COURT OF COMMON PLEAS ­ CRIMINAL DIVISION BUCKS COUNTY, PA Pa.R. Crim.P.536(B) APPLICATION FOR BAIL PIECE Commonwealth of Pennsylvania VS. : : Case Number Charge: I, _____________________________________________, Surety in the Court of Common Pleas of Bucks County for the above-named defendant in the amount of $___________ on _____________________, do certify that I wish to be removed as Surety in the case(s) listed above for the following reasons: __________________________________________________ with full knowledge that the defendant will be lