BOND ASSIGNMENT CASE Plaintiff vs. Defendant BOND ASSIGNMENT I hereby assign the proceeds of the bond posted by me in this case to be applied as follows: Fine $ Electronic Monitoring $ Restitution $ PSI/Screen Fee $ Drug Testing $ Probation Enrollment Fee $ Other Child Support $ in Case No. which case is located in County District Court, Nebraska. AND/OR Assign Bond to another individual: Name: Address: The balance of the Bond, $, shall be refunded to: Name: Address: Date Signature Name (Defendant/Assignee) Bar Number and Firm Name (attorneys only) Street Address/P.O. Box City/State/ZIP Code Phone E-mail Address Subscribed and sworn before me this day of , 20 . Notary Public/Clerk of District Court American LegalNet, Inc. www.FormsWorkFlow.com