IN THE UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF OHIO EASTERN DIVISION United States of America vs ________________________________ Index under: ________________________________ ________________________________ (Insert names of property owners) Case No. _________________________ LIEN ON REAL PROPERTY AS SECURITY FOR BOND IN A CRIMINAL CASE The purpose of this document is to create a lien in favor of the United States of America on the property described below. The lien is to serve as security for the release of the above-named defendant, who has been or will be released on terms and conditions which are set forth in an order of the United States District Court for the Southern District of Ohio dated ________________________________, 2002. The terms of that order that create an obligation of the defendant in favor of the United States, and the terms of any bond signed by that defendant, are incorporated herein. In consideration of the order of release, and as security for the monetary obligation of the defendant to the United States, set in the amount of $_________________________ (dollars and 00 cents), we, the undersigned, voluntarily grant to the United States a lien on the property described below: _____________________________________________________________ (In lieu of a property description a copy of a deed or other documents adequately describing the property may be attached). American LegalNet, Inc. www.FormsWorkFlow.com If the defendant complies with all of the conditions of release, and for the period of time that the order setting conditions of release is in effect, this lien shall be discharged. If there is any violation of any conditions of the order of release, the United States may elect to foreclose on this lien and have the property sold or forfeited to the United States to satisfy the bond that has been posted. This document is intended to be recorded in the appropriate office which maintains records concerning real property for the county in which the property is located. WARNING: BY SIGNING THIS DOCUMENT YOU ARE CREATING A LIEN ON YOUR PROPERTY AND AGREEING THAT IF THE DEFENDANT DOES NOT COMPLY WITH THE ORDER OF RELEASE, THE PROPERTY MAY BE SOLD AND THE PROCEEDS USED TO PAY THE AMOUNT OF THE RELEASE BOND TO THE UNITED STATES, OR THE PROPERTY ITSELF MAY BE FORFEITED TO THE UNITED STATES TO SATISFY THE BOND. I/we understand all of the terms of this document and sign it voluntarily. ______________________________________ Witness ______________________________________ Witness ____________________________________ Owner ____________________________________ Owner ACKNOWLEDGMENT ______________________________, one of the persons who signed this document, acknowledged to me that the signature is his or hers and that the document was executed by him or her voluntarily. Date: __________________________ ____________________________________ Notary public, Judicial Officer, or Clerk of Court ACKNOWLEDGMENT _________________________________, one of the persons who signed this document, acknowledged to me that the signature is his or hers and that the document was executed by him or her voluntarily. Date: __________________________ ____________________________________ Notary public, Judicial Officer, or Clerk of Court -2- American LegalNet, Inc. www.FormsWorkFlow.com