AO 100B (Rev. 01/09) Surety Information Sheet
UNITED STATES DISTRICT COURT
for the ) ) ) ) ) __________ District of __________ United States of America v.
SURETY INFORMATION SHEET (Under Fed. R. Crim. P. 49.1, this form may only be filed in court if redacted or under seal.) Use separate information sheet for each surety. Attach photocopies of two pieces of personal identification, including at least one picture i.d. for each. Surety information: Name: Date of birth: Immigration status: Home address: Home/cell phone No(s).: Employer's name: Employer's address: Monthly salary (gross): $ Work phone No.: Source of additional income (if applicable): Amount of additional income (if applicable): Real property owned by surety (if more than one piece of property, please use additional sheets): Address: Value: $ Any holders of trust deeds: Is proof of surety's title to property attached? AUSA:
Social Security No.: Alien Registration No.:
Length of employment:
Equity in property: $
Are payments/taxes current? ' Yes ' No
' No Surety:
AO 100B (Rev. 01/09) Surety Information Sheet (Page 2)
Affidavit by Owner of Cash Security (Complete if applicable) I, , declare that the $ cash deposited as security on the foregoing bond is owned by me and is to be returned to me at the address listed on page one of this information sheet upon exoneration of this bond. I subject these funds to the provisions of any applicable local court rule and agree that in case of default or willful contempt of court on the part of the principal, the court may, upon at least 10 days notice to me, summarily render judgment against the cash security.
Justification of Surety and Surety Agreement , declare under penalty of perjury, that my net worth is $ and that I have read and understand this two-page information sheet. I further understand that by signing the appearance bond and this information sheet, I will be responsible for the defendant's appearances in court and the defendant's compliance with all conditions of release as ordered by the court. If the defendant does not appear or comply with the conditions of release, I will be required to pay the amount of the bond, any security I have posted may be taken by the Government, and a judgment may be entered against me. If judgment is entered against me, a judgment lien will be filed with the county recorder in all appropriate counties for the full amount of the bond. I declare under penalty of perjury that all information contained in this bond and on this surety information sheet is true. I,
Signed before me.
Signature of witness to surety's signature
Printed name of witness to surety's signature
Address of witness to surety's signature