COLLATERAL RECEIPT AND INFORMATIONAL NOTICE
Date:
Receipt No: ASC
1. Received From:
2. Address:
3. Home Phone: Work Phone:
4. Social Security Number:
The person(s) name on line (1) above has deposited the collateral or executed the collateral documents checked below:
Indemnity Agreement Promissory Note Mortgage Deed and Promissory Note
Money in the amount of $ dollars by:
Cash: $ And/Or Check No. , in the amount of $
Other Collateral:
The above collateral is placed as security for the bond(s) and for lawful costs incurred due to underwriting the bond(s) for the following:
5. Defendant:
6. Bond Amount: Power No's:
7. Court: Offense(s):
Received by:
Accredited Surety and Casualty Company,Inc.
P.O. Box 140855 - Orlando, FL 32814-0855
Unless a properly drawn, executed, and notarized legal assignment document is accepted and acknowledged by surety agent and the surety company name above, the collateral listed above the will be returned only to the person(s) named on line (1) above. Collateral, except for those documents the surety must retain as directed by the law, will be returned within 21 days after the bail bond(s) has been discharged in writing by the court and all lawful costs incurred by the surety have been paid in full. The undersigned hereby acknowledge receipt of a copy of this documents, a copy of all collateral documents.

 

X
Depositor's Signature

 

X
Depositor's Signature

 
RECEIPT FOR RETURN OF COLLATERAL
The undersigned hereby surrenders the original of this collateral receipt and acknowledges the return and receipt of all collateral listed above. The collateral has been returned in good and sufficient condition and the depositor(s) hereby relieves the surety company from any further liability or responsibility in relation to the collateral.
9. Date: I/We have received the items listed below.

 

Amount originally deposited plus any accrued interest $ .

 

Less applicable costs and expenses allowed by law $. .

 

Total Amount Returned: $ .

 

Other collateral returned:

 

 

Received By:

 

Received By:

INFORMATIONAL NOTICE

CONDITIONS OF BOND
1. The SURETY, as bail, shall have control and jurisdiction over the principal during the term for which the bond is executed and shall have the right to apprehend, arrest and surrender the principal to the proper officials at any time as provided by law.
2. In the event surrender of the principal is made prior to the time set for this principal's appearances, and for any reason other than as enumerated below in paragraph 3, then principal 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 principal's obligation to the SURETY hereunder, and the SURETY shall have the right to forthwith apprehend, arrest and surrender principal, and principal shall have no right to any refund of premium whatsoever. Said events which shall constitute a breach of the principal's obligations hereunder are:
(a) If principal shall depart the jurisdiction of the court without written consent of the court and the SURETY or its Agent.
(b) If the principal shall move from one address to another without notifying the SURETY or its agent in writing prior to said move.
(c) If principal shall commit any act which shall constitute reasonable evidence of principal's intention to cause a forfeiture of said bond.
(d) If the principal is arrested and incarcerated for any other offense other than a minor traffic violation.
(e) If principal shall make any material false statement in the application.

Other Conditions:

 

Court Date: Time: Place:

No Date Set

 

 

X
Principal Signature
INDEMNITOR INFORMATION
In addition to the terms and conditions of any Indemnity Agreement or other collateral documents which you have executed this is to notify you that:
1. The Indemnity(s) will have the defendant(s) forthcoming before the court named in bond, at the court time therein fixed, and as may be further ordered by the court.
2. The Indemnity(s) is responsible for any and all losses or costs of any kind whatsoever which surety may incur as a result of this undertaking, and any collateral or indemnity given shall also guarantee the payment of all lawful costs incurred by the surety. There should not be any costs or losses provided the defendant(s) does not violate the conditions of the bond and appears on time at all required court hearings.
3. Collateral will be returned to the person(s) named in the collateral receipt, or their legal assigns, within 10 days after the surety has received written notice of discharge of the bond(s) from the court and all lawful costs incurred by the surety have paid in full. It may take several Weeks after the case(s) is disposed of before the courts discharges the surety bonds.
FOR COMPLAINTS OR INQUIRES CONTACT

Agency:

Florida Department of Insurance
Bureau of Consumer Assistance
Larson Building
Tallahassee, FL 32399-0300
1-800-342-2762