Bail Bond

APPLICATION FOR APPEARANCE BOND			DEFENDANT:
AMERICAN CONTRACTORS INDEMNITY COMPANY, Bail Bond Department			AGENT:
5153 N. Shadeland, Indianapolis, Indiana 46226-2603			POWER ON:
I, the undersigned, value=""title="Please enter the amount" class="required textBoxStyle"/>			COURSE ON:
in the course of: wherein I am			EXECUTION DATE:
charged with			CONTACT BY
and I agree to the following terms and conditions prescribed by the State of			DATE:
			TIME
			RELATIONSHIP

TERMS AND CONDITIONS

The following terms and conditions are an integral part of this application for appearance bond no(s). Date:
for which AMERICAN CONTRACTORS INDEMNITY COMPANY or its Agent shall receive a premium in the amount of Dollars $
1. AMERICAN CONTRACTORS INDEMNITY COMPANY, as surety, shall have control and jurisdiction over the Defendant during the term for 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. It is understood and agreed that the happening of any one of the following events shall constitute a breach of Defendant's obligations to AMERICAN CONTRACTORS INDEMNITY COMPANY hereunder, and AMERICAN CONTRACTORS INDEMNITY 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 events which 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 CONTRACTORS INDEMNITY COMPANY, or its Agent.
(b) If Defendant shall move from one address to another without notifying AMERICAN CONTRACTORS INDEMNITY COMPANY or its Agent in writing prior to said move.
(c) It Defendant shall commit any act which shall constitute reasonable evidence of Defendant's intention to cause a forfeiture of said bond
(d) If Defendant is arrested and incarcerated for any offense other than a minor traffic violation.
(e) If Defendant shall make any material false statement in the application.

ALL INFORMATION BELOW MUST BE COMPLETED IN FULL, OR DELAY WILL OCCUR

ALL INFORMATION BELOW MUST BE COMPLETED IN FULL, OR DELAY WILL OCCUR
Name of Defendant Nickname/Alias
Street Address: City: St.: Zip: Phone: How Long:
Former Address: How Long:
Employed By Clock # Dept. # How Long
Employer's Address Boss Union Local # Phone #
Previous Employment : How Long:

Date of Birth:	Height:	Weight:	Eyes:	Hair:	Race:

Left Handed:	Right Handed:	Glasses:	Dentures:	Beard/Mustache:

Identification marks or tattoos:		Social Security No.

Spouse's Employment:		Address:		Phone:

Children: Name and Age:		School:

Children: Name and Age:		School:

Children: Name and Age:		School:

Parent's Name		Address:		Phone:

Spouse's Parents		Address:		Phone:

Brothers or Sisters		Address:		Phone:

Brothers or Sisters		Address:		Phone:

Brothers or Sisters		Address:		Phone:

Best Friend		Address:		Phone:

Defendant's Attorney		Address:		Phone:

Indemnitor's Name:		Address:		Phone:

Indemnitor's Relationship to Applicant

Indemnitor's Employment:		Address:		Phone:

Defendant Arrested Before Y/N		Convicted Y/N	Offense	Gallery No.

Automobile - Year	Make	Model	Color	License No.

When and where did you buy car?	Amount owing $	To whom

Driver's License No.	State	Draft Registration No.

Are tou under any bail bond now?	Agent or Surety

Remarks:

The Defendant hereby warrants that the foregoing declarations made and answers given are the truth without reservation and are made for the purpose of inducing 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, employers, bankers, the Federal Social Security Administration, the Internal Revenue, 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 other persons or organizations having information concerning the Defendant's whereabouts to give such information to AMERICAN CONTRACTORS INDEMNITY COMPANY and its assigns and/or duly authorized 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 CONTRACTORS INDEMNITY COMPANY and its assigns and/or duly authorized representatives. In addition, if the Defendant escapes from the custody of AMERICAN CONTRACTORS INDEMNITY COMPANY and is subsequently captured in a 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 proceedings.

This Agreement shall be construed and enforced under the laws of the State of In the event any of the provisions of this Agreement are inconsistent with the laws of this State, this Agreement, as to these provisions only, shall be null and void, and the remainder shall be enforced with the same effect as though such provisions were omitted.

