PIMA COUNTY CONSOLIDATED JUSTICE COURT 240 N STONE AVE. TUCSON, AZ 85701-1130 STATE OF ARIZONA VS CASE NO. BOND REQUEST I, of $ in the above-mentioned case. certify that I have posted a bond in the amount I request that this bond be converted to pay the fees and fine owed to the court in this case. Any funds not used to pay the fees and fine should be returned to me at the address noted below. Any funds not applied to the fees and fine or given to the bond poster may be released to Name Address City State/Zip I request that the bond be released to the bond poster. BOND POSTER: ADDRESS: Street PHONE: NOTICE: If bond funds are not released by the person posting the bond (bond poster) the bond will, by law be returned to the bond poster unless bond has been forfeited. VERIFICATION STATE OF ARIZONA ) ) SS: COUNTY OF PIMA ) I swear/affirm that I am the Bond Poster in this action, that I have read this form and that the statements are true to the best of my knowledge. __________________________________________ BOND POSTER SUBSCRIBED AND SWORN to before me this date: My Commission Expires: ____________________________________________________ NOTARY PUBLIC/CLERK JP210 1-05 (Rev 11-18-13) ec/fb/bd /kr riginal-Court Copy-Defendant/Bond Poster American LegalNet, Inc. www.FormsWorkFlow.com City State/Zip