860-247-2245 - 800-570-5544

BAIL BOND APPLICATION & CONTRACT DEFENDANT’S INFORMATION SPOUSE/PARTNER/GIRLFRIEND/BOYFRIEND’S INFORMATION

NAME: ________________________________________ NAME: _______________________________

(FIRST) (MIDDLE) (LAST) (FIRST) (MIDDLE) (LAST)

NICKNAME/STREETNAME/ALIAS: ___________________ NICKNAME/STREETNAME/ALIAS: __________

DATE OF BIRTH: _________________ DATE OF BIRTH: _____________

SOCIAL SECURITY NUMBER: ____________________ SOCIAL SECURITY NUMBER: ___________

ADDRESS: _______________________Apt. #________ ADDRESS: ________________APT#______

CITY: ___________________ST: ______ ZIP: ________ CITY: _______________ST: ___ ZIP: ______

PHONE: ____ ___________CELL: ___ ___________ PHONE: ___ ________CELL: ___ ______

E-MAIL: ______________________ E-MAIL: _____________________

EMPLOYER/OCCUPATION: ______________________ EMPLOYER/OCCUPATION: _____________

ADDRESS: ____________________________________ ADDRESS: ___________________________

CITY: ___________________ ST: ______ ZIP: ______ CITY: _______________ST: ____ ZIP: _____

PHONE: ______ _______________________________ PHONE: _____ _______________________

SHIFT/HOURS: ____________ TO ______________ SHIFT/HOURS: ________ TO ____________

DRIVER’S LICENSE OR ID # _____________________STATE____

EYE COLOR: ____________ HAIR: ________________ HEIGHT: ___________ WEIGHT: ___________ RACE: _____ PLACE OF BIRTH: ___________________ MOTHER’S MAIDEN NAME: _____________

SCARS – MARKS - TATTOOS – MENTIONABLES: MOTHER’S DATE OF BIRTH: ___ ___ _____

______________________________________________________________________________________

______________________________________________________________________________________

CHILDREN: AGE: NAME /ADDRESS: SCHOOL/EMPLOYER: PHONE:

________ ______________________ ___________________________ ____________________ ________ ______________________ ___________________________ ____________________ ________ ______________________ ___________________________ ____________________

AUTO YEAR_____ MAKE ___________ MODEL ____________ COLOR _________ PLATE __________

ATTORNEY: ____________ ADDRESS: _____________________________ PHONE: ______________

PREVIOUS CHARGES: ______________________ WHEN: ___ ___ ____ WHERE: _________________

ON PROBATION/PAROLE? WHERE: _________________________ PROB OFF: _______________

REFERENCES (PEOPLE WHO KNOW THE DEFENDANT):

NAME (FIRST & LAST) ADDRESS, CITY, STATE, ZIP PHONE NUMBER RELATION

I declare under penalty of perjury that the above information is the truth to the best of my knowledge.

DEFENDANT’S SIGNATURE_______________________________ DATE_______________ I have read and reviewed the above

Revised 4/2020

Initials

57 Fishfry Street, Hartford CT 06120 15 Arch Street, New Britain CT 06051

Bond Amount $ ______________________Premium Amount $ ______________________Amount Paid $ ______________________Balance Due $ ______________________

Print Form

YOU ARE ASSUMING SPECIFIC OBLIGATIONS - READ CAREFULLY!

THIS AGREEMENT made between the undersigned ______________________________________________________________________ herein after called Indemnitor(s) 3-

D BAIL BONDS, INC. (Hereinafter called the Company).

WITNESSETH:

WHEREAS, the Company has executed, or is about to execute in behalf of and/or at the instance of the Indemnitor(s), the bond or undertaking described in the foregoing

application, upon the security and indemnity herein provided, which application is hereby referred to and made a part of this agreement.

NOW THEREFORE, in consideration of the execution by the

Company of such bond or undertaking, the Indemnitor (s) covenants(s) and agree(s) with the Company as follows:

1. The Indemnitor(s) will pay the Company, or its duly authorized Agent, the premium(s) specified in said application at the times and in the amounts therein stated.

2. The Indemnitor(s) will pay any collection cost(s)and/or fee(s) (including the State(s) maximum legal interest rate) on uncollected premium(s), and/or cost(s) of

apprehension of Defendant should he forfeit his/her bail bond(s), including but not limited to Bail Enforcement, private investigators, confidential informants, travel, and any other

reasonable expenses incurred in relation to the forfeiture including the actual amount to be paid to the State in the event of non-capture.

