911 Bail Bonds - Defendant's Forms

911 Bail Bonds - Defendant's Forms

For the person who was arrested. Please fill this out truthfully and completely. Every box must be answered. Type N/A if something doesn’t apply to you, or Unknown if you don’t know. Read each section before you initial or sign. Questions? Call or text Deborah at (775) 385-2200.
Defendant's Personal Information

Tell us about yourself. Use your legal name as it appears on your ID, and give a phone number and address where we can always reach you.
Defendant's Full Name

First NameMiddle NameLast Name
Date of Application

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Alias / Nickname / Street Name
Email
example@example.com
Social Security No.
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Place of Birth
Height
Weight
Eye Color
Hair Color
Scars / Tattoos / Marks
Defendant's Street Address
Apt. #
Residence
City
State
Zip Code
Landlord
Previous Address
Offense / Bond Information

Fill in what you know, such as the charge or the bail amount. If you’re not sure, leave it blank. Deborah will fill in the rest from the jail and court records.
Offense (if known)
Bail Amount $
Defendant's Employment Information

Where do you work now? If you’re not working, type Unemployed in the Employer box and N/A in the rest. Include your previous job if you’ve been at your current one less than a year.
Present Occupation(s)
Previous Occupation
Employer
Shift
How Long (Current Employment)
Employer Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Job Title
Employer Phone
Please enter a valid phone number.Format: (000) 000-0000.
Previous Employer
How Long (Previous Employment)
Union
Local #
Defendant's Spouse's Information

If you’re married or have a live-in partner, tell us about them. If not, type N/A in the Spouse Name box and leave the rest blank.
Are you married?
Spouse Full Name

First NameMiddle NameLast Name
Spouse Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Spouse Social Security No.
Maiden Name
Spouse Occupation(s)
Spouse Employer
Spouse Shift
Spouse How Long (Employment)
Spouse Employer Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Spouse Job Title
Spouse Employer Phone
Please enter a valid phone number.Format: (000) 000-0000.
Defendant's Children's Information

List your children, if you have any. If you have no children, type N/A in Child 1’s name and leave the rest blank. If you have more than 3, list the others in the “Additional Information” box or tell Deborah.
Child 1 Name

First NameMiddle NameLast Name
Child 1 Age
Child 1 Address, City, State, Zip
Child 1 School / Employer
Child 1 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Child 2 Name

First NameMiddle NameLast Name
Child 2 Age
Child 2 Address, City, State, Zip
Child 2 School / Employer
Child 2 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Child 3 Name

First NameMiddle NameLast Name
Child 3 Age
Child 3 Address, City, State, Zip
Child 3 School / Employer
Child 3 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Defendant's Vehicle / License / Criminal / Financial Details

Tell us about your vehicle, driver’s license, any past arrests, and your credit cards. No vehicle or license? Type N/A in all boxes. Be honest about past arrests/probation. False answers can cancel your bond. For credit cards, enter only the last 4 digits, never the full card number. Card payments are taken by phone.
Auto Year
Make
Model
Color
License Plate #
State (License Plate)
Amount Owed $ (Vehicle)
Lien Holder
Insurance Agent & Company
Driver's License #
Driver's License State
Previous Arrests For
Previous Arrests - Where
On Probation / Parole
On Probation / Parole - Where
Probation / Parole Officer
Credit Card Company 1
Credit Card 1 - Last 4 Digits Only
Credit Card Company 2
Credit Card 2 - Last 4 Digits Only
Defendant's Attorney and Family / Emergency Contacts

Attorney: If you have a lawyer, list them. If you don’t have one yet or have a public defender, type Public Defender or N/A. Family & Contacts: list people who can reach you if we can’t. Give a working phone number for each. If a person doesn’t apply, for example, you have no siblings or ex-spouse, type N/A in the boxes.
Attorney
Attorney Address
Attorney Phone
Please enter a valid phone number.Format: (000) 000-0000.
Defendant's Mother - Name

First NameMiddle NameLast Name
Mother - Address, City, State, Zip
Mother - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Father - Name

First NameMiddle NameLast Name
Defendant's Father - Address, City, State, Zip
Father - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Defendant's Sibling 1 - Name

First NameMiddle NameLast Name
Sibling 1 - Address, City, State, Zip
Sibling 1 - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Sibling 2 - Name

