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Release Bail Bonds

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					                                                           BAIL BONDING APPLICATION
                                IMPORTANT NOTICE - FRAUD WARNING: (Pursuant to 10-1-127(7), C.R.S.)
“It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the
company. Penalties may include imprisonment, fines, and denial of insurance and civil damages. Any insurance company or agent of an insurance company who knowingly
provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or
claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory
Agencies.”

CO-SIGNER(S): Please be sure to read this document carefully. Each and every question that you have been asked to complete and answer on each document that you have
signed to complete your obligation that you have assumed as taking the position of GUARANTOR (co-signer) for the person that you have requested THIS BAIL
BONDING AGENT, or any affiliate, to post a surety bond for (DEFENDANT)_____________________________________________.

___________________________________________________________________________________________________________________________________________
INDEMNITOR FULL NAME (CO-SIGNOR)                          (NICK NAME)            HOME PHONE                      CELL PHONE
_____________________________________________________________________________________________________
ADDRESS                                      APT NUMBER AND COMPLEX NAME                      CITY               STATE        ZIPCODE
____________________________________________________________________Y___N___________________________
DATE OF BIRTH               HEIGHT/WEIGHT              HAIR COLOR             US CITIZEN           SOCIAL SECURITY             DRIVERS LICESNCE #/STATE
_____________________________________________________________________________________________________
MARRIED/SINGLE/DIVORCED/WIDOWED/COMMON LAW                                   MATE’S FULL NAME                               DOB
_____________________________________________________________________________________________________
PHONE                                        ADDRESS/CITY/STATE
_____________________________________________________________________________________________________
EMPLOYER NAME                                                                                                                            PHONE
_____________________________________________________________________________________________________
EMPLOYER ADDRESS                                                                                                       SALARY/WAGES
_____________________________________________________________________________________________________________
OCCUPATION                                          SUPERVISOR                                                                           YEARS ON JOB
_____________________________________________________________________________________________________
MILITARY BRANCH (IF APPLICABLE)                                     SERVICE NUMBER                       DISCHARGE DATE                  UNION            LOCAL
_____________________________________________________________________________________________________
RELATIVE                  ADDRESS                                    PHONE               RELATIVE                   ADDRESS                                   PHONE
_____________________________________________________________________________________________________
PERSONAL REFERENCE                                       ADDRESS                                                                    PHONE         RELATIONSHIP
_____________________________________________________________________________________________________
BANK NAME                                           CREDIT CARD ACCT                        TYPE /LIMIT
_____________________________________________________________________________________________________
REAL PROPERTY LOCATION                  OWNER(S)                  HOW LONG                 VALUE/ EQUITY                    FINANCED BY/PHONE
_____________________________________________________________________________________________________
VEHICLE       MAKE / MODEL YEAR/COLOR LICENSE PLATE                                            VEHICLE       MAKE / MODEL YEAR/COLOR LICENSE PLATE

DEFENDANT INFORMATION:

________ ___________________________________________________________________________________________________________________________________
FULL NAME                                     ALIAS/NICKNAME             PHONE                     RELATIONSHIP TO DEFENDANT
_____________________________________________________________________________________________________
ADDRESS                          CITY/STATE/ZIPCODE                                       VEHICLE       MAKE / MODEL YEAR/COLOR LICENSE PLATE
_____________________________________________________________________________________________________
EMPLOYER NAME                               ADDRESS                CITY/STATE/ZIPCODE                          PHONE
______________________________________________________________________Y___N_________________________
DATE OF BIRTH          SOCIAL SECURITY NUMBER                 IS DEFENDANT CURRENTLY ON BOND?                     NAME OF AGENT/PHONE


TRANSLATION ACKNOWLEDGEMENT: I/WE READ AND UNDERSTAND THE ENGLISH LANGUAGE (CIRCLE ONE) YES NO INITIALS ________
If indemnitor checked no, I affirm that I have read verbatim or translated this entire document, to the signer(s).
____________________________________________________________________________________________________________
 FULL NAME (WRITE)                            SIGNATURE OF TRANSLATOR


The maker of the above statement herby authorizes the Surety to confirm the bank balances claimed and all other items comprising said statement IN WITNESS
WHEREOF, the parties have executed this Agreement this _______day of ________________________, 20_______.