3. The Indemnitor(s) will at all times indemnify and keep indemnified the Company and save harmless the Company from and against any and all claims, demands,

liabilities, costs, charges, legal fees, disbursements and expenses of every kind and nature, which the Company shall at any time sustain or incur, and as well from all orders,

decrees, judgments and adjudication against the Company by reason or in consequence of having executed such bond or undertaking in behalf of and/or at the instance of the

Indemnitor(s)(or any of them) and will pay over, reimburse and make good to the Company, its successors and assigns, all sums and amounts of money required to meet every

claim, demand, liability, costs, expense, suit, order, decree, payment and/or adjudication against the Company by reason of the execution of such bond or undertaking and any

other bonds or undertakings executed in behalf of and/or at the instance of the Indemnitor(s) and before the Company shall be required to pay thereunder. The liability for legal

fees and disbursements includes all legal fees and disbursements that the Company may pay or incur in any legal proceedings, including proceedings in which the Company may

assert or defend its right to collect or to charge for any legal fees and/or disbursements incurred in earlier proceedings.

4. The Indemnitor(s) will immediately notify the Company of the making of any demand or the paying of any notice or the commencement of any proceeding or the fixing

of any liability, which the Company may be required to discharge by reason or the execution of any such bond, or undertaking.

5. The vouchers or other evidence of payment by the Company, in discharge of any liability under or incurred in connection with any such bond or undertaking, or incurred

in connection with any collateral held by the Company, shall be conclusive evidence against the Indemnitor(s) of the fact and amount of the liability of the Indemnitor(s) to the

Company.

6. In the event the Company executes any bond or undertaking with Co-Sureties, or reinsures any portion of any such bond or undertaking, or procures the execution of any

such bond or undertaking, the Indemnitor(s) agree(s) that all of the terms and conditions of this instrument shall apply to and operate for the benefit of the Company, the procured

sureties and/or co-sureties and/or reinsurers as their respective interests may appear.

7. The Company shall have the right at any time, without notice to the Indemnitor(s), to transfer and assign this agreement and/or the collateral pledged thereunder, to any

person, reinsurer, Co-Surety, Surety or Insurance Company which may take over and assume in whole or in part, the obligation of the Company under any such bond or

undertaking and thereupon the transferee shall become vested with all the powers and rights given to the Company thereunder and the Company shall be relieved and fully

discharged from any liability or responsibility for said collateral under this agreement.

8. The Indemnitor(s) agree(s) that the Company may at any time take such steps as it may deem necessary to obtain its release from any and all liability under any of said

bonds or undertakings, and it shall not be necessary for the Company to give the Indemnitor(s) notice of any fact or information coming to the Company’s notice or knowledge

concerning or affecting its rights or liability under any such bond or undertaking, notice of all such being hereby expressly waived; and that the Company may secure and further

indemnify itself against loss, damages and/or expenses in connection with any such bond or undertaking in any manner it may think proper including surrender of the defendant

(either before or after forfeiture and/or payment) if the Company shall deem the same advisable; and all expenses which the Company may sustain or incur in obtaining such

release or in further securing itself against loss, shall be borne and paid by the Indemnitor(s).

9. The Indemnitor(s) hereby authorize(s) any attorney of any court of record to appear for him or them in and before any court, in any action, suit or proceeding, and receive

process on behalf of the Indemnitor(s), or waive the issuing and service of process, and enter or confess judgment, or permit judgment to be entered, against the Indemnitor(s),

(jointly and/or jointly and severally) in favor of the Company, for the amount of any forfeiture which may be taken against the Company on the said bond or undertaking and for

the amount of any and all sums hereinabove in paragraphs 1, 2, 3 and 7 referred to; and to release all error and waive all right to stay of execution or appeal; and to do and perform

all acts and execute all papers in the name of Indemnitor(s) in order to carry into effect the authority hereinabove given in as full and ample manner as the Indemnitor(s) might do

if personally present; hereby ratifying and confirming all that the said attorney shall do or cause to be done by virtue thereof and the Indemnitor(s) hereby irrevocably waive(s) the

benefit or advantage of any and all valuation, stay, appraisement or homestead exemption law or laws of any state of The United States, now in force or hereafter enacted.

10. This instrument shall be binding not only upon the Indemnitor (or Indemnitor(s), jointly and/or jointly and severally), but as well upon the heirs, executors,

administrators, successors and assigns of the Indemnitor(s).