First NameMiddle NameLast Name
Sibling 2 - Address, City, State, Zip
Sibling 2 - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Sibling 3 - Name

First NameMiddle NameLast Name
Sibling 3 - Address, City, State, Zip
Sibling 3 - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Sibling 4 - Name

First NameMiddle NameLast Name
Sibling 4 - Address, City, State, Zip
Sibling 4 - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Defendant's Mother-in-Law - Name

First NameMiddle NameLast Name
Mother-in-Law - Address, City, State, Zip
Mother-in-Law - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Defendant's Father-in-Law - Name

First NameMiddle NameLast Name
Father-in-Law - Address, City, State, Zip
Father-in-Law - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Defendant's Grandparent - Name

First NameMiddle NameLast Name
Grandparent - Address, City, State, Zip
Grandparent - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Defendant's Best Friend - Name

First NameMiddle NameLast Name
Best Friend - Address, City, State, Zip
Best Friend - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Ex-Spouse - Name

First NameMiddle NameLast Name
Ex-Spouse - Address, City, State, Zip
Ex-Spouse - Phone
Please enter a valid phone number.Format: (000) 000-0000.
D0: Bail Bond Application and Agreement

Please read before signing. This is your agreement with Financial Casualty & Surety, the insurance company backing your bond. In short: • You must stay in touch, keep your address and phone number current, and go to every court date. • If you leave the area without permission, get arrested again, or give false information, your bond can be revoked, and you can be returned to jail. • You agree we can check your records to verify your information. Questions? Call Deborah at (775) 385-2200 before you sign.
TERMS & CONDITIONS OF FINANCIAL CASUALTY & SURETY, INC.

Financial Casualty & Surety, Inc. • P.O. Box 4479, Houston, TX 77210 •

877-737-2245 (toll free) • 713-351-8401 (fax)

I have read and explained to me and understand the following terms and conditions of Financial Casualty and Surety Inc., hereafter called Financial Casualty, executing the above-listed surety bail bond (s) on my behalf.

1. Financial Casualty shall have control and jurisdiction over me during the term of which my bail bond is executed and shall have the right to apprehend and surrender me to the proper officials at any time for violation of my bail bond obligations to the Courts and Financial Casualty as provided by law.

2. It is understood and agreed that any one of the following actions by me shall constitute a breach of my obligations to Financial Casualty and that Financial Casualty and/or its agent shall have the right to forthwith apprehend and surrender me in exoneration of my bail bond.

a. If I depart the jurisdiction of the Court without the written consent of the Court, or Financial Casualty or its agent.

b. If I move from one address to another or change my phone number without notifying Financial Casualty or its agent.

c. If I commit any act that shall constitute reasonable evidence of my intention to cause a forfeiture of my bail bond.

d. If I am arrested and incarcerated for any offence other than a minor traffic violation.

e. If I make any false statements in my surety bail bond application and agreement with financial casualty.

3. If I depart the jurisdiction of the Court where my bail bond is posted by Financial Casualty for any reason. I am captured by Financial Casualty and/or its agent, or any law enforcement agency, in a state other than the one where my bail bond is posted. I hereby agree to return to the state of our original jurisdiction voluntarily. I hereby waive extradition proceedings and further consent to applying such reasonable force as may be necessary to effect such return.

4. I hereby waive any and all rights I may have under Title 29, Privacy Act, Freedom of Information Act, Title 6, Fair Credit Reporting Act, and any such local or state law. I consent to an authorize financial casualty and/or its agent to obtain any and all private or public information and/or records concerning me from any party or agency, private or governmental local state federal, including but not limited to Social Security records, criminal records, civil records, driving records, telephone records, medical records, school records, workmen's compensation records, and employment records. I authorize without reservation any party or agency, private or governmental, local, state, or federal, contacted by Financial Casualty, and/or its agent to furnish any and all private and public information and records in their possession concerning me to Financial Casualty, and/or its agent.
Defendant's Signature
Defendant's Printed Name

First NameMiddle NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Copy Received (Initials)
D1: Defendant Rules & Check-In