________________________________________________                              X_______________________________________________________
AGENT/WITNESS                                                                  SIGNATURE OF INDEMNITOR

Christina Gilford, 294781                        American Surety Company              Power of Attorney #:
Release Bail Bonding 303-523-4447                P.O. Box 68932                       Name of Defendant:
P.O. Box 5764 Denver, CO 80217                   Indianapolis, IN 46268               Amt Bail: __________ Amt Prem. Charged: _______________
                                                 800-966-1827                         Amt Collateral: ______________________
                                                                                      Description of Collateral: ________________________
                                                                                      ALL COLLATERAL WILL BE RETURNED WHEN BOND RELEASE
                                                                                      IS SUBMITTED TO AGENT
                                                                   PROMISSORY NOTE
$______________________ _____________________________, Colorado __________________________
             (BOND AMOUNT                                              (CITY)                                                           (DATE)

THIS NOTE IS DUE IMMEDIATELY UPON FAILURE TO APPEAR OF _______________________________________________ I/WE (CO-SIGNOR) AFTER
DATE FOR VALUE RECEIVED WE PROMISE TO PAY TO THE ORDER OF AFOREMENTIONED SURETY. PAYMENTS WILL BE MADE TO THE SURETY
FOR ________________________________________________________ DOLLARS, WITH INTEREST AT THE RATE OF TWENTY ONE (21%) PER ANNUM,
WHICH IS PAYABLE IN FULL IN THE EVENT OF DEFAULT AND ON UPON DEMAND.

IT IS AGREED THAT IF THIS NOTE IS NOT PAID WHEN DUE OR DECLARED DUE HEREUNDER, THE ENTIRE PRINCIPAL AND ACCURED INTEREST
THEREON SHALL DRAW INTEREST AT THE RATE OF 21% PER ANNUM, AND THAT FAILURE TO MAKE ANY PAYMENT OF PRINCIPAL OR INTEREST
WHEN DUE OR ANY DEFAULT UNDER ANY ENCUMBRANCE OR AGREEMENT SECURING THIS NOTE SHALL CAUSE THE WHOLE NOTE TO BECOME
DUE AT ONCE, OR THE INTEREST TO BE COUNTED AS PRINCIPAL AT THE OPTION OF THE HOLDER OF THE NOTE. PRESENTMENT FOR PAYMENT,
NOTICE OF DISHONOR, PROTEST NOTICE OF NON-PAYMENT AND OF PROTEST, ARE HEREBY WAIVED BY THE MAKER OF MAKERS AND
ENDORSER AND ENDORSERS AND EACH ENDORSER FOR HIMSELF GUARANTEES THE PAYMENT OF THIS NOTE ACCORDING TO ITS TERMS. NO
EXTENSION OF PAYMENT SHALL RELEASE ANY SIGNER OR ENDORSER HEREOF IF GIVEN WITHOUT HIS CONSENT AND ALL EXPENSES OF
COLLECTION TO INCLUDE, BUT NOT LIMITED TO COLLECTION AGENCY FEES AND SKIP TRACING COSTS AND FEES. WHETHER THEY BE PRE OR
POST JUDGMENT, WITH OR WITHOUT SUIT, INCLUDING REASONABLE ATTORNEY FEES TO BE ADDED BY THE PUBLIC TRUSTEE TO THE COST OF
FORECLOSURE SHALL; BE PAID BY THE PARTIES LIABLE FOR THE PAYMENT OF THIS NOTE. DUE: UPON DEMAND OF ANY FAILURE TO APPEAR BY
THE DEFENDANT.