Signed and delivered this	day of	20
AGENT WITNESS HERE	DEFENDANT SIGN HERE X
	INDEMNITOR SIGN HERE X

AMERICAN CONTRACTORS INDEMNITY COMPANY		DEFENDANT
BAIL BOND DEPARTMENT		AGENT
5153 N. Shadeland, Indianapolis, Indiana 46226-2603		POWER NO.
INDEMNITY AGREEMENT		EXECUTION DATE
(Complete in Full)

Name of Indemnitor	Phone	Date of Birth

Residence	City	State	Zip:

Social Security No.	Employed By	Boss

Employer's Address	Clock #	How Long	Phone

Spouse's Name	Date of Birth

Employed By	Date of Birth	Phone

Parents	Address	Phone

Name of Co-Indemnitor	Phone	Date of Birth

Residence	City	State	Zip

Social Security No.	Employed By	Boss

Employer's Address	Clock #	How Long	Phone

	PERSONAL REFERENCES	WORK OR HOME ADDRESS	PHONE
1
2
3

YOU ARE ASSUMING SPECIFIC OBLIGATIONS - READ CAREFULLY!

THIS AGREEMENT is made by and between the undersigned Defendant, Indemnitors, and AMERICAN CONTRACTORS INDEMNITY COMPANY, its agents and/or assigns through its duly authorized Agent

authorized Agent WHEREAS AMERICAN CONTRACTORS INDEMNITY COMPANY (hereinafter called ''Surety''), at the request of the Indemnitors has or is about to become SURETY on an appearance bond for Defendant in the sum of Dollars$ by it's certain bondexecuted on power of attorney number(s)

NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, the parties jointly and severally agree as follows:

1. That the Indemnitors will have Defendant forthcoming before the Court named on said Bond at the time(s) therein fixed, and at such other times as may be ordered by the Court.

2. That the Indemnitors will at all times indemnify and save the Surety harmless from and against any and all claims, demands, liabilities, costs, charges, counsel fees, expenses, suits, orders, judgments, or adjudications whatsoever which the Surety shall or may for any cause sustain or incur, by reason of Surety having executed said Bond or undertaking, and will, upon demand, place funds with the Surety to meet all such claims, demands, liabilities, costs, charges, counsel fees, expenses, suits, orders, judgments, or adjudications against it, by reason of its Suretyship, and before the Surety shall be required to pay the same..

That the agreement of Indemnity contained in paragraph 2 above shall continue as long as the Surety has any liability or has sustained any loss, upon the bond(s) referred to herein, and the undersigned further agrees not to make any transfer, or any attempted transfer of any of the property, real or personal, in which the undersigned has an interest or in which the undersigned may subsequently acquire any interest, and it is further agreed that the Surety shall have a lien upon all property of the undersigned for any sums due it or for which it has become, or may become, liable by reason of its having executed the Bond(s) referred to herein. It is further agreed that the Indemnity Agreement contained in Paragraph 2 above and the provisions of this paragraph shall be binding upon and apply to any subsidiary, affiliate, parent or related enterprises created or acquired by the undersigned.

That the voucher, or any other evidence of any payment made by the Surety, by reason of this Suretyship, shall itself be conclusive evidence of such payment as to the Indemnitors, their estate, and those entitled to share in their estate, and their successors and assigns.

That the Surety may withdraw, at any time provided by law, from its Suretyship upon the Bond(s) or undertaking herein, without liability to any party.

6. That Indemnitors' liability to Surety is not limited to the Bond(s) referred to herein, but shall apply to all other bonds or undertakings issued by Surety at the request of the Indemnitors

7. That Indemnitors obligations and Indemnities as contained herein shall not terminate upon exoneration of the bond(s) or undertaking but shall continue until such time that Surety is relieved of all duties, demands, liabilities, obligations, costs or expenses in any way related thereto.

8. That the waiver by Surety of any breach of any term or condition herein shall not be deemed a waiver of same of any subsequent breach of the same term or condition, and that failure of any Indemnitor to comply with the terms and conditions herein shall not act as or be construed as a release or waiver as to the remaining Indemnitor who shall remain liable and bound by all provisions of this Agreement

9. This Agreement shall be construed and enforced under the laws of the State of In the event any of the provisions of this Agreement are inconsistent with the laws of this State, this Agreement, as to these provisions only, shall be null and void, and the remainder shall be enforced with the same effect as though such provisions were omitted.

