Fillable - Original Bondsman Packet Revised Dko (16th Circuit Court of Jackson County, Missouri)

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- Original Bondsman Packet Revised Dko (16th Circuit Court of Jackson County, Missouri)

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LIST OF FORMS AND DOCUMENTS REQUIRED IN
BAIL BONDING QUALIFICATION PACKETS
ITEM
NO. PROPERTY QUALIFIED
SUGGESTED
FORM PAGE
NUMBER INSURANCE QUALIFIED
SUGGESTED
FORM PAGE
NUMBER
1
GENERAL AFFIDAVIT OF QUALIFICATIONS OF BONDSMEN 1 - 4 GENERAL AFFIDAVIT OF QUALIFICATION OF BONDSMEN 5 - 7
2
AFFIDAVIT OF GENERAL BAIL BOND AGENT 8
3
POWER OF ATTORNEY AND AUTHORIZATION TO EXECUTE… 9 - 10
4
BAIL BOND AGENT AFFIDAVIT OF QUALIFICATION 11 - 12
5
CURRENT LICENSE OF GENERAL BAIL BOND AGENT
6
CURRENT LICENSE OF EACH ATTORNEY-IN-FACT
7
CURRENT TITLE OPINION ON EACH REALTY PARCEL
USED TO QUALIFY FROM AN ATTORNEY OR TITLE
COMPANY
QUALIFYING POWER OF ATTORNEY TO GENERAL BAIL
BOND AGENT FROM SURETY INSURANCE COMPANY
8
CURRENT STATEMENT FROM COUNTY APPRAISER
SHOWING APPRAISED OR FAIR MARKET VALUE AND
SHOWING ASSESSED VALUE OF EACH REALTY PARCEL
USED TO QUALIFY
QUALIFYING POWER OF ATTORNEY TO EACH ATTORNEY-
IN-FACT FROM SURETY INSTURANCE COMPANY
9
PROOF OF TITLE AND AMOUNT OF ANY CASH OR STOCK
ACCOUNTS USED TO QUALIFY DATED WITHIN 30 DAYS
OF SUBMISSION
MISSOURI CERTIFICATE OF AUTHORITY ISSUED TO
INSURER FOR THE WRITING OF SURETY INSURANCE IN
THE STATE
10
POWER OF ATTORNEY FROM SPOUSE TO ANY JOINT
ASSETS USED; IF REALTY, THE POWER MUST BE
RECORDED ON THE PROPERTY RECORDS OF EACH
COUNTY WHEREIN THE REALTY LIES; IF CASH OR
EQUIVALENT ACCOUNTS, ACKNOWLEDGEMENT OF THE
POWER OF ATTORNEY FROM EACH BANK, CREDIT
UNION, OR FINANCIAL INSTITUTION.
13 - 14
CURRENT AUDITED FINANCIAL STATEMENT FROM
SURETY INSURER
11
LIST OF ALL MISSOURI AND FEDERAL BAIL BONDS WRITTEN AND OUTSTANDING WITH THE DETAIL CONTAINED ON THE SUGGESTED
FORM. IF THIS LISTING IS MORE THAN ONE PAGE, EACH PAGE MUST HAVE A SUBTOTAL. A TOTAL MUST APPEAR AT THE END OF THE
REPORT. 15
2
GENERAL AFFIDAVIT OF QUALIFICATION OF GENERAL BAIL BONDSMEN
(Property Qualified)
STATE OF MISSOURI )
) ss.
COUNTY OF )
IN THE 16
th
JUDICIAL CIRCUIT COURT
WITHIN AND FOR THE SAID COUNTY OF JACKSON
I, _____________________________________, being desirous from time to time of
signing various bail bonds in this court during the month next following the filing of this
affidavit and questionnaire, do hereby upon my oath state that I have read over and
have carefully answered each of the questions in the following questionnaire, and that
the answers to the same are true, and that I have made the same for the purpose of
establishing my qualification to sign such bonds; and that I have, in addition to signing
and swearing of this affidavit, affixed my signature at the end of the questionnaire for
the purpose of identification and to guarantee the genuineness and truthfulness
thereof.
Initial one only:
_____ Individual
_____ Corporate Offic
er
_____ LLC Owner or Manager
_____ Partner
By: ____________________________________
Subscribed and sworn to before me this day of ,20 .
Notary Public
(SEAL) My Commission Expires:
3
PROPERTY QUALIFIED QUESTIONNAIRE
16
th
JUDICIAL CIRCUIT COURT OF JACKSON COUNTY, MISSOURI
1. State your name: _________________________________
2. Age: ________
3. Company/Corporation you work for:
Self
Name of Corporation/LLC: ______________________________
Partnership Name: ____________________________________
4. Marital status:
Married
Divorced
Single
5. If married or separated, state name of your spouse: ________________________
6. Present residential address: ___________________________________________
7. Length of time you have lived at your current residential address: ________
8. Address immediately prior to moving to your present address: ________________
_____________________________________________________________________________
9. Have you ever been convicted of a criminal offense in the Courts of this or any
other State or territory of the United States or of any foreign country (conviction of
violations of municipal ordinances not included)? Yes __ or No __
10. Are you an attorney at law, duly admitted to the practice of law by the Supreme
Court of Missouri? Yes __ or No __
11. If you have ever been so licensed, has your license ever been suspended or have
you been disbarred from the practice of law? Yes __ or No __
12. Are you a party upon any bail bond in any Court of this or any State or any territory
of the United States, which after being forfeited, remain unpaid or unsatisfied? Yes __ or
No __
13. Have you written any bail bond as the agent of any surety in any Court of this state
or any other State or territory of the United States, which after being forfeited, remains
unpaid or unsatisfied? Yes __ or No __
4
14. Have you acted as a director, officer, or shareholder of any company or corporate
surety which posed a bail bond in any Court of this State or any other State or territory o
the United States, where the bond, after being forfeited, remains unpaid or unsatisfied?
Yes __ or No __
15. List here an inventory of all real estate of which you are the sole legal and
equitable owner:
**NOTE: Do not list any property in which you or your spouse own as tenants by
the entirety or joint tenants, and do not list any property in which you own only a
life estate or remainder.**
Tract One:
A. Legal Description: ________________________________________________
B. City, zone, street, and street number: _________________________________
C. Description of all improvements thereon: ______________________________
D. Appraised (fair market) valuation at last County assessment: $_____________
E. Assessed valuation at the last assessment: $___________________________
F. Any encumbrances with amounts and names of persons holding the same
(mortgages, mechanics’ liens, tax liens, and other liens): __________________
_______________________________________________________________
Tract Two:
A. Legal Description: ________________________________________________
B. City, zone, street, and street number: _________________________________
C. Description of all improvements thereon: ______________________________
D. Appraised (fair market) valuation at last County assessment: $_____________
E. Assessed valuation at the last assessment: $___________________________
F. Any encumbrances with amounts and names of persons holding the same
(mortgages, mechanics’ liens, tax liens, and other liens): __________________
_______________________________________________________________
Tract Three:
A. Legal Description: ________________________________________________
B. City, zone, street, and street number: _________________________________
C. Description of all improvements thereon: ______________________________
D. Appraised (fair market) valuation at last County assessment: $_____________
5
E. Assessed valuation at the last assessment: $___________________________
F. Any encumbrances with amounts and names of persons holding the same
(mortgages, mechanics’ liens, tax liens, and other liens):__________________
_______________________________________________________________
Tract Four:
A. Legal Description: ________________________________________________
B. City, zone, street, and street number: _________________________________
C. Description of all improvements thereon: ______________________________
D. Appraised (fair market) valuation at last County assessment: $_____________
E. Assessed valuation at the last assessment: $___________________________
F. Any encumbrances with amounts and names of persons holding the same
(mortgages, mechanics’ liens, tax liens, and other liens): __________________
_______________________________________________________________
*(If there is insufficient space for all of your real estate held, give the same
information as to additional tracts on an attached separate sheet of paper.)
