AOC-360 Doc. Code: BS Rev. 4-09 Page 1 of 1 Commonwealth of Kentucky Court of Justice www.courts.ky.gov RCr 4.34; KRS 431.535 COMMONWEALTH OF KENTUCKY v. O NW E A LT H O F K E NT lex et justitia Case No. ____________________ Court _______________________ COM M U C KY RT OF JUS TI SWORNSCHEDULEFORBAILBOND County ______________________ SECUREDBYREALESTATE PLAINTIFF Amount of Bond $___________________ ________________________________________________DEFENDANT Affiant(s),______________________, state(s) that he/she is the sole owner (or if jointly owned, Affiants are the sole owners) of the real estate herein described, and he/she offers it as security for the appearance of the defendant in accordance with the conditions of release imposed by the court. Affiant(s) hereby grant(s) a lien upon this property for this purpose in the amount of $___________________. Affiant further states that the property and any structure attached to the property is NOT exempt from execution, foreclosure, or any related type of liquidation. Affiant hereby WAIVES his/her statutory right to a $5,000 homestead exemption (KRS 427.060) and an exemption of $20,200 (KRS 427.170 and 11 U.S.C. §522). 1 This waiver is made for the sole purpose of securing bail bond in the above-referenced case and shall become null and void upon release of said bail bond. No change in the exemption amount(s) of any of the above-referenced statutes shall abrogate, impair, alter, amend, rescind, supercede, nullify, void or otherwise change the terms of this sworn schedule. The real estate is located in ___________________ County, Kentucky. A legal description is attached hereto, and is recorded in Deed Book __________, Page ____________ in that county. The following is a list of all encumbrances and exemptions on the real estate: Amount: $____________________________________ _____________________________________ _____________________________________ Held by: __________________________________ __________________________________ __________________________________ The market value of the unencumbered equity is $_________________________, which at least is twice the amount of the bond over and above any encumbrances or exemptions. The real estate has not previously been used or accepted as bail in this Commonwealth during the 12 months preceding the date of this bail, or if it has been so used, affiant is the defendant or is related to defendant no further removed than first cousin or is (are) the father-in-law, mother-in-law, son-in-law or daughter-in-law of the defendant. The affiants have read the above schedule and file this with the surety bond herein. The affiants further state that the statements herein are true to the best of their knowledge and that they are subject to penalty of perjury if a false statement has been made. _______________________________________ Signature of Affiant _______________________________________ Address _______________________________________ Address ______________________________________ Signature of Affiant ______________________________________ Address ______________________________________ Address Subscribed and sworn to before me by ____________________ this ________ day of ___________________, 2_____. ____________________________________________ Notary Public Copy Distribution: Original - Court file Certified Copy - County Clerk where property located (with certified copy of Bail Bond and recording fees) 1 C Failure to state that the property is not exempt from execution, foreclosure or any related type of liquidation will disqualify you from using the property to post bond (KRS 431.535 & RCr 4.34). Failure to waive your statutory right to the state and federal exemptions will result in the unencumbered equity of your property being reduced by $20,200. CO U E My Commission expires:_______________________