CJ&V Bail Bond Information Sheet

CJ & V BAIL BONDS, LLC

3923 Lake Worth Rd. Ste. 216 Palm Springs, FL 33461

(O)#: 561.507.5676 (C)#: 561.512.6538

BAIL BOND INFORMATION SHEET

BOND DEFENDANT

POWER OF ATTORNEY NUMBER(S)

AS PRINCIPAL (DEFENDANT) AND/OR INDEN{NITOR (GUARANTOR) ON A BAIL BOND, YOU MUST BE GIVEN A COPY OF ANY COLLATERAL DOCUMENTS THAT YOU SIGN RELATING TO THE ABOVE BOND(S).

WHEN ALL AGREEMENTS HAVE BEEN FULFILLED AND THE BOND IS DISCHARGED IN WRITING BY THE COURT, AND WITHOUT LOSS EXPENSE ON THE BOND(S), YOUR COLLATERAL WILL BE RETURNED TO YOU.

BE AWARE: YOUR COLLATERAL IS AT RISK IF THE PRINCIPAL FAILS TO APPEAR IN COURT OR IF THE PRINCIPAL COMMITS ANY BREACH (VIOLATION) OF THE AGREEMENT.

ANY OF THE FOLLOWING HAPPENINGS IS A BREACH OF THE AGREEMENT:

1. If the principal fails to appear in court;

2. If the principal shall depart the jurisdiction of the court without the written consent of the court and the Surety, or its agent;

3. If the principal shall move from one address to another without notiö'ing the Surety, or its Agent, in writing, prior to the said move;

4. If the principal shall commit any act which shall constitute reasonable evidence of the principal's intention to cause a forfeiture of the bond(s);

5. If the principal is arrested and incarcerated for any offense other than a minor traffic violation;

6. If principal shall make any material false statement in the application;

7. If principal shall violate any special restriction or condition of the bond(s) imposed by the Court.

FOR GENERAL INFORMATION REGARDING YOUR COLLATERAL, CONTACT THE AGENT AS SHOWN ON THE TOP OF THIS SHEET.

FOR FURTHER INQUIRY/COMPLAINT, CONTACT

Bail Bond Administrator

Florida Insurance Dept.

200 East Gaines Street

Tallahassee, FL 32399-0300 Phone: 850-413-3136

PRINCIPAL/INDEMNITOR ACKNOWLEDGMENT

I/WE HAVE RECEIVED A COPY OF THIS INFORMATION SHEET. I/WE HAVE RECEIVED A COPY OF ALL COLLATERAL DOCUMENTS THAT I/WE SIGNED REGARDING THE ABOVE BOND(S).

SIGN *

SIGNED ORIGINAL TO AGENT'S BOND FILE COPY TO DEFENDANT AND EACH INDEMNITOR *

***** READ CAREFULLY *****

CONTINGENT PROMISSORY NOTE

POWER No.

($)

Florida,

YEAR

As applicable after date, for value received, the undersigned promise to pay the order of PALMETTO SURETY CORPORATION

DOLLARS, at 126 SEVEN FARMS DRIVE, CHARLESTON, SOUTH CAROLINA, if and only if the following stated contingency occurs: Upon the forfeiture or estreature of the surety bond or bonds posted on behalf of

Defendant in Case Number

Power Number

In the court of

County, Florida, by mortgage, or upon payment of any expenses incurred by the mortgage to produce the defendant before the appropriate court of courts, of competent jurisdiction in the above cause, with interest thereon at the rate of

per annum, from the occurrence of the above-stated contingency, until fully paid. Interest is payable semi-annually. The maker and endorser of this note further agree to waive demand, a notice of non-payment and protest; and in case the suit is brought for collection hereof, or the same has to be collected upon demand of an attorney; to pay reasonable attorneys fees and assessable costs, for making such collection. Deferred interest payments to bear interest from maturity at

at percent per annum, payable semi-annually. It is further agreed and specifically understood between the parties to this note that there is presently no outstanding loan or debt represented by this Promissory Note, and that this Note is given only to secure future advances up to and including

Dollars and interest. It is further agreed and specifically understood that this Note shall become null and void in the event said the defendant

shall appear in the proper court at all times or times so directed by the Judge or Judges of competent jurisdiction until the obligations under the appearance bond or bands posted on behalf of the defendant have been fulfilled and the surety discharged of all liability thereunder in writing: otherwise to remain in full force and effect.

X *

DATE *

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