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BAIL_BONDING_APPLICATION_2009_CG.241030

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					                                                          A RELEASE BAIL BONDING
                                                               APPLICATION
    REFERRED BY______________________________                                                          COURTESY BOND_____________________

IMPORTANT NOTICE - FRAUD WARNING: Pursuant to § 10-1-128 (6)(a) , 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, 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 further known as DEFENDANT.

___________________________________________________________________________________________________________________________________________
INDEMNITOR FULL NAME (CO-SIGNER)                          (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 NUMBER
_____________________________________________________________________________________________________
EMPLOYER NAME                                       PHONE                                             ADDRESS
_____________________________________________________________________________________________________
OCCUPATION                                       SUPERVISOR                                            SALARY/WAGES                             YEARS ON JOB
_____________________________________________________________________________________________________
MILITARY BRANCH (IF APPLICABLE)                                 SERVICE NUMBER                      DISCHARGE DATE                UNION            LOCAL

1.______________________________________________/2.____________________________________________________
RELATIVE        ADDRESS                  PHONE      RELATIVE       ADDRESS                  PHONE
_____________________________________________________________________________________________________
PERSONAL REFERENCE                                    ADDRESS                                                                PHONE         RELATIONSHIP

_____________________________________________________________________________________________________
BANK NAME                                      ACCOUNT TYPES
_____________________________________________________________________________________________________
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                                         CONTACT PHONE


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
                                                                                  Power of Attorney #:
Agent Stamp:                                                                      Name of Defendant:
Christina Gilford, 294781         American Surety Company                         Amt Bail: __________ Amt Prem. Charged: _______________
Release Bail Bonding 303-523-4447 P.O. Box 68932                                  Amt Collateral: ______________________
                                  Indianapolis, IN 46268                          Description of Collateral: ________________________
P.O. Box 5764 Denver, CO 80217
                                               800-966-1827                       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 REFUNDABLE                                                                _______ (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 AND UNPAID PREMIUMS 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 returned to the address on the application.

Credit card type __________________ Number _______________________________________________ Expiration date __________________ CCV________

Authorization number __________________________________

Signature ____________________________________________ Date______________________

Witness/Agent ________________________________________ Date ______________________

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

                                                                                         ___________________________________________________________________
                                                                                         ________________________________________
                                                                                                       PROMISSORY NOTE
     This note is Secured by _________________________

     ____________________________________________
     ____________________________________________

     ____________________________________________        $ __________________________________________________                         _____________________________________, 20______

                                                         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 _________________________
 ____________________________________________
 ____________________________________________
 ____________________________________________




                                                         $ __________________________________________________                         _____________________________________, 20____

                                                         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
                                                                                                                          RELEASE IS SUBMITTED TO AGENT

                                                                                                                          _________________________________________________________________
                                                                                                                          __________________________________________

                                                                                                                          _________________________________________________________________
                                                                                                                          __________________________________________

                                                                                                                          Court in which the bond is executed:
                                                                   INDEMNITOR AGREEMENT
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)                                                        American Surety Company
                 Christina Gilford, 294781
                 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-SIGNER                                          SIGNATURE OF CO-SIGNER
                              Bail Bond Payment Plan Agreement

Date: _________________                                 Balance Due: _________________


Defendant: ________________________



By signing this document you are agreeing to pay the remaining balance of this debt. You are liable and may be
assessed late fees and collection costs if the debt is not paid in full and on time. This creditor will use the same
collection methods against you and the defendant to include wage assignments. Non-payment of this debt can
negatively impact your credit rating.

I____________________________ am responsible for payment of the premium and any unpaid balance for
the bond posted for the above named Defendant.


I hereby agree as follows: All Payments due by 5:00 p.m.

Amount Paid: __________________________________

Date: ______________ Amount Due $______________

Date: ______________ Amount Due $______________

Date: ______________ Amount Due $______________

Date: ______________ Amount Due $______________


______________________________                 _________________________________
  Co-Signer Print Name                               Co-Signer Signature


______________________________
      Agent/Witness




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
                                                              RELEASE IS SUBMITTED TO AGENT

                                                              _________________________________________________________________
                                                              __________________________________________

                                                              _________________________________________________________________
                                                              __________________________________________
                                         Bond Premium Adjustment Agreement


Addendum to bonding agreement dated _____________________, 20 ___ between Christina M. Gilford, 294781
Agent, for Release Bail Bonding and ____________________________________ for the posting of bail bond(s)
on ______________________________.
        (DEFENDANT)

It is hereby understood that the normal bond premium charged by Release Bail Bonding for bail bonds is
15% (the standard and approved rate in Colorado) of the bond amount.

