Florida Administrative Code
69 - DEPARTMENT OF FINANCIAL SERVICES
69B - Division of Insurance Agent and Agency Services
Chapter 69B-221 - BAIL, BONDS, AND BAIL BOND AGENTS
Section 69B-221.125 - Collateral Security; Affidavit; Form

Every bail bond agent who accepts collateral security for a bail bond shall, for each bail bond written, make and attach to such bail bond an affidavit on the form prescribed by the Department, to wit:

AFFIDAVIT

STATE OF FLORIDA

COUNTY OF ___

Before me today, the undersigned authority, personally appeared ___, who by me being duly sworn, deposes and says: That he is a duly licensed bail bond agent pursuant to chapter 648, F.S., and has registered for the current year with the office of the Sheriff and Clerk of the Circuit Court of the aforementioned county, and has filed a certified copy of his appointment by Power of Attorney for the Surety, with the office of the Sheriff and Clerk of the Circuit Court of the aforementioned County. That ___ (Principal) of ___ (Address) has (given or promised to give) the sum of ___ ($) Dollars, as consideration for Bail Bond Number ___ filed with the Clerk of the ___ located in ___ together with the (promise or receipt) of security belonging to ___ (Name) of ___ (Address) as follows: (Provide detailed description and source of security) ___. That a duly signed receipt has been given to the said ___ (Principal) for the consideration given and/or that the said ___ (Name) has (also been) given a receipt for the security described above.

Sworn to and subscribed before me in ___, ___ Florida, on this ___ day of ___

Rulemaking Authority 648.26, 648.442(9) FS. Law Implemented 903.14(1), 648.36, 648.44(1)(m), 648.442, 648.45 FS.

Repromulgated 12-24-74, Formerly 4-1.14, Amended 9-10-91, Formerly 4-1.014, Amended 4-14-97, Formerly 4-221.125.