11. The Company reserves the right to decline to issue the bond for which application is hereby made, and no claim shall be made against the Company as a consequence of

its failure to execute such bond; nor shall any claim be made in case the bond, if executed, be not accepted by of on behalf of the obligee.

12. The Indemnitor(s) hereby warrant(s) that the foregoing declarations made and answers given are the truth without reservation and are made for the purpose of including

the Company to become surety or to procure suretyship on the bond or undertaking applied for herein, with the intent and purpose that they be fully relied on.

13. The Company shall not be first obliged to proceed against the Principal(s) on any such bond or undertaking before having recourse against the Indemnitor(s) or any of

them, the Indemnitor(s) hereby expressly waiving the benefit or any law requiring the Company to make claim upon or proceed or enforce its remedies against the Principal(s)

before making demand upon or proceeding and/or enforcing its remedies against any Indemnitor.

14. The acceptance of this Agreement and of the Indemnitor(s) agreement to pay premiums on the execution and on the continuance of said bond(s) on undertaking(s), and/or

the acceptance at any time by the Company of the other collateral security or agreement, shall not in any way abridge or limit the right of the Company to be subjugated to any

right or remedy, or limit any right or remedy which the Company may otherwise have, acquire, exercise or enforce under this or any other agreement or by law allowed, and the

Company shall have every right and remedy which an individual surety acting without compensation would have, all such rights being construed to be commutative and for the

sole benefit of the Company, its successors and/or its assigns.

15. If any provision or provisions of this instrument be void or unenforceable under the laws of any place governing its construction or enforcement, this instrument shall not

be void or vitiated thereby but shall be construed and enforced with the same effect as though such provision or provisions omitted.

16. In making application for the hereinabove described Bail Bond(s) we warrant all of the statements made on this instrument to be true and we agree to advise the

Company or its agent of any change (including but not limited to change of address and/or phone number) within 48 hours after such change has occurred and agree that any

failure to so notify shall be cause for the immediate surrender of the defendant without any liability for the return of any part of the premium.

THE PREMIUM PAID ON THIS BOND IS NOT RETURNABLE

IN TESTIMONY WHEREOF we have hereunto set our hand and affixed our seals this ___________ day of ______________________, ________

I have read and had explained to me and understand the following terms and conditions of 3-D Bail Bonds, INC. (hereinafter called The Company) executing the above listed

Surety Bail Bonds on my behalf:

1. The Company shall have control and jurisdiction over me during the term for which my bail bond(s) is executed and shall have the right to apprehend and surrender me

to the proper officials at any time for violation or my bail bond(s) obligations to the Court and The Company as provided by law.

2. It is understood and agreed that any one of the following actions by me shall constitute a breach of my obligations to The Company and that The Company and/or its

Agent shall have the right to forthwith apprehend and surrender me in exoneration of my bail bond(s):

a. If I depart the jurisdiction of the Court without the written consent or the Court and The Company, or its Agent.

b. If I shall move from one address to another or change my phone number without notifying The Company, and/or its Agent.

c. If I commit any act, which shall constitute reasonable evidence of my intention to cause a forfeiture of my bail bond(s).

d. If I am arrested and incarcerated for any offense other than a minor traffic violation.

e. If I make any material false statement in my Bail Bond Application and Contract with The Company.

f. If I fail to meet any financial obligation(s) pertaining to premium on my Bail Bond Application and Contract with The Company

3. If I depart the jurisdiction of the Court wherein my bail bond(s) is posted by The Company for any reason, and I am captured by The Company and/or its Agent, or any

other law enforcement agency, in a State other than the one in which my bail bond(s) is posted, I hereby agree to voluntarily return to the State of original jurisdiction, and I hereby

waive extradition proceedings and further consent to the application of such reasonable force as may be necessary to effect such return.

4. I hereby waive any and all rights I may have under Title 29 Privacy Act - Freedom of Information Act, Title 6, HIPPA, Fair Credit Reporting Act, and any such local or

State law. I consent to and authorize The Company, and/or its Agent, to obtain any and all private or public information and/or records concerning me from any party or agency,

private or governmental (local, State, Federal), including but not limited to Social Security Records, criminal records, Prison records, civil records, Court records, driving records,

telephone records, hospital and medical records, school records, workers compensation records, employment records. I authorize without reservation, any party or agency, private

or governmental (local, State, Federal), contacted by The Company, and/or its Agent, to furnish any and all private and public information and records in their possession

concerning me to The Company, and/or its Agent.