The parties to this transaction agree to a bond premium reduction to _____% providing that the following criteria
are met:

1.         That ANY payments remaining for earned bond premium are paid according to the terms specified in
           payment agreement:

2.         That any checks tendered for earned bond premium are cleared through issuer's bank at the time of
           presentation or that any credit card charge is cleared without any dispute/charge-back;

3.         That the Defendant does not miss ANY scheduled court appearances in cases for which the bond(s) are
           posted;

4.         That the Defendant does not violate the primary conditions of bond:

           a.      The Defendant completes and returns required paperwork within 72 hours of release
                   from custody (not including weekends and holidays),

           b.      That Defendant DOES NOT leave the jurisdiction of the State of Colorado AT ANY TIME
                   without the prior written consent of the surety,

           c.      That the Defendant advises surety in writing of any change in employment and/or
                   residence within 7 days of said change.

It is hereby understood by all parties to this transaction that if ANY of the above conditions are NOT met that
surety MAY then charge the difference between the normal bond premium rate of 15% and the discounted rate of
_______%. Said balance will be due and payable to surety. Such demand to be made in writing and considered
delivered if mailed via the USPS.

____________________________________                            ____________________________
Indemnitor Signature                                                        Date

____________________________________                            ____________________________
Indemnitor Signature                                                        Date


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
                                                                     RELEASE IS SUBMITTED TO AGENT

                                                                     _________________________________________________________________
                                                        DISCLOSURE STATEMENT
Christina Gilford, 294781
                                                                                                             American Surety Company
Release Bail Bonding                                                                                         P.O. Box 68932
P.O. Box 5764                                                                                                Indianapolis, IN 46268
Denver, CO 80217                                                                                             800-966-1827
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
                                      BAIL BONDING - DEFENDANT FORM
                                                 WAIVER OF PRIVACY ACT

I, _____________________________________, hereby authorize my relatives, employers, bankers, the Federal
Social Security Administration, 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, credit agencies, telephone/communication
companies, and any other persons or organizations having information concerning me to release such information
to the SURETY, its Agent, Successors or Assigns, and/or duly authorized representatives. I understand that any
information obtained will be used for the purpose of assuring my appearance at the appropriate court(s). I hereby
waive my rights with respect to the Privacy Act, HIPA and authorize the use of copies of this document by the
SURETY, its Agent, Successors or Assigns and/or duly authorized representatives.

                                                       BOND CONDITIONS
    1.       Defendant may not leave the State of Colorado without written consent of the SURETY, and the Court(s).

    2.       Defendant must notify the SURETY or office o any changes of ADDRESS, EMPLOYMENT, or PHONE number
             immediately, in person and in writing.

    3.       Defendant shall not commit any act(s), which constitute a reasonable suspicion by the SURETY that the defendant’s
             intention to cause a forfeiture of the Bond(s).

    4.       Defendant shall not make any material false statement on the paperwork completed by the defendant, or any other
             documents concerning this Bond(s).

    5.       If the defendant fails to appear at any scheduled court proceeding, his or her picture and vital information will be published
             and placed on the Internet.

    6.       Defendant must check in once a week and after all court appearances.

    Failure to abide by any one of the BOND CONDITIONS as listed above shall be grounds for immediate
    Bond(s) Revocation, Re-arrest and RE-incarceration at the co-signers expense.

DEFENDANT SIGNATURE _________________________________________ DATE ________________
_______________________________________________________________________________________________________________________________________
FULL NAME                                    ALIAS/NICKNAME                                              PHONE
____________________________________________________________________________________________________
ADDRESS                    CITY/STATE/ZIPCODE                            VEHICLE     MAKE / MODEL YEAR/COLOR LICENSE PLATE
____________________________________________________________________________________________________
EMPLOYER NAME                       ADDRESS           CITY/STATE/ZIPCODE                   PHONE
____________________________________________________________________________________________________
DATE OF BIRTH                SOCIAL SECURITY NUMBER                         CURRENTLY ON BOND?         NAME OF AGENT/PHONE

_______________________________________________________________________________________________________________________________________
RELATIVE NOT LIVING WITH YOU                          ADDRESS                                                 PHONE

_______________________________________________________________________________________________________________________________________
FRIEND                                                ADDRESS                                                 PHONE

_______________________________________________________________________________________________________________________________________
TATOO(S)                                              LOCATION                            CAR DESCRIPTION / TAG NUMBER

___________________        ________________
NEXT COURT DATE            INITIAL
                                                                                             Return Form to:
                                                                                             Release Bail Bonding
                                                                                             P.O. Box 5764
                                                                                             Denver, CO 80217

				
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posted:8/22/2011
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