CASE NAME: United States v ______________________ CASE NO._____________________ BAIL INFORMATION SHEET Defendant Information: Name: ________________________________________________________________________ Date of Birth: ______________________________________ S.S.#: _______________________ Immigration status: _________________________________ "A" Number:___________________ Home address: __________________________________________________________________ ___________________________________________ Home phone: ( )_________________ Employer's name: ________________________________________________________________ Employer's address: ______________________________________________________________ Length of employment: ______________________ Work phone: ( )_____________________ Name(s), address(es), and phone number(s) of person(s) with whom defendant will live during pendency of case. ______________________________________________________________________________ ______________________________________________________________________________ Name(s) address(es), and phone number(s) of person(s) residing in United States who will know how to contact defendant; aside from sureties on this bond. _______________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Defense Attorney Information: Name: _______________________________ Address: __________________________________ __________________________________________________ Phone: _____________________ AUSA________(initials) 2005 American LegalNet, Inc. www.USCourtForms.com