THIS NOTE IS SECURED BY: 1) INDEMNITY AGREEMENT 2) _______________________ 3) ________________________

IT IS FUTHER AGREED AND SPECIFICALLY UNDERSTOOD THAT THIS NOTE SHALL BECOME SATISFIED IN THE EVENT THE SAID DEFENDANT
SHALL APPEAR IN PROPER COURT AT THE TIME SO DIRECTED BY THE JUDGES OF COMPETENT JURISDICTION UNTIL THE OBLIGATIONS UNDER
APPEARANCE BOND OR BONDS POSTED ON BEHALF OF THE DEFENDANT HAVE BEEN FULFILLED AND THAT THIS BAIL BONDING AGENCY IS
DISCHGARGED OF ALL LIABILITY THERUNDER, OTHERWISE TO REMAIN IN FULL FORCE AND EFFECT. IT IS FURTHER AGREED AND
SPECIFICIALLY UNDERSTOOD THAT THIS NOTE SHALL BECOME NULL AND VOID IN THE EVENT THAT SAID DEFENDANT SHALL APPEAR IN THE
PROPER COURT AT THE TIME OR TIMES SO DIRECTED BY THE JUDGE OR JUDGES OF COMPETENT JURISDICTION UNTIL THE OBLIGATIONS UNDER
THE APPEARANCE BOND OR BONDS POSTED ON BEHALF OF THE DEFENDANT HAVE BEEN FULFILLED AND THE SURETY DISCHARGED OF ALL
LIABILITY THEREUNDER, OTHERWISE TO REMAIN IN FULL FORCE AND EFFECT.

PRINT NAME______________________________________                     SIGNATURE________________________________________

S.S.#__________________________________ DL # _________________________________ STATE ____________________




                                                           CREDIT CARD AUTHORIZATION
NOW THEREFORE, in consideration of the premises and other good and valuable consideration, the record and sufficiency of which is hereby acknowledged, the
undersigned do hereby undertake, agree and bind themselves, their legal representatives, successors and assigns as follows:

1.      THE PREMIUM ON THE BONDS(S) OR UNDERTAKING DESCRIBRED ABOVE IS NOT REFUND                                                                    _______ (INITIAL)
2.      If a check, or any instrument, for any part of the premium or fees associated with this undertaking or Bond(s) be returned for insufficient funds, contested charge,
        stopped payment, or closed account the maker of such instrument may be liable for up to three (3) times the amount plus costs of handling and collection.
                                                                                                                             ________(INITIAL)

3.      If a check, or any instrument, for any part of the premium or fees associated with this undertaking or Bond(s) be returned for insufficient funds, contested charge,
        stopped payment, or closed account the maker of such instrument may be subject to prosecution according to Colorado law for Insurance fraud and /or misuse of a
        financial transaction device.                                                                                                    _______ (INITIAL)

4.      I agree that any failure to appear, bounty hunter search fees, and/or forfeiture costs related to this bond will be charged to this credit card. ________(INITIAL)

I, _________________________________________, do hereby agree to the charges shown above to be made against my credit card and that the charge is not contestable.

I further understand that nay collateral given to secure the bond(s) will not be returned until the bond(s) is released by the court and the financial conditions concerning the
bond, as per Colorado Statute and the Indemnity Agreement, have been met. Collateral will be retuned to the address on the application.