DEFENDANT NAME ____________________________________ SIGNATURE ___________________________________ DATE ______________________________

INDEMNITOR NAME ___________________________________ SIGNATURE ___________________________________ DATE ______________________________

INDEMNITOR NAME ___________________________________ SIGNATURE ___________________________________ DATE ______________________________

INDEMNITOR NAME ___________________________________ SIGNATURE ___________________________________ DATE ______________________________

STATE OF _________________ COUNTY OF ___________________

ON THIS _____________ DAY OF ________________________20_____, BEFORE ME PERSONALLY APPEARED, __________________________

TO BE KNOWN TO ME THE PERSON(S) DESCRIBED IN AND WHO EXECUTED THE FOREGOING INSTRUMENT AND __________________

ACKNOWLEDGED TO ME THAT __HE/SHE___ EXECUTED THE SAME.

NOTARY_________________________________________ MY COMMISSION EXPIRES _______________ Rev.4/2020

57 Fishfry Street, Hartford CT 06120 15 Arch Street, New Britain CT 06051

860-247-2245 - 800-570-5544

PROMISSORY NOTE

I (we) obtained a surety bail bond release for _____________________________.There is an unpaid balance of $_____________ (____________________________________________________________________) dollars.

AFTER DATE, FOR VALUE RECEIVED, the undersigned promises to pay to the order of 3-D BAIL BONDS, INC.

the principal sum as indicated in the above paragraph as follows:

*I hereby agree to pay the balance in full on or before .

*I agree to make an initial payment of $ . on . AND

*I agree to pay $ . per _________ until the unpaid balance is paid in full. Payments will begin on or before .

*Default payment term states all ballances must be paid in full within 15 months from execution of bond.

IT IS HEREBY AGREED that I am responsible for all costs of collection, including reasonable interest and/or attorney’s fees, and if it becomes necessary to apprehend and surrender the defendant to the court; all expenses incurred as a result of such forfeiture shall become a part of this debt and may be collected as a part thereof in any action necessary to collect this note. I understand I remain responsible for the entire amount of the debt even if the above named principal becomes incarcerated and is withdrawn from any civil action.

DEFAULT IN THE PAYMENT when due for a period of thirty (30) days after any of the same became due and payable, or the occurrence of any other event of default, or the filing of a petition in bankruptcy by or against the Maker, and the continuance of any such decree or order, unstayed, and in effect for a period of sixty (60) consecutive days; or any substantial change in the composition of the Maker shall render the whole of this Note immediately due and payable at the option of the holder hereof, and any failure to exercise said option with respect to the default shall not constitute a waiver of the right of said holder to exercise said option at a later time with respect to a subsequent default.

THE MAKER FURTHER WAIVES diligence, demand, presentment for payment, notice of nonpayment, protest, and notice of protest, and notice of any renewals or extensions of this note.

SHOULD THIS NOTE BE SIGNED by more than one maker, references in this note to Maker or Makers in the singular shall include the plural and all obligations herein contained shall be the joint and several obligations of each Maker hereof.

THE MAKER HEREIN RESERVES the right to anticipate payment under this note at any time, without penalty.

THE COVENANTS AND AGREEMENTS contained herein shall bind and the rights herein shall transfer to the benefit of the respective heirs, beneficiaries and assigns of the Maker and the Holder.

THE HOLDER HAS extended the courtesy of offering payment terms. It is the responsibility of the Maker to ensure payments are made at the office of the holder or at its discretion, AND ON TIME.

This Note dated shall be governed and interpreted under the laws of the State of Connecticut.

Defendant Co-Signer Co-Signer Co-Signer

Signature Signature Signature Signature

Print Name Print Name Print Name Print Name

Phone Phone Phone

WITNESSED BY DATED . Read and reviewed the above

Rev. 4/2020

Initials

860-247-2245 - 800-570-5544

57 Fishfry Street, Hartford CT 06120

15 Arch Street, New Britain CT 06051

CONFIDENTIAL LOCATION ADDENDUM FOR BAIL BOND

I, the undersigned, do hereby agree that 3-D Bail Bonds Inc, will act as my bail bond and as part of that agreement, they will be able to use location technologies to locate my wireless device at any time during the period of my bail. The following privacy/terms and conditions are an integral part of this addendum and bond(s) is conditioned upon full compliance by the principal of all said terms and conditions and is a part of said bonds and application therefore.

