CHECK REPLACEMENT INDEMNITY AGREEMENT
On __________________________
, the Alachua County Clerk of Court issued Warrant
No. ___________ in the amount of $____________ payable to ______________________________
and;
The undersigned represents that the Warrant was either not received, or was lost, misplaced or stolen
without being endorsed or negotiated; and
This Indemnity Agreement is entered into to induce the CLERK to enter a written stop payment of the
Warrant and issue a duplicate or replacement warrant.
The undersigned agrees to indemnify the Alachua County Clerk of Court for the full face amount of the
Warrant together with all costs, fees, damages, and expenses that it may incur in the event the CLERK
should be subjected to any claim of any holder of the warrant. By the execution of this Indemnity
Agreement, the undersigned waives any claim for exemption from garnishment or otherwise should
collection procedures become necessary.
Dated ____________________________________.
Signature:
Name:
Title:
STATE OF ____________________
COUNTY OF __________________
The foregoing instrument was acknowledged before me on ____________________________, by
___________________________________.
Name of person acknowledging
_______________________________________
Signature of Notary Public
___ Personally Known OR
___ Produced Identification; Type of Identification Produced _________________________________
ALACHUA COUNTY CLERK OF COURT & COMPTROLLER
Finance and Accounting Department
12 SE 1st Street, Fourth Floor Gainesville, Florida 32601
