STATE OF NEBRASKA FORM NO. CC 13:2 08/2007 Rev. IN THE COUNTY COURT OF STATE OF NEBRASKA Plaintiff vs. Defendant
CASE NUMBER
ASSIGNMENT OF BOND
COUNTY, NEBRASKA
ASSIGNMENT OF BOND PAYMENT OF FINES AND COSTS
I request the bond posted by me in this case be used in payment of the fines and costs assessed by the Court. The balance is to be made payable to
, at . DATE: DATE: DEFENDANT: SURETY:
Bail Bond (Face value) Amount Received 10% Bond Costs Court Costs Sheriff Fees Witness Fees Certified Mail Fees $ $ $ $ $
$ $
Chemical Test Fees $ Fines Restitution Probation Fees Other $ $ $ $ $ $ $
TOTAL FINES & COSTS AMOUNT APPLIED FROM BOND BALANCE DUE COURT / DEFENDANT CK/REC #