Bail Bond Form – Fill Out and Use This PDF

LIST OF FORMS AND DOCUMENTS REQUIRED IN

BAIL BONDING QUALIFICATION PACKETS

GENERAL AFFIDAVIT OF QUALIFICATION OF GENERAL BAIL BONDSMEN

(Property Qualified)

IN THE 16th JUDICIAL CIRCUIT COURT

WITHIN AND FOR THE SAID COUNTY OF JACKSON

I, _____________________________________, being desirous from time to time of

signing various bail bonds in this court during the month next following the filing of this affidavit and questionnaire, do hereby upon my oath state that I have read over and have carefully answered each of the questions in the following questionnaire, and that the answers to the same are true, and that I have made the same for the purpose of establishing my qualification to sign such bonds; and that I have, in addition to signing and swearing of this affidavit, affixed my signature at the end of the questionnaire for the purpose of identification and to guarantee the genuineness and truthfulness thereof.

Initial one only:

_____ Individual

_____ Corporate Officer

_____ LLC Owner or Manager

_____ Partner

By: ____________________________________

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PROPERTY QUALIFIED QUESTIONNAIRE

16th JUDICIAL CIRCUIT COURT OF JACKSON COUNTY, MISSOURI

1.State your name: _________________________________

2.Age: ________

3.Company/Corporation you work for:

Self

Name of Corporation/LLC: ______________________________

Partnership Name: ____________________________________

4.Marital status:

Married

Divorced

Single

5.If married or separated, state name of your spouse: ________________________

6.Present residential address: ___________________________________________

7.Length of time you have lived at your current residential address: ________

8.Address immediately prior to moving to your present address: ________________

_____________________________________________________________________________

9.Have you ever been convicted of a criminal offense in the Courts of this or any other State or territory of the United States or of any foreign country (conviction of violations of municipal ordinances not included)? Yes __ or No __

10.Are you an attorney at law, duly admitted to the practice of law by the Supreme Court of Missouri? Yes __ or No __

11.If you have ever been so licensed, has your license ever been suspended or have you been disbarred from the practice of law? Yes __ or No __

12.Are you a party upon any bail bond in any Court of this or any State or any territory of the United States, which after being forfeited, remain unpaid or unsatisfied? Yes __ or No __

13.Have you written any bail bond as the agent of any surety in any Court of this state or any other State or territory of the United States, which after being forfeited, remains unpaid or unsatisfied? Yes __ or No __

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14.Have you acted as a director, officer, or shareholder of any company or corporate surety which posed a bail bond in any Court of this State or any other State or territory o the United States, where the bond, after being forfeited, remains unpaid or unsatisfied?

Yes __ or No __

15.List here an inventory of all real estate of which you are the sole legal and equitable owner:

**NOTE: Do not list any property in which you or your spouse own as tenants by the entirety or joint tenants, and do not list any property in which you own only a life estate or remainder.**

Tract One:

A.Legal Description: ________________________________________________

B.City, zone, street, and street number: _________________________________

C.Description of all improvements thereon: ______________________________

D.Appraised (fair market) valuation at last County assessment: $_____________

E.Assessed valuation at the last assessment: $___________________________

F.Any encumbrances with amounts and names of persons holding the same (mortgages, mechanics’ liens, tax liens, and other liens): __________________

_______________________________________________________________

Tract Two:

A.Legal Description: ________________________________________________

B.City, zone, street, and street number: _________________________________

C.Description of all improvements thereon: ______________________________

D.Appraised (fair market) valuation at last County assessment: $_____________

E.Assessed valuation at the last assessment: $___________________________

F.Any encumbrances with amounts and names of persons holding the same (mortgages, mechanics’ liens, tax liens, and other liens): __________________

_______________________________________________________________

Tract Three:

A.Legal Description: ________________________________________________

B.City, zone, street, and street number: _________________________________

C.Description of all improvements thereon: ______________________________

D.Appraised (fair market) valuation at last County assessment: $_____________

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E.Assessed valuation at the last assessment: $___________________________

F.Any encumbrances with amounts and names of persons holding the same (mortgages, mechanics’ liens, tax liens, and other liens):__________________

_______________________________________________________________

Tract Four:

A.Legal Description: ________________________________________________

B.City, zone, street, and street number: _________________________________

C.Description of all improvements thereon: ______________________________

D.Appraised (fair market) valuation at last County assessment: $_____________

E.Assessed valuation at the last assessment: $___________________________

F.Any encumbrances with amounts and names of persons holding the same (mortgages, mechanics’ liens, tax liens, and other liens): __________________

_______________________________________________________________

*(If there is insufficient space for all of your real estate held, give the same information as to additional tracts on an attached separate sheet of paper.)

16.If any of the above real estate is subject to a lease for longer than two years, state the name of the lessee, term of the lease, and the rental amount: ___________________

_______________________________________________________________________

17.Provide an inventory of cash assets or those assets equivalent to cash: ________

_______________________________________________________________________

18.If any of the above listed personal property is subject to any encumbrances or liens, state the nature and amount of the same and by whom held: __________________

_______________________________________________________________________

19.Has any federal tax lien been filed against you? Yes __ or No __

20.Provide the approximate amount of your outstanding debts, other than those listed above: $_____________________________

21.List all bail bonds upon which you are surety and which are now outstanding, specifying separately the amount of each bond, the name of the defendant, the offense with which he is charged, the court in which the prosecution against him is pending, and the name of the attorney-in-fact writing the bond. This list may be attached and incorporated by reference but you are certifying to this Court by executing this affidavit that the list is accurate and complete and that the total of these bonds is $____________.