Save our number now: (775) 385-2200. You’ll text it every week to check in.
Under your bail bond agreement, you must follow the rules below to stay on bond with 911 Bail Bonds. Initial next to each rule.
Rule 1: Report in person to 911 Bail Bonds, 531 Court Street, Elko, within 24 hours of release. Bring photo identification.
Initials for Rule 1
Rule 2: Check in every week by texting "[Your Full Name], checking in" to (775) 385-2200 on the day written below.
Today's Day of the Week - This Shall be YOUR Weekly Check-In Day. (Example: if today is Wednesday, you check in every Wednesday.)
Initials for Rule 2
Rule 3: Text (775) 385-2200 within 24 hours of any change to your employment, phone number, or home address.
Initials for Rule 3
Rule 4: Before leaving Nevada, text (775) 385-2200 your destination city and state and your return date. You must also have any permission required by the Court.
Initials for Rule 4
Rule 5: If you miss a court date, call us immediately so we can help you get back on the court calendar and out of warrant status.
Initials for Rule 5
Failure to follow these rules is a violation of your bail bond agreement and may result in revocation of your bond and your surrender to custody.
Defendant Signature
Defendant Printed Name

First NameMiddle NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Important Contacts

Elko Township Justice Court, 571 Idaho Street, Elko, (775) 738-8403. Call to find your next court date. You will pass through a metal detector, so leave metal objects at home.

Fourth Judicial District Court (felony cases), 571 Idaho Street, Elko, (775) 753-4601. If your case is bound over to District Court, call here for your court date.

Elko County Public Defender, 569 Court Street, Elko, (775) 738-2521. Call to find out who your public defender (your lawyer) is. Across the street from the courthouse.

911 Bail Bonds, 531 Court Street, Elko, (775) 385-2200. Need a ride to court? Call us to arrange a free ride.* (*Rides available within 25 miles of the Elko Justice Court.)
Copy Received (Initials)
D2: Authorization to Release Information

Please read before signing. This form lets 911 Bail Bonds and the insurance company check the information you gave us. If you miss court, it also lets us locate you. It stays in effect until your bond is closed by the court.
I, the Defendant named above, authorize any person, company, agency, or organization to release records and information about me to 911 Bail Bonds, Inc. and Financial Casualty & Surety, Inc., their agents and representatives, and the law enforcement agencies and attorneys assisting them (together, the "Recipients").

1. Purpose: This information will be used to verify the statements in my bail bond application and, if I fail to appear or otherwise breach my bail bond obligations, to locate me and my associates.

2. Records Covered: Bank and other financial institution statements and account information; tax records; postal and billing records (utilities, telephone, etc.); military records; credit card records; court records; criminal history records; employment and employment benefit records; Social Security records; and medical and dental records, limited to the information needed to locate me (such as dates and places of treatment and contact information).

3. Duration and Right to Revoke: This authorization remains in effect until my bail bond is exonerated by the Court and all of my obligations under my bail bond agreement are satisfied. I may revoke it at any time by written notice delivered to 911 Bail Bonds, Inc., except to the extent action has already been taken in reliance on it.

4. Acknowledgments:

• Information released under this authorization may be re-disclosed by the Recipients and may no longer be protected by federal or state privacy laws.

• No health care provider may condition my treatment, payment, enrollment, or eligibility for benefits on whether I sign this authorization.

• I release from civil liability any person or organization that releases information in good-faith reliance on this authorization.

• If I do not meet my obligations to the Court, the Recipients may pursue the remedies available under my bail bond agreement and Nevada law, including seeking a court judgment against me.

• A photocopy, fax, or electronic copy of this authorization is as valid as the original.
Defendant Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Defendant Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Copy Received Initials
D3: Defendant & Indemnitor Agreement (Nevada)

Please read each section and initial the “Defendant” box. If your co-signer’s initial boxes appear, leave them blank. Your co-signer signs their part separately. Key points: the premium is not refundable once the bond is posted, you must go to every court date, and you and your co-signer can be responsible for costs if you don’t.
This Agreement is between 911 Bail Bonds, Inc. ("911 Bail Bonds"), the Defendant, and the Indemnitor (Co-Signer) (if applicable) named below, in connection with the bail bond written through Financial Casualty & Surety, Inc. Defendant must initial every section where indicated.
Defendant Name

First NameMiddle NameLast Name
Indemnitor (Co-Signer) Name (if applicable)

First NameMiddle NameLast Name
Bond Amount $
1. Premium

The premium is charged as authorized by NRS 697.300 and is fully earned when the bond is posted. It is not refunded because the case is dismissed, the Defendant pleads or is sentenced, or the bond is later exonerated or revoked. The only exception is NRS 697.330: if 911 Bail Bonds surrenders the Defendant before the scheduled appearance without good cause, the premium will be returned in full.
Section 1 - Defendant Initials (Premium)
2. Indemnitor Liability

