AOC-490 Rev. 7-11 Page 1 of 1 Doc. Code: ACA COM M O NW E A LT H O F K E lex et justitia Case No. ____________________ U C KY E NT Commonwealth of Kentucky Court of Justice www.courts.ky.gov KRS 520.070; 520.080 U Court [ ] Circuit [ ] District RT OF JUS TI C Acknowledgment Of Scheduled Court Appearance CO County ______________________ Division _____________________ COMMONWEALTH OF KENTUCKY VS. PLAINTIFF _______________________________________________ DEFENDANT I hereby acknowledge and certify to the Court that I fully understand and realize the next date I have been ordered and directed to appear in the _________________________________ [ ] Circuit OR [ ] District Courtroom No. __________, for proceedings in the above-styled case is the ________ day of ____________________, 2_______, at _______________ [ ] a.m. [ ] p.m. I promise to appear as ordered by the Court. I acknowledge and certify to the Court that I have been furnished a true copy of this document; that I have read it in its entirety; that I fully understand it; and that I am aware that if I fail to promptly appear on the date and at the time and place set out herein that I will subject myself to being prosecuted for the offense of bail jumping. Bail jumping in the first-degree is a Class D felony punishable by not less than one (1) year nor more than five (5) years imprisonment under KRS 520.070. Bail jumping in the second-degree is a Class A misdemeanor punishable by not less than ninety (90) days nor more than twelve (12) months imprisonment under KRS 520.080. Date: ____________________, 2_______. ______________________________________ Defendant's Signature Distribution: Court File Defendant American LegalNet, Inc. www.FormsWorkFlow.com