SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE
JUSTICE CENTER:
G Central - 700 Civic Center Dr. West, Santa Ana, CA 92701
G Harbor-Newport Beach Facility - 4601 Jamboree Rd., Newport Beach, CA 92660
G Lamoreaux - 341 The City Drive, Orange, CA 92868
G North - 1275 N. Berkeley Ave., Fullerton, CA 92835
G West - 8141 13th Street, Westminster, CA 92683
G
FOR COURT USE ONLY
PEOPLE OF THE STATE OF CALIFORNIA
VS.
DEFENDANT:
AUTHORIZATION TO APPLY THIRD PARTY BAIL
CASE NUMBER:
TO THE CLERK OF THE COURT:
I, __________________________________, hereby authorize the cash bail deposited by me on ________________ to be
applied toward the payment of any fine imposed against defendant, ______________________________________, in the
above named case and the balance of the deposit, if any, returned to:
Name: __________________________________________
Address: ________________________________________
City, State:_______________________________________
Date: _____________________ _______________________________________
Signature of Depositor
.................................................................................................................................................................
(To be completed by the Deputy Sheriff/Clerk)
I have witnessed the signature and examined the following legal photo identification G Driver License #________________________ ;
G DMV Identification Card # ___________________________; G Other (specify): # ______________________________________ .
G DON BARNES, Sheriff-Coroner G DAVID H. YAMASAKI, Clerk of the Court
Date: By: By:
Deputy Deputy Clerk
IF THIS FORM IS RETURNED TO COURT BY MAIL, IT MUST BE NOTARIZED
State of _________________________________
County of ________________________________
On ___________________________________, before me,
________________________________________________
the undersigned Notary Public, personally appeared
________________________________________________
personally known to me (or proved to me on the basis of satisfactory evidence) to be the
person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me
that he/she/they executed the same in his/her/their authorized capacity(ies), and that by
his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which
the person(s), acted, executed the instrument.
WITNESS my hand and official seal
_______________________________________________
Notary's Signature
AUTHORIZATION TO APPLY THIRD PARTY BAIL
L-1191 (Rev. 02/26/2019)
Form Adopted for Mandatory Use