Credit card type __________________ Number _______________________________________________ CCV________ Expiration date __________________

Authorization number __________________________________

Signature ____________________________________________ Date______________________

Witness/Agent ________________________________________ Date ______________________
                                                                                      PO #:                       Defendant:
Christina Gilford, 294781                       American Surety Company
Release Bail Bonding 303-523-4447               P.O. Box 68932
                                                Indianapolis, IN 46268                Amt Bail: __________ Amt Prem. Charged: _______________
P.O. Box 5764 Denver, CO 80217
                                                800-966-1827                          Amt Collateral: ______________________
                                                                                      Description of Collateral: ________________________
                                                                                      ALL COLLATERAL WILL BE RETURNED WHEN BOND RELEASE
                                                                                      IS SUBMITTED TO AGENT
                                                                                                       PROMISSORY NOTE
     This note is Secured by _________________________
     ____________________________________________
     ____________________________________________
     ____________________________________________


                                                         $ __________________________________________________                         _____________________________________, 200 ________

                                                         within _________________________________________________________________ after date, for the value received _______________


                                                         (I/We) promise to pay to the order of American Surety Company, P.O. Box 68932 Indianapolis. IN. 46268 (800-969-1827), and/or

                                                         Agent Name:_____________________________ at Address:______________________________________________________________
                                                         _________________________________________________________________________________________________________ Dollars,
                                                         with interest from the day of forfeiture at the rate of 21 percent per annum, payable in the event of default.
                                                         IT IS AGREED that if this note is not paid when due or declared due hereunder, the entire principal and accrued interest thereon shall draw
                                                         interest at the rate of 21 percent per annum, and that failure to make any payment of principal or interest when due or any default under any
                                                         encumbrance or agreement securing this note shall cause the whole note to become due at once, or the interest to be counted as principal,
                                                         at the option of the holder of the note. The makers and endorses hereof severally waive presentment for payment, protest, notice of non
                                                         payment and or protest, and agree to any extension of time of payment and partial payments before, at or after maturity, and if this note or
                                                         interest thereon is not paid when due, or suits brought, agree to pay all reasonable costs of collection, and if foreclosure is made by the
                                                         Public Trustee all reasonable attorney’s fees to be added by the Public Trustee to the cost of foreclosure.
                                                         DUE ___________________________

                                                         SIGNATURE      X_______________________________________                     SIGNATURE      X______________________________________




                                                                                                       PROMISSORY NOTE
 This note is Secured by _________________________
 ____________________________________________
 ____________________________________________
 ____________________________________________




                                                         $ __________________________________________________                         _____________________________________, 200 ________
                                                         within _________________________________________________________________ after date, for the value received _______________

                                                         (I/We) promise to pay to the order of American Surety Company, P.O. Box 68932 Indianapolis. IN. 46268 (800-969-1827), and/or

                                                         Agent Name:_____________________________ at Address:______________________________________________________________
                                                         _________________________________________________________________________________________________________ Dollars

                                                         with interest from the day of forfeiture at the rate of 21 percent per annum, payable in the event of default.
                                                         IT IS AGREED that if this note is not paid when due or declared due hereunder, the entire principal and accrued interest thereon shall draw
                                                         interest at the rate of 21 percent per annum, and that failure to make any payment of principal or interest when due or any default under any
                                                         encumbrance or agreement securing this note shall cause the whole note to become due at once, or the interest to be counted as principal,
                                                         at the option of the holder of the note. The makers and endorses hereof severally waive presentment for payment, protest, notice of non
                                                         payment and or protest, and agree to any extension of time of payment and partial payments before, at or after maturity, and if this note or
                                                         interest thereon is not paid when due, or suits brought, agree to pay all reasonable costs of collection, and if foreclosure is made by the
                                                         Public Trustee all reasonable attorney’s fees to be added by the Public Trustee to the cost of foreclosure.
                                                         DUE ___________________________

                                                         SIGNATURE      X_______________________________________                     SIGNATURE      X______________________________________




