SUPERIOR COURT OF CALIFORNIA, COUNTY OF TEHAMA 445 Pine Street Red Bluff, CA 96080 530-527-3563 FOR COURT USE ONLY PEOPLE OF THE STATE OF CALIFORNIA VS. DEFENDANT: AUTHORIZATION TO APPLY THIRD PARTY BAIL TO THE CLERK OF THE COURT: CASE NUMBER: I, __________________________________, hereby authorize the cash bail deposited by me on _______________ to be applied toward the payment of any fine imposed against defendant, _____________________________________, in the above named case and the balance of the deposit, if any, returned to: Name: __________________________________________ Address: ________________________________________ City, State:_______________________________________ Date: _____________________ (To be completed by the Deputy Sheriff/Clerk) ................................................................................................................................................................. I have witnessed the signature and examined the following legal photo identification Driver License #___________________________ DMV Identification Card # ___________________________ Other (specify): # ___________________________________________ ______________________________________ Signature of Depositor DAVE HENCRATT, Sheriff-Coroner CARYN A. DOWNING, Clerk of the Court Date: _____________ By: __________________________ Deputy By: _____________________________ Deputy Clerk IF THIS FORM IS RETURNED TO COURT BY MAIL, IT MUST BE NOTARIZED State of _________________________________ County of ________________________________ On ___________________________________, before me, ________________________________________________ the undersigned Notary Public, personally appeared ________________________________________________ personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s), acted, executed the instrument. WITNESS my hand and official seal _______________________________________________ Notary's Signature AUTHORIZATION TO APPLY THIRD PARTY BAIL AC002 ­ Authorization to Apply Third Party Bail Form (10/15) American LegalNet, Inc. www.FormsWorkFlow.com