UNITED STATES DISTRICT COURT EASTERN DISTRICT OF MISSOURI UNITED STATES OF AMERICA, | Plaintiff | | | vs | Case No. | , | Defendant | AFFIDAVIT OF OWNERSHIP I, , on oath say that the legal owner(s) of the $ cash deposited as security on the bond posted for the defendant named above is . Upon conclu sion of O wner of Funds the case, the funds should be returned to the owner at the following address: ddress ity, State and Zip hone number or email address required for notification when funds will be sent The funds deposited are to be returned to the said owner(s) upon exoneration of this bond. I understand that this bond is subject to forfeiture if the defendant does not comply with conditions set by the Court. Date Signa ture of Owner/Agent of cash security Subscribed and sworn to before me this day of , 20. GREGORY J. LINHARES, CLERK By: Deputy Clerk White Financial Pink Case File Blue Customer Copy American LegalNet, Inc. www.FormsWorkFlow.com