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Bond Refund Authorization Form. This is a Ohio form and can be use in Hamilton County (Court Of Common Pleas).
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Tags: Bond Refund Authorization Form, Ohio County (Court Of Common Pleas), Hamilton
PATRICIA M. CLANCY
HAMILTON COUNTY CLERK OF COURTS
AUTHORIZATION BY SURETY TO RELEASE
CRIMINAL BAIL BOND REFUND TO A THIRD PARTY
1.
, hereby authorize the Hamilton County
I, [insert printed name]
Clerk of Courts (the “Clerk”) to release to the individual described below the bond refund due to me in Case
.
No(s).
2.
I understand that the refund check will still be issued in my name although the refund check itself will be
given to the person described below.
3.
I have attached to this authorization the original receipt copy for the bond being refunded or, in the case of a
lost or missing bond receipt, I have attached to this authorization the required “Lost Bond Receipt Affidavit”
in order to have a duplicate receipt generated.
4.
As proof of my intentional authorization I have had this authorization form witnessed and notarized and have
attached a photocopy of my current Driver’s License or State of Ohio Identification Card, as applicable.
5.
The person to whom this bond refund check should be issued is described below and he or she shall
provide a valid Driver’s License or State of Ohio Identification Card (or other appropriate photo I.D.) as proof
of his or her identity:
Name: _________________________________________________________________
Address: _______________________________________________________________
Home Telephone: ________________________________________________________
Social Security No.: _____________________________________________________________
Driver’s License No.: ____________________________________________________________
Date of Birth: ________________
Gender: M ( ) or F ( )
Race: ______________________
6.
In Witness Whereof, I have hereunto subscribed my name.
Signed: __________________________________ (“Surety”)
Print Name: ___________________________________
Dated: _______________________________________
Sworn to and subscribed in my presence at
day of
on the
, 20
.
Signed:
Notary Public/Witness
[SEAL]
My Commission Expires:
HCCOC STAFF:
• Be sure that there is a bond refund due and payable.
• Be sure original receipt or lost receipt affidavit attached.
• Be sure that Surety’s photo identification copy is attached.
• Be sure that this form is notarized.
• Be sure that person picking up bond refund check has photo I.D. and that a copy of it is made and attached
to this paperwork.
Insert here: Refund Amount: $
Refund Check No.:
Bond Refund Auth Form - Revised 01/05/09
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