CAUSE NO._____________________
BOOKING NO.__________________
______________________________
OFFENSE:______________________
Defendant’s D.O.B ______________
Full Name of Defendant(Principal)____________________
AFFIDAVIT OF SURETY TO SURRENDER
TO THE PRESIDING JUDGE OF SAID COURT:
Before me, the undersigned authority, on this day personally appeared ___________________________
d/b/a_______________________________, who being duly sworn according to law, on oath states:
My name is__________________________ licensed agent of ____________________________(insert
insurance company’s name). I am of sound mind and capable of making this affidavit. I am personally acquainted
with the facts stated in this Affidavit and they are true and correct of my own personal knowledge.
By filing this Affidavit, along with the Motion to which it is attached, it is my intention to surrender the
principal named above.
Date of the Bond ______________ and Amount of the Bond Is: $ ____________.
The reason for the intended surrender is:
____ The defendant is incarcerated in _____________ County, Texas; or
____ The defendant is incarcerated in Federal custody at the following location _______________; or
____ The defendant is incarcerated in the custody of the State of _________. Location __________; or
____ The defendant is deceased; or
____ The defendant’s co-signor to the bond has requested to withdraw from the bond; or
____ Other (show cause may be required)___________________________________________.
As required by the Texas Occupations Code Section 1704.207 notice of bondsman intention to surrender has
been given to the defendant’s attorney in the manner as provided by rule 21a, Texas Rules of Civil
Procedure._____________ (Agent’s Initials)
Attorney’s Name: ____________________________________________________________________
X __________________________________
__________________________________
(PRINTED NAME OF AGENT)
SUBSCRIBED AND SWORN TO BE BEFORE ME by _______________________________, on this the _____
day of _______________________________, 20__.
______________________________ Notary Public, State of Texas