1. 3-D Bail Bonds Inc. will use network-based location technologies to find principal solely at their discretion.

2. This addendum will service as the sole notice for the collection of location information for the

principal until their bond liability is fully discharged.

3. 3-D Bail Bonds Inc. will only retain location data while the bail bond is actively in force.

4. 3-D Bail Bonds Inc. will only disclose location information to the courts as required by court order.

5. 3-D Bail Bonds Inc. will be the only person with access to location information for a specific

principal.

6. The principal WILL NOT have the option to OPT-OUT of location use during the period of bail.

7. All questions relating to location capability should be directed to 3-D Bail Bonds Inc. Name: ______________________________________ Address: _____________________________________ Mobile Telephone Number: ______________________

1. 3-D Bail Bonds Inc. to call mobile telephone number when principal application is completed to

ensure accuracy of the phone number. 2. If an incorrect phone number is provided by the principal that would constitute a material false

statement in the application and result in the SURETY having the right to apprehend arrest and surrender principal.

X ____________________________________________________

860-247-2245 - 800-570-5544

57 Fishfry Street, Hartford CT 06120 15 Arch Street, New Britain CT 06051

AUTHORIZATION FOR RELEASE OF PERSONAL INFORMATION

I, _________________________ hereby authorize 3-D Bail Bonds Inc. and/or its agents licensed under the laws of the state of Connecticut to disclose to, use and/or disclose to, any third party, including any federal, state, or local law enforcement agency, any information in their possession concerning me or my whereabouts should I fail to appear in court as required in the conditions of my release and/or the conditions of my appearance bond. I further authorize 3-D Bail Bonds Inc. or its agents, or anyone acting at their request upon my non appearance in court to gain access to any and all private or public information and/or records concerning me from any party or agency, private or governmental (local, state, federal), including but not limited to Social Security records, criminal records, prison records, civil records, credit records, court records, driving records, telephone records, hospital and medical records, HIPPA, school records, workers compensation records, and employment records. I also authorize without reservation, any party or agency, private or governmental (local, state, federal), contacted by 3-D Bail Bonds Inc., and/or its agent, to furnish any and all private and public information and records in their possession concerning me to them and/or their agent(s). In the event that any bond provided by 3-D Bail Bonds Inc. on my behalf is forfeited by the court, it is my intention that this authorization be extended to any duly authorized agent of the division of criminal justice with my permission and full understanding that it may be used for all purposes implied or expressed herein. A photocopy of this authorization shall be considered as effective and valid as the original, even though such photocopy does not bear an original writing of my signature.

Defendant's Signature: X_______________________________ Date:

Defendant's Name: ______________________________________________________ Address: ________________________________Apartment Number: ______________ City: ___________________________State:______ Zip Code: ___________________ Phone: _____ __________________ Cell: ____ _____________________________ Date of Birth: Social Security Number ___________________ Witnessed By Signature:________________________________ Date: Name: Address: 57 Fishfry Street Hartford, CT 06120

I have read and reviewed the above

Rev 4/2020

Initials

860-247-2245 - 800-570-5544

WAIVER OF EXTRADITION PROCEEDINGS AND VOLUNTARY RETURN TO JURISDICTION

If I depart the jurisdiction of the Court where my bail bond(s) is/are posted by 3-D

Bail Bonds, Inc., for any reason, and I am captured by that Bail Bond Company

and/or their Agents or any other Law Enforcement Agency, in a State other than

the one in which my bail bond(s) is/are posted, I hereby agree to voluntarily

return to the State of original jurisdiction, and I hereby waive extradition

proceedings and further consent to the application of such reasonable force as

may be necessary to effect such return.

Defendant's Signature: X ____________________________ Date:

Defendant's Name: _____________________________________________________ Phone: ____ _____________________Cell: ____ ____________________________ State of Connecticut ss: County of ______________________ On this ________ day of ____________, (year) __________________, before

me, the subscriber, personally appeared_____________________________________,

known to me, and known to me to be the person described in and who executed the

above instrument, and he/she acknowledged to me that He/she executed the same for

the purposes therein mentioned.

_______________________________________ Notary Public

_______________________________________ County

Rev. 4/2020

Initials

I have read and reviewed the above

57 Fishfry Street, Hartford CT 06120

15 Arch Street, New Britain CT 06051