Agent Stamp:                                                                            American Surety Company      Power of Attorney #:
Christina Gilford, 294781                                                               P.O. Box 68932               Name of Defendant:
Release Bail Bonding 303-523-4447                                                       Indianapolis, IN 46268       Amt Bail: __________ Amt Prem. Charged: _______________
P.O. Box 5764 Denver, CO 80217                                                          800-966-1827                 Amt Collateral: ______________________
                                                                                                                     Description of Collateral: ________________________
                                                                                                                     ALL COLLATERAL WILL BE RETURNED WHEN BOND
                                                                                               INDEMNITOR AGREEMENT
                                                                                                                     RELEASE IS SUBMITTED TO AGENT
                                             THIS IS A BINDING CONTRACT YOU ARE ASSUMING AN IMPORTANT OBLIGATION. READ EACH PARAGRAPH CAREFULLY; YOU MAY WISH TO CONSULT AN ATTORNEY.
                                      Whereas This bail bonding agency (hereinafter called “SURETY”) “its agent(s)” successors and assigns), at the request of the undersigned, and in reliance upon
                                                                                                               _________________________________________________________________
                                                                                                               __________________________________________
this Indemnity Agreement (this Agreement) has or is about to become the surety on an appearance bond (further known as the Bond(s)) for the defendant in the sum of
_________________ for appearance before the Court(s) listed on the bond(s) through its agent(s) and by its certain bond executed on the power of attorney.
(Agent Stamp)
                 Christina Gilford, 294781                              American Surety Company
                 Release Bail Bonding 303-523-4447                      P.O. Box 68932
                 P.O. Box 5764 Denver, CO 80217                         Indianapolis, IN 46268
NOW, THEREFORE, in consideration of the premises and other good and valuable consideration, the receipt and sufficiency of which i.e. hereby acknowledged, the
undersigned do hereby undertake, agree and bind themselves their legal representatives, successors and assigns as follows:
            (read and initial the following)
  1. Once the bail has been posted the premium on the bond(s) or undertaking described above is not refundable.
       If a check, or any instrument, for any part of the premium or fees associated with this undertaking or Bond(s)s be returned for insufficient funds, stopped
  2. payment, or closed account, the maker of such instrument may be liable for up to three (3) times the amount plus costs of handling and collection.
       The Indemnitors will have the defendant forthcoming before the court(s) named on the bond at the time fixed by such court(s) and from day to day and term to
  3. term thereafter, as may be ordered by such court(s).
       The Indemnitors will at all times unconditionally indemnify and hold the SURETY harmless from and against all claims, demands, liabilities, costs, charges,
       counsel fees, suits, orders, judgments adjudications, and expenses including court costs and attorney fees and against all liability, losses, and damages of any nature
       whatsoever, that the SURETY shall or may, for any cause sustain, incur or be put to reason or in consequence of the execution of the bond(s) by the SURETY, or
       any continuation, extension, alteration or renewal thereof, and any new bond or obligation in replacement of the foregoing, together with interest on any amounts
  4. so expended by the SURETY, at the maximum rate permitted by law. The obligation of the undersigned in this Agreement shall be irrevocable.
       Upon Demand. The undersigned shall remit to the SURETY, all funds necessary to meet every claim demand, suit, action, debt, cost, charge, order, judgment,
       adjudication, and expense, including court costs and attorney’s fees, or other liability, loss or damage of any nature whatsoever incurred by the SURETY, by
  5. reason of its suretyship, whether before or after the SURETY shall be required to pay the same.
       The acceptance of collateral or other consideration as security of performance of the undersigned’s obligations shall not be construed as a waiver or limitation of
  6. any right or remedy that SURETY may have under this Agreement, by statute or otherwise.
    S As long as there is any liability or potential loss of any nature whatsoever to the SURETY upon the Bond(s), the undersigned shall not make any transfer, or any
      attempted transfer of any property, real or person, given as collateral to secure the Agreement or Bond(s) or in which the undersigned may subsequently acquire,
