ensure that regular payments are being made. Payment agreement is as follows: Minimum payments are to be $ per until the balance is paid in full. 11. Defendant understands that if payments are defaulted or there is an outstanding financial balance with DEPENDABLE BAIL BONDS, LLC the account is subject to being turned over to a third party collections agency. Defendant and indemnitor then become subject to the collection agency s their fees and repercussions in addition to the balance owed to DEPENDABLE BAIL BONDS, LLC. The defendant and indemnitor will be responsible to pay the collection agency s fee, any attorney fees and/or court costs in connection with any and all legal action taken to recover payment on the account. Dependable Bail Bonds 226 US Highway 1 Suite N Edison NJ P F DEPENDABLEBAIL@OPTIMUM.NET

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