Licensing Section
Arizona Department of Insurance
100 North 15
th
Avenue, Suite 102, Phoenix, Arizona 85007-2624
Phone: (602) 364-4457 | Toll-free: (877) 660-0964
Web: https://insurance.az.gov | E-mail: Licensing@azinsurance.gov
Form L-BBAA (Rev. 20180618)
FORM L-BBAA: BAIL BOND AGENT AFFFIDAVIT OF RESIDENCY
Arizona Revised Statutes § 20-340.01(A) requires each applicant for a bail bond agent license to
submit an affidavit attesting to the applicant’s residency in Arizona for at least one year immediately
preceding the date of the application. Each individual applying for a bail bond agent license must
submit a completed and notarized version of this form with the license application.
State of Arizona )
) ss.
County of Maricopa )
I, _______________________________________________________________, declare
(Print your full name)
under penalty of perjury that the following statements are true and correct to the best of my
knowledge, information and belief:
1. I have resided in the State of Arizona for at least one year immediately preceding the
execution date of this affidavit.
2. I understand that falsification of this affidavit may result in an administrative action,
including denial, suspension or revocation, of my license.
DATED this day of , 20____.
Bail Bond Agent Applicant Signature
SUBSCRIBED AND SWORN TO before me this _____ day of ________________, 20____.
My Commission Expires:
NOTARY PUBLIC