1 0. The use of the plural herein shall include the singular. Obligations of the Indemnitors shall be joint and several and the provisions of this Agreement shall be binding upon Indemnitors' heirs, successors, representatives and assigns.

WAIVER AND RELEASE

The undersigned hereby waive any and all rights I/we may have under Title 29 of the Privacy Act, Freedom of Information Act, Title 6, Fair Credit Reporting Act and any such state or local laws.

In addition, I / We hereby authorize and direct our relatives, employers, bankers, the Federal Social Security Administration, the Internal Revenue, 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 other persons or organizations having information concerning the Defendant's whereabouts to give such information to AMERICAN CONTRACTORS INDEMNITY COMPANY and its assigns and/or duly authorized representatives. I / We 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. I / We authorize the use of copies of this document by AMERICAN CONTRACTORS INDEMNITY COMPANY and its assigns and/or duly authorized representatives. In addition, if the Defendant escapes from the custody of AMERICAN CONTRACTORS INDEMNITY COMPANY and is subsequently captured in a 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 proceedings.

IN WITNESS WHEREOF, the parties have executed this Agreement this day of 20
WITNESSES:
	X
		Signature of Defendant
	X
		Signature of Indemnitor
	X
		Signature of co_Indemnitor

State of

Country of

On this day of 20 before me personally appeared

to me known to be the person described in and who

executed the foregoing instrument and thereupon acknowledged to me that executed the same.

My Commission Expires

County of Residence	Notary Public

IMPORTANT
	1. Will appear in court every time I am told to.
(Defendant)	2. Cannot move or leave the county where I was arrested without written permission from the Court and my Bail Agent.
	3. Must do everything possible to avoid any further problems while out on this bond.
	4. Realize I can go back to jail at any time for any reason.
	1. Must have in Court each and every time he/she is told to be in Court
(Indemnitor)	2. Must pay all costs and expenses if has to be put back in jail.
	3. May have to pay the full amount of the bond and all expenses.

Witness for All:	Defendant

	Indemnitor

	Co-Indemnitor

PROMISSORY NOTE
$ City and State Date
On demand after date, for value received, Promise to pay to the order of
AMERICAN CONTRACTORS INDEMNITY COMPANY, or assigns
DOLLARS,at , with interest thereon at the rate of per cent, per annum from Call Date until fully paid. Interest payable semi-annually. The maker and endorser of this note further agree to waive demand, notice of non-payment and protest; and in case suit shall be brought for the collection hereof, or the same has to be collected upon demand of an attorney, to pay reasonable attorney's fees for making such collection. Deferred interest payments to bear interest from maturity at per cent, per annum payable semi-annually.
It is further agreed and specifically understood that this note shall become Null and Void in the event the 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.

	SIGNATURE OF DEFENDANT

Date	SIGNATURE OF INDEMNITOR

	SIGNATURE OF CO-INDEMNITOR

WAIVER AND RELEASE
If I depart the jurisdiction of the Court wherein my bail bond(s) is posted by A.C.I.C. for any reason, and I am captured by A.C.I.C. and or its Agent, or any law enforcement agency, in a State other than the one in which my bail bond(s) is posted, I hereby agree to voluntarily return to the State of original jurisdiction, and I hereby waive extradition proceedings. I hereby waive any and all rights I may have under Title 29 Privacy Act - Freedom of Information Act, Title 6, Fair Credit Reporting Act, and any such local or State law. I consent to and authorize AMERICAN CONTRACTORS INDEMNITY CO., and/or its Agent, to obtain any and all private or public information and/or records concerning me from any party or agency, private or governmental (local, State, Federal), including but not limited to social security records. criminal records, civil records, driving records, telephone records, medical records, school records, workers compensation records, employment records. I authorize without reservation, any party or agency, private or governmental (local, State, Federal), contacted by AMERICAN CONTRACTORS INDEMNITY CO., and/or its Agent, to furnish any and all private and public information and records in their possession concerning me to AMERICAN CONTRACTORS INDEMNITY CO., and/or Its Agent.
This Agreement shall be construed and enforced under the laws of the State of In the event any of the provisions of this Agreement are inconsistent with the laws of this State, this Agreement, as to these provisions only, shall be null and void, and the remainder shall be enforced with the same effect as though such provisions were omitted.
Date	Signature of Defendant

(SIGNATURE OF AGENT)