COST BOND (CIVIL ACTIONS) DOCKET#___________ COURT COUNTY ____________________________ _____________________________ PLAINTIFF DEFENDANT ____________________________ _____________________________ We, the undersigned principal and sureties, agree to pay the State of Tennessee the amount indicated unless the plaintiff, names above in a civil action filed today in this court, against the above named defendant, pays all costs which may be awarded against plaintiff by the court in its decrees, judgments or orders in the action. BOND AMOUNT DATE PRINCIPAL ________________ ________ _____________________________ _____________________________ _____________________________ SIGNED______________________ SURETY SURETY _________________________________ ______________________________ _________________________________ ______________________________ _________________________________ ______________________________ SIGNED_________________________ SIGNED______________________ APPROVED AND FILED THIS DATE________________________ BY_______________________________________________________ American LegalNet, Inc. www.USCourtForms.com