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22.State whether or not you or anyone on your behalf has received or has been promised any consideration or security for the suretyship herein, and, if so, the nature and amount thereof and the name of the person or persons by whom such promise was made or from whom such security or consideration was received: ___________________

_______________________________________________________________________

I affix my signature at the end of this questionnaire for the purpose of identification and to guarantee the genuineness and truthfulness thereof.

Initial one only:

_____ Individual

_____ Corporate Officer

_____ LLC Owner or Manager

_____ Partner

By: ____________________________________

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GENERAL AFFIDAVIT OF QUALIFICATION OF GENERAL BAIL BONDSMEN

(Insurance Qualified)

IN THE 16th JUDICIAL CIRCUIT COURT

WITHIN AND FOR THE SAID COUNTY OF JACKSON

I, _____________________________________, being desirous from time to time of

signing various bail bonds in this court during the month next following the filing of this affidavit and questionnaire, do hereby upon my oath state that I have read over and have carefully answered each of the questions in the following questionnaire, and that the answers to the same are true, and that I have made the same for the purpose of establishing my qualification to sign such bonds; and that I have, in addition to signing and swearing of this affidavit, affixed my signature at the end of the questionnaire for the purpose of identification and to guarantee the genuineness and truthfulness thereof.

Initial one only:

_____ Individual

_____ Corporate Officer

_____ LLC Owner or Manager

_____ Partner

By: ____________________________________

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INSURANCE QUALIFIED QUESTIONNAIRE

16th JUDICIAL CIRCUIT COURT OF JACKSON COUNTY, MISSOURI

1.State your name: _________________________________

2.Age: ________

3.Company/Corporation you work for:

Self

Name of Corporation/LLC: ______________________________

Partnership Name: ____________________________________

4.Marital status:

Married

Divorced

Single

5.If married or separated, state name of your spouse: ________________________

6.Present residential address: ___________________________________________

7.Length of time you have lived at your current residential address: ________

8.Address immediately prior to moving to your present address: ________________

_____________________________________________________________________________

9.Have you ever been convicted of a criminal offense in the Courts of this or any other State or territory of the United States or of any foreign country (conviction of violations of municipal ordinances not included)? Yes __ or No __

10.Are you an attorney at law, duly admitted to the practice of law by the Supreme Court of Missouri? Yes __ or No __

11.If you have ever been so licensed, has your license ever been suspended or have you been disbarred from the practice of law? Yes __ or No __

12.Are you a party upon any bail bond in any Court of this or any State or any territory of the United States, which after being forfeited, remain unpaid or unsatisfied? Yes __ or No __

13.Have you written any bail bond as the agent of any surety in any Court of this state or any other State or territory of the United States, which after being forfeited, remains unpaid or unsatisfied? Yes __ or No __

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14.Have you acted as a director, officer, or shareholder of any company or corporate surety which posed a bail bond in any Court of this State or any other State or territory o the United States, where the bond, after being forfeited, remains unpaid or unsatisfied?

Yes __ or No __

15.Has any federal tax lien been filed against you? Yes __ or No __

16.Provide the approximate amount of your outstanding debts: $________________

17.List all bail bonds upon which you are surety and which are now outstanding, specifying separately the amount of each bond, the name of the defendant, the offense with which he is charged, the court in which the prosecution against him is pending, and the name of the attorney-in-fact writing the bond. This list may be attached and incorporated by reference but you are certifying to this Court by executing this affidavit that the list is accurate and complete and that the total of these bonds is $________________.

18.State whether or not you or anyone on your behalf has received or has been promised any consideration or security for the suretyship herein, and, if so, the nature and amount thereof and the name of the person or persons by whom such promise was made or from whom such security or consideration was received: __________________

______________________________________________________________________

**Attach a true copy of the State of Missouri’s authorization to the corporation, association or company named above to issue surety insurance and a true copy of the qualifying power of attorney issued to the general bail bondsman and to each of the attorneys-in-fact by the surety insurer.**

I affix my signature at the end of this questionnaire for the purpose of identification and to guarantee the genuineness and truthfulness thereof.

Initial one only:

_____ Individual

_____ Corporate Officer

_____ LLC Owner or Manager

_____ Partner

By: ____________________________________

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AFFIDAVIT OF GENERAL BAIL BOND AGENT

The individual who signs below is either the General Bail Bond Agent, or a specified officer of a corporate General Bail Bond Agent with full authority to act for the corporation, or a partner in a partnership which has been granted a General Bail Bond Agent’s license, or the owner or manager of a limited liability company. Except as listed below, there are no outstanding bail bond forfeitures or unsatisfied judgments thereon entered in any court in this State or of the United States where the undersigned or any of the undersigned’s agents or employees:

posted the bond as surety;

wrote the bond as agent of this or any other surety; or

where the surety was a company or corporation, acted as director, officer or stockholder of that surety.

_____________________________________

[Print Name of General Bail Bond Agent]

Initial one only:

_____ Individual

_____ Corporate Officer

_____ LLC Owner or Manager

_____ Partner

By: ____________________________________

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