      or of any interest therein, and the SURETY shall have a lien upon all property of the undersigned for any sums due the SURETY or for which the SURETY has
  7. become, or may become liable by reason of its having executed or delivered the Bond(s).
       The undersigned hereby waives for the benefit of the SURETY any right to claim any property as exempt under the constitution or laws of the United States of
  8. America or of any state from levy, execution, attachment, sale or other method of seizure at law or inequity and any notice of default.
       The SURETY shall have the exclusive right, in its sole and absolute discretion, to determine whether any claim or demand upon the Bond(s) shall be paid,
       compromised, defended or appealed. The check or other evidence of any payment, made by the SURETY, by reason of such suretyship, shall be conclusive
       evidence of such payment for the benefit of the undersigned and their estate, both as though the propriety of such payment and the liability of the undersigned to
  9. the SURETY for such payment.
       The SURETY may withdraw from its suretyship upon the Bond(s), as permitted by law, at any time in its sole discretion, upon giving notice to that effect to the
 10. court(s).
       If this Agreement is executed by more than one person or entity, each of the undersigned shall be jointly and severally liable under this Agreement and the failure
       of any of the undersigned to comply with the provisions of this Agreement shall constitute a breach of the Agreement and shall not release or otherwise affect the
 11. liability of the other persons or entities liable to the SURETY under this Agreement.
       Any waiver, alteration or modification of any of the printed provisions of this Agreement shall be valid only if made in writing and signed by the SURETY. The
       failure of the SURETY to enforce at any time or for any period of time, any of the provisions of the Agreement shall not be construed as a waiver of such future.
 12. words used in the plural in this Agreement shall be deemed and construed to include the singular where only one person executes this Agreement.
       The undersigned acknowledges by signing this Agreement they are waiving their rights under the Privacy Act and hereby authorizes his/her relatives, employers,
       bankers, the Federal Social Security Administration, the Internal Revenue Service, The State Division of Motor Vehicles, all Municipal, County, State and Federal
       Law enforcement agencies, credit agencies, telephone/communication companies and any other persons or organizations having information concerning the
       representatives. The undersigned principal(s) understands that any information concerning the representatives. The undersigned principal understands that any
       information obtained will be used for the purposes of assuring principal’s appearance at the appropriate court(s). The principal(s) hereby waives his/her rights with
 13. respect to the Privacy Act and authorizes the use of the copies of this document by the SURETY and/or duly authorized representatives.
      Other Specified Bond Conditions, violations of which may constitute a forfeiture of the bond(s) include, but not limited to,
14.    those checked. The conditions may be changed during the course of the bond(s) to assure compliance, as the SURETY may direct:
  a. Defendant may not leave the State of Colorado without written consent of the undersigned, the SURETY and the court(s);
  b. The undersigned must complete any payment plan as established;
  c. Defendant must check in to the office within 24 hours after posting of the bond to complete a defendant application;
  d. Defendant must notify SURETY or office of any change of address, employment or phone number immediately, in person and in writing;
       Defendant shall not commit any act(s) which constitutes a reasonable suspicion by the SURETY that the defendant's intention is to cause a forfeiture of this
  e. Bond(s).
  f. Defendant shall not make any material false statements on the paperwork completed by the defendant, or any other documents concerned with this Bond(s).
       The use of the plural herein shall include the singular. Obligation of the Indemnitors shall be joint and several and the provisions of this Agreement shall be upon
  g. the Indemnitor heirs, successors, representatives, and assignees.
IN ADDITION THE UNDERSIGNED AGREES:
              To pay $75.00 per hour, per man hour, for any time spent by THIS BAIL BONDING AGENCY or any associate of THIS BAIL BONDING AGENCY in
1.            making court appearances as a result of the defendants failure to appear, or of bond revocation, administrative work or to reinstate original bond at the
              request of the Indemnitor or to enforce any provision of this agreement.
              To pay $75.00 per hour, per man, for any time spent by THIS BAIL BONDING AGENCY or any associate of THIS BAIL BONDING AGENCY to
2.            apprehend the Defendant and return HIM/HER to the custody of the SHERIFF and/or the JURISDICTION of the court as a result of failure to appear by
              the Defendant or as a result of bond revocation.

