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FINANCIAL CASUALTY & SURETY, INC.

DISCLOSURE STATEMENT

Bail Agency

Address:

Bail Bondsman:

Bond Number(s):

Bond Amount:

Defendant:

ATTENTION

DISCLOSURE OF LIEN AGAINST REAL PROPERTY. DO NOT SIGN THIS DOCUMENT UNTIL YOU READ AND UNDERSTAND IT!

THIS BAIL BOND WILL BE SECURED BY REAL PROPERTY YOU OWN OR IN WHICH YOU HAVE AN INTEREST. THE FAILURE TO PAY THE BAIL BOND PREMIUMS WHEN DUE OR THE FAILURE OF THE DEFENDANT TO COMPLY WITH THE CONDITIONS OF THE BAIL COULD RESULT IN THE LOSS OF YOUR PROPERTY!

After you have read the above Disclosure Statement and received a completed copy of the Bail Bond Agreement and the Mortgage Deed and/or Mortgage Agreement, please execute this Disclosure Statement in the space provided below, acknowledging that you have read and understood this Disclosure Statement and that you have received a completed copy of the Bail Bond Agreement and the Mortgage Deed and/or Mortgage Agreement. You will be asked to execute this document again, in the corresponding space provided below, upon delivery to you of a full Satisfaction of Mortgage, which, upon recordation terminates the lien on your real property created by the Mortgage Deed and/or Mortgage agreement.

I HAVE READ AND UNDERSTAND THE ABOVE DISCLOSURE STATEMENT AND HAVE RECEIVED A COMPLETED COPY OF THE BAIL BOND AGREEMENT AND MORTGAGE DEED AND/OR MORTGAGE AGREEMENT.

Print Name A.)

Sign Name A.)

Date

Print Name B.)

Sign Name B.)

Date

I HAVE RECEIVED A SATISFACTION OF MORTGAGE, A CERTIFICATE OF DISCHARGE, OR A FULL RELEASE OF ANY LIEN AGAINST REAL PROPERTY TO SECURE PERFORMANCE OF THE CONDITIONS OF THE BAIL BOND.

Print Name A.)

Sign Name A.)

Date

Print Name B.)

Sign Name B.)

Date

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