PERFORMANCE BOND Case No Va. Code 16.1-278.16; 20-114 [ ] Juvenile and Domestic Relations District Court [ ] Circuit Court CITY/COUNTY v./ In re Date of Order, Judgment or Decree Type of performance to be secured by bond: [ ] custody [ ]visitation [ ] support [ ] other Name(s) and address(es) of the principal(s): Name(s) and address(es) of the surety and, if executed by someone au thorized to act for the surety, the name(s) and address(es) andtitle (attorney-in-fact, etc.) of such authorized person. The undersigned each hereby acknowledge himself, his heirs, and his assi gns indebted jointly and severally to in the sum of $ that is secured by[ ] Cash [OR] [ ] Surety (and if property is used to establish the solvency of the suret y, the undersigned, having demonstrated thenature of their interest in the property to the officer taking this bond , also make oath that the equity of the undersigned in the propertyequals or exceeds the amount of this bond). The undersigned each waives all benefit of the homestead exemptions as to the debt ofthis bond. The condition of this debt shall be that shall perform all of the terms and conditions of an order, decree or jud gment entered by this court, which is described above andwhich is incorporated by reference in this bond, and that such performan ce shall be made as prescribed in such order, decree or judgment without variance from its terms. If this condition if faithfull y filled, this debt is to be void; otherwise, it is to remain in fullforce and effect until satisfied, declared void, or released either by a court of competent jurisdiction or by a release executed by allpersons for whose benefit the bond is posted. (seal) (seal) PRINCIPAL SURETY (seal) (seal) PRINCIPAL SURETY (seal) SURETY Commonwealth of ,[ ] City [ ] County of Acknowledged, subscribed and sworn to/acknowledged before me this day by the above-named persons. DATE [ ] CLERK [ ] JUDGE [ ] NOTARY PUBLIC My Commission Expires: Court Use Only: DATE RECEIVED RECEIPT NO. (IF CASH DEPOSITED) DATE DISBURSED/DISCHARGEDAccepted by: FORM DC-660 (PAGE ONE OF ONE) 9/02 PDF American LegalNet, Inc. www.USCourtForms.com