WHEREAS, ALL PARTIES CONTAINED IN THIS AGREEMENT HAVE READ AND UNDERSTAND THE ENGLISH LANGUAGE, ALL CONTENTS
THEREIN AND AGREE TO ALL STIPULATIONS OF THE SAME ON THIS ________DAY OF _________________________________________, 20____.
    X_______________________________________     x_______________________________________
           SIGNATURE OF CO-SIGNOR                                          SIGNATURE OF CO-SIGNOR

                                                               DISCLOSURE STATEMENT
Christina Gilford, 294781
                                                                                                                         American Surety Company
                                                                                                                         P.O. Box 68932
                                                                                                                         Indianapolis, IN 46268
                                                                                                                         800-966-1827
Release Bail Bonding
P.O. Box 5764
Denver, CO 80217
303-523-4447


Power of Attorney #: ____________________________

Name of Defendant: _____________________________________________________________________

Amount of Bail: ______________________ Amount of Premium Charged: _________________________

Name of Third Party Indemnitor: ___________________________________________________________

Amount of Collateral: ______________________ Description of Collateral: ________________________

___________________________________________________________________________________________________________

Court in which the bond is executed: ________________________________________________________

RE:       COLLATERAL
In order to receive a return of your collateral from your bail bonding agent, you must deliver a copy of the court order resulting in a release of bond
by the court to the bail bonding agent or Surety Company. Pursuant to 12-7-109(I)(d.5), C.R.S., your collateral must be returned within ten working
days of such delivery to your bail bonding agent or the surety company. Pursuant to 16-4-104(3)(a)(IV), C.R.S., your reconveyance of title, certificate of
discharge, or a full release of any lien shall be provided within 30 days after receiving notice that the time for appealing an order that exonerated the bail
bond has expired.

Bail bonding agents are regulated by the Colorado Division of Insurance. TO ENSURE THE PROMPT RETURN OF YOUR COLLATERAL, THE
DIVISION RECOMMENDS YOU HAND DELIVER THE COURT’S BOND DISCHARGE/BOND RELEASE TO THE BAIL BONDING AGENT.
GET A RECEIPT FROM THE BAIL BONDING AGENT SHOWING THE DATE YOU DELIVERED THE DISCHARGE/RELEASE. If you deliver
the bond discharge/release to the bail bonding agent by mail, it is suggested to use certified mail, return receipt requested, with another certified copy to
the Surety Company. YOU SHOULD RETAIN A COPY OF ALL DOCUMENTS RELATED TO THIS BAIL BOND. Please go to the Division’s
website at www.dora.state.co.us/insurance and click on the tab on the left of the web page titled “bail bonding information”, scroll down and click on “a
publication on Bail Bond” scroll down and click on “Your Guide to Bail Bonds in Colorado” for more information on your rights as a consumer.

Pursuant to 12-7-108(1)(a), C.R.S. (2004) enacted in House Bill 04-1260, the bail bonding agent, with your consent, may use your collateral to secure the
following obligations:

         Compliance with the bond issued on behalf of the defendant (which may include costs associated with recovering the defendant should the
          defendant fail to appear for any court appearance associated with this bond if the court revokes the defendant’s bond;
         Any balance due on the premium, commission, or fee for the bond; and
         Any related costs incurred by the agent as a result of issuing the bond.

READ YOUR EXECUTED AGREEMENT WITH THE BAIL BONDING AGENT CAREFULLY. BE SURE YOU UNDERSTAND ALL OF THE
TERMS YOU ARE AGREEING TO.

I have read and understood this Disclosure Statement and consent that the bail bonding agent in this matter may use my collateral to secure the above
obligations.

Dated: _________________                                               _____________________________________________________
                                                                       Signature of defendant or third party indemnitor


I certify that the terms of this Disclosure Statement as it pertains to collateral are not inconsistent with the Executed Agreement/Indemnity Agreement in
this matter.

Dated: _________________                                               _____________________________________________________
                                                                       Signature of the Bail Bonding Agent

				
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