File No. STATE OF NORTH CAROLINA Film No. County In The General Court Of Justice District Superior Court Division Name Of Plaintiff DEFENDANT'S BOND IN CLAIM AND DELIVERY VERSUS Name Of Defendant G.S. 1-478 The undersigned principal and surety acknowledge ourselves bound to the plaintiff in the sum indicated below. If the property is returned to the principal, it shall be delivered to the plaintiff upon order of the Court with damages not less than the difference in value of the property at the time of the execution of this bond and the value of the property at the time of its delivery to the plaintiff, together with damages for detention and the costs of the action, if such delivery can be made. If for any cause delivery cannot be made, the plaintiff shall be paid such sum as may be recovered against the principal for the value of the property at the time of the wrongful taking or detention, with interest thereon, as damage for the seizure and detention, together with the costs of the action. Signature Of Defendant (Principal) Amount Of Bond Date Of Bond Signature Of Surety Signature Of Additional Surety, If Used Name Of Surety (Type Or Print) Name Of Additional Surety, If Used (Type Or Print) Address Address City, State, Zip City, State, Zip $ JUSTIFICATION The undersigned surety, being first duly sworn, says that he/she is a resident of the State of North Carolina, and is worth the amount of the bond, over and above all liabilities and exemptions allowed by law. Signature Of Surety SWORN AND SUBSCRIBED TO BEFORE ME Signature Of Person Authorized to Administer Oaths Date Deputy CSC Assistant CSC Signature Of Additional Surety, If Used Clerk Of Superior Court Date My Commission Expires Notary County Where Notarized SEAL AOC-CV-900M, Rev. 10/06 © 2006 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkflow.com