AFFIDAVIT OF UNDERTAKING OF BAIL FOR SURRENDER OF DEFENDANT

PURSUANT TO PENAL CODE SECTION 1300 (A) (1)

I ________________________________________, Declare that I am a California Bail

Licensee doing business as _______________________________________________,
License number ________________that the following information represents a true and
correct statement of facts as they pertain to the bail bond posted on.

Defendant’s Name: _____________________________

DOB: ______________________

Court: _________________________

County: ________________________

State: ______________________

Bond Amount: $________________

Bond Number (s): _____________________________________________________

Original Charge: _______________________________________________________

Surety Company: ______________________________________________________

Bond Company: ______________________________________________________

Person (s) authorized to apprehend and surrender defendant:

____________________________________ ________________________________

____________________________________ _________________________________

I declare under the penalty of perjury that the foregoing is true and correct.

Affiants Signature:______________________________

Date:________________________________