The Indemnitor guarantees the Defendant's appearance and agrees to pay any amount that 911 Bail Bonds or the surety must pay because of a forfeiture of the bond, plus the expenses permitted by NRS 697.300(1)(c) and (d). This obligation is continuous and cannot be withdrawn unless:

• (a) the Defendant is surrendered to custody and the bond is exonerated; or

• (b) 911 Bail Bonds accepts a substitute Indemnitor in writing.
Section 2 - Defendant Initials (Indemnitor Liability)
3. Collateral

Collateral will be receipted in writing, held in a fiduciary capacity, and kept separate from 911 Bail Bonds' own funds (NRS 697.320; NAC 697.460). It will be returned to the person who deposited it once the bond is exonerated by the Court and the obligations under this Agreement are discharged. If the bond is forfeited, the collateral may be applied to the forfeiture and allowable expenses, and any excess will be returned.

If collateral is a vehicle title, the Indemnitor agrees that:

• The title is signed over and held by 911 Bail Bonds as security.

• If the bond is forfeited and the forfeiture is not set aside, the Indemnitor will deliver the vehicle to 911 Bail Bonds on request so it can be sold to satisfy the forfeiture and allowable expenses. Any excess will be returned to the Indemnitor.

• If the Indemnitor keeps possession of the vehicle, the Indemnitor will provide a spare key and proof of insurance listing 911 Bail Bonds, Inc. as lienholder.
Section 3 - Defendant Initials (Collateral)
4. Surrender of the Defendant

911 Bail Bonds may surrender the Defendant to custody before the scheduled appearance only for good cause, as provided in NAC 697.550. Good cause includes, but is not limited to:

• Credible information that the Defendant intends not to appear in court;

• Materially false information in the Defendant's application;

• An increase in bail by the Court beyond 911 Bail Bonds' underwriting criteria;

• A material change in the collateral posted, including collateral withdrawn or lost because of the Indemnitor's default;

• A change of address or phone number without reasonable notice to 911 Bail Bonds;

• A new crime, other than a minor traffic violation, committed while on bail;

• Failure to appear in court at the appointed time; or

• A finding of guilt by a court of competent jurisdiction.

Failure to report or check in as required by the Defendant Rules (Form 911-D1) may be treated as information that the Defendant intends not to appear. If the Defendant is surrendered early, 911 Bail Bonds will file the notice required by NAC 697.550(3).
Section 4 - Defendant Initials (Surrender of the Defendant)
5. Remedies on Default

If the Defendant or the Indemnitor defaults under this Agreement, 911 Bail Bonds may pursue collection through the courts, including a judgment and any liens allowed by law after judgment.
Section 5 - Defendant Initials (Remedies on Default)
6. Costs

If the bond is forfeited or the Defendant is surrendered for good cause, the Defendant and the Indemnitor are each responsible for the actual, reasonable expenses allowed by NRS 697.300(1)(c) and (d), including apprehension, transportation, and court costs. In any action to enforce this Agreement, 911 Bail Bonds may recover its reasonable attorney's fees and costs.
Section 6 - Defendant Initials (Costs)
7. Governing Law and Venue

This Agreement is governed by Nevada law. Any dispute will be heard in a court of competent jurisdiction in Elko County, Nevada.
Section 7 - Defendant Initials (Governing Law and Venue)
8. Copies

Each signer acknowledges receiving a copy of this Agreement (NAC 697.450; NAC 697.470).
Section 8 - Defendant Initials (Copies)
Defendant Signature (Agreement)
Defendant Printed Name (Agreement)

First NameMiddle NameLast Name
Defendant Phone (Agreement)
Please enter a valid phone number.Format: (000) 000-0000.
Date (Defendant Signature - Agreement)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

911 Bail Bonds - Defendant's Forms

Defendant's Personal Information

Offense / Bond Information

Defendant's Employment Information

Defendant's Spouse's Information

Defendant's Children's Information

Defendant's Vehicle / License / Criminal / Financial Details

Defendant's Attorney and Family / Emergency Contacts

D0: Bail Bond Application and Agreement

D1: Defendant Rules & Check-In

D2: Authorization to Release Information

D3: Defendant & Indemnitor Agreement (Nevada)