16. If any of the above real estate is subject to a lease for longer than two years, state
the name of the lessee, term of the lease, and the rental amount: ___________________
_______________________________________________________________________
17. Provide an inventory of cash assets or those assets equivalent to cash: ________
_______________________________________________________________________
18. If any of the above listed personal property is subject to any encumbrances or
liens, state the nature and amount of the same and by whom held: __________________
_______________________________________________________________________
19. Has any federal tax lien been filed against you? Yes __ or No __
20. Provide the approximate amount of your outstanding debts, other than those listed
above: $_____________________________
21. List all bail bonds upon which you are surety and which are now outstanding,
specifying separately the amount of each bond, the name of the defendant, the offense
with which he is charged, the court in which the prosecution against him is pending, and
the name of the attorney-in-fact writing the bond. This list may be attached and
incorporated by reference but you are certifying to this Court by executing this affidavit
that the list is accurate and complete and that the total of these bonds is $____________.
6
22. State whether or not you or anyone on your behalf has received or has been
promised any consideration or security for the suretyship herein, and, if so, the nature
and amount thereof and the name of the person or persons by whom such promise was
made or from whom such security or consideration was received: ___________________
_______________________________________________________________________
I affix my signature at the end of this questionnaire for the purpose of identification
and to guarantee the genuineness and truthfulness thereof.
Initial one only:
_____ Individual
_____ Corporate Officer
_____ LLC Owner or Manager
_____ Partner
By: ____________________________________
7
GENERAL AFFIDAVIT OF QUALIFICATION OF GENERAL BAIL BONDSMEN
(Insurance Qualified)
STATE OF MISSOURI )
) ss.
COUNTY OF )
IN THE 16
th
JUDICIAL CIRCUIT COURT
WITHIN AND FOR THE SAID COUNTY OF JACKSON
I, _____________________________________, being desirous from time to time of
signing various bail bonds in this court during the month next following the filing of this
affidavit and questionnaire, do hereby upon my oath state that I have read over and
have carefully answered each of the questions in the following questionnaire, and that
the answers to the same are true, and that I have made the same for the purpose of
establishing my qualification to sign such bonds; and that I have, in addition to signing
and swearing of this affidavit, affixed my signature at the end of the questionnaire for
the purpose of identification and to guarantee the genuineness and truthfulness
thereof.
Initial one only:
_____ Individual
_____ Corporate Offic
er
_____ LLC Owner or Manager
_____ Partner
By: ____________________________________
Subscribed and sworn to before me this day of ,20 .
Notary Public
(SEAL) My Commission Expires:
8
INSURANCE QUALIFIED QUESTIONNAIRE
16
th
JUDICIAL CIRCUIT COURT OF JACKSON COUNTY, MISSOURI
1. State your name: _________________________________
2. Age: ________
3. Company/Corporation you work for:
Self
Name of Corporation/LLC: ______________________________
Partnership Name: ____________________________________
4. Marital status:
Married
Divorced
Single
5. If married or separated, state name of your spouse: ________________________
6. Present residential address: ___________________________________________
7. Length of time you have lived at your current residential address: ________
8. Address immediately prior to moving to your present address: ________________
_____________________________________________________________________________
9. Have you ever been convicted of a criminal offense in the Courts of this or any
other State or territory of the United States or of any foreign country (conviction of
violations of municipal ordinances not included)? Yes __ or No __
10. Are you an attorney at law, duly admitted to the practice of law by the Supreme
Court of Missouri? Yes __ or No __
11. If you have ever been so licensed, has your license ever been suspended or have
you been disbarred from the practice of law? Yes __ or No __
12. Are you a party upon any bail bond in any Court of this or any State or any territory
of the United States, which after being forfeited, remain unpaid or unsatisfied? Yes __ or
No __
13. Have you written any bail bond as the agent of any surety in any Court of this state
or any other State or territory of the United States, which after being forfeited, remains
unpaid or unsatisfied? Yes __ or No __
9
14. Have you acted as a director, officer, or shareholder of any company or corporate
surety which posed a bail bond in any Court of this State or any other State or territory o
the United States, where the bond, after being forfeited, remains unpaid or unsatisfied?
Yes __ or No __
15. Has any federal tax lien been filed against you? Yes __ or No __
16. Provide the approximate amount of your outstanding debts: $________________
17. List all bail bonds upon which you are surety and which are now outstanding,
specifying separately the amount of each bond, the name of the defendant, the offense
with which he is charged, the court in which the prosecution against him is pending, and
the name of the attorney-in-fact writing the bond. This list may be attached and
incorporated by reference but you are certifying to this Court by executing this affidavit
that the list is accurate and complete and that the total of these bonds is
$________________.
18. State whether or not you or anyone on your behalf has received or has been
promised any consideration or security for the suretyship herein, and, if so, the nature
and amount thereof and the name of the person or persons by whom such promise was
made or from whom such security or consideration was received: __________________
______________________________________________________________________
**Attach a true copy of the State of Missouri’s authorization to the corporation,
association or company named above to issue surety insurance and a true copy
of the qualifying power of attorney issued to the general bail bondsman and to
each of the attorneys-in-fact by the surety insurer.**
I affix my signature at the end of this questionnaire for the purpose of identification
and to guarantee the genuineness and truthfulness thereof.
Initial one only:
_____ Individual
_____ Corporate Officer
_____ LLC Owner or Manager
_____ Partner
By: ____________________________________
10
AFFIDAVIT OF GENERAL BAIL BOND AGENT
STATE OF MISSOURI )
) ss.
COUNTY OF )
The individual who signs below is either the General Bail Bond Agent, or a
specified officer of a corporate General Bail Bond Agent with full authority to act
for the corporation, or a partner in a partnership which has been granted a
General Bail Bond Agent’s license, or the owner or manager of a limited liability
company. Except as listed below, there are no outstanding bail bond forfeitures
or unsatisfied judgments thereon entered in any court in this State or of the
United States where the undersigned or any of the undersigned’s agents or
employees:
posted the bond as surety;
wrote the bond as agent of this or any other surety; or
where the surety was a company or corporation, acted as director, officer or
stockholder of that surety.
_____________________________________
[Print Name of General Bail Bond Agent]
Initial one only:
_____ Individual
_____ Corporate Officer
_____ LLC Owner or Manager
_____ Partner
By: ____________________________________
Subscribed and sworn to before me this day of ,20 .
(SEAL) Notary Public
My Commission Expires:
11
POWER OF ATTORNEY
AND
AUTHORIZATION TO EXECUTE CERTAIN DOCUMENTS
The General Bail Bond Agent named below, does appoint each Bail Bond Agent listed
in Section II of this instrument as an attorney-in-fact of the General Bail Bond Agent to sign bail
bonds in the name of the General Bail Bond Agent in judicial proceedings in all Divisions of the
Sixteenth Judicial Circuit (Jackson County) of the State of Missouri and, further, to sign in the
name of the General Bail Bond Agent the Special Affidavit of Qualification of General Bail Bond
Agent which is required with each bail bond, and authorizes each listed Bail Bond Agent to do
so.
The General Bail Bond Agent acknowledges that each Bail Bond Agent listed
alphabetically in Section 2 is an agent of the General Bail Bond Agent and any knowledge of
that Bail Bond Agent with respect to forfeitures and unsatisfied judgments thereon entered upon
any bail bond in any Court of this state or of the United States will be imputed to the General
Bail Bond Agent.
This power of attorney and authorization is granted to gain Circuit Court approval of the
application of the General Bail Bond Agent named below to sign bail bonds in person or through
employed Bail Bond Agents for approximately one month at a time and may not be revoked
during the time for which approval is granted.
(Print Name of General Bail Bond Agent as Licensed)
Initial one only:
_____ Individual
_____ Corporate Officer
_____ LLC Owner or Manager
_____ Partner
By: ____________________________________
Section 2
Bail Bond Agent (list alphabetically)
Social Security
No.
License Expiration Date:
Attach to this instrument a true copy of the current licenses issued to the General Bail Bond Agent
and to each Bail Bond Agent listed above.
12
STATE OF MISSOURI )
) ss.
COUNTY OF )
On this day of _______________, 20 , before me personally
appeared , to me known
to be the person described in and who executed the Power of Attorney and
Authorization on the reverse side hereof, and acknowledged that he/she executed the
same as his/her free act and deed.
In testimony whereof, I have hereunto set my hand and affixed my official seal in
my office in the County and State aforesaid, on the day and year first above written.
(Seal)
Notary Public
My Commission Expires:
13
BAIL BOND AGENT
AFFIDAVIT OF QUALIFICATIONS
STATE OF MISSOURI )
) ss.
COUNTY OF )
I, , as Attorney-in-Fact for
, licensed to transact the business of
suretyship in the State of Missouri, being desirous from time to time of signing various bail bonds in the
Courts of Jackson County, Missouri, during the month next following the filing of this affidavit do hereby
upon my oath state:
1. My name is .
2. I am reputable and at least 21 years of age.
3. My marital status is . My spouse’s name is
.
4. My current residence address is:
and I have lived at this address since .
5. My prior address was .
6. I have not been convicted of any felony under the laws of any state or of the United States.
7. I am not a lawyer, nor have I ever been licensed and later disbarred or suspended.
8.
I am not an elected or appointed official or employee of the State of Missouri or of any county
or other political subdivision thereof.
9. I am a duly licensed Bail Bond Agent, licensed under the provisions of Sections 374.700 to
374.775 RSMo 1978, and my license has not been suspended nor revoked by the Missouri
Department of Insurance.
10. There are no unsatisfied judgments entered upon any bail bond in any court of this state or of
the United States written by me in the capacity of agent of a surety or against me as
surety or against any company in which I am or was an officer, director or
stockholder, except:
11. I have no unsatisfied judgments against me.
12. I have reviewed the
list of current outstanding bail bonds to be submitted by my general bail
bond agent and acknowledge that the listing accurately shows those bonds written by me
for the surety.
13. I understand that on any and all bonds executed on behalf of my surety, I will show my
surety’s name as it appears on my
14
bail bonding license or be disqualified from acting as surety or surety’s agent on bail
bonds in Jackson County, Missouri for 60 days.
14. I further understand that any outstanding forfeitures or unpaid judgments on bail
bonds written by me will result in my disqualification to act as either a general bail
bond agent or as a bail bond agent for the same or any other general bail bond agent
in Jackson County.
Attorney-In-Fact
Subscribed and sworn to before me this day of ,20__.
Notary Public
My Commission Expires:
MISSOURI AND FEDERAL BAIL BONDS WRITTEN BY SURETY
LIST COMPLETE THROUGH
COURT
CASE NO. DEFENDANT NAME OFFENSE BOND AMT.
ATTORNEY-
IN-FACT
PAGE SUBTOTAL $
PAGE #
15
AFFIDAVIT OF MATERIAL CHANGES
STATE OF MISSOURI )
COUNTY OF )
The individual who signs below is either the General Bail Bond Agent, or a
specified officer of a corporate General Bail Bond Agent with full authority to act for the
corporation, or a partner in a partnership which has been granted a General Bail Bond
Agent’s license, or the owner or manager of a limited liability company.
There have been no material changes in the information submitted in the yearly bond
qualification packet, e.g. changes in the property or other assets used to collateralize
outstanding bonds except as listed below:
[If there are any changes in information previously provided concerning property or other
assets, including changes in the encumbrances or liens against such property or other
assets, the value of the property or other assets, and/or the outstanding debts of the
General Bail Bond Agent, list the changes above. If additional property or other assets
are being provided or are being substituted for property or other assets previously
provided, list the property above and provide the documentation required under the
Procedure for Qualification of Sureties' section 1.G.i.]
___________________________________
[Print Name of General Bail Bond Agent]
Initial one only:
_____ Individual
_____ Corporate Offic
er
_____ LLC Owner or Manager
_____ Partner
By: ____________________________________
Subscribed and sworn to before me this day of , 20 .
(SEAL)
Notary Public
My Commission Expires:
16
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- Original Bondsman Packet Revised Dko (16th Circuit Court of Jackson County, Missouri)

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Completed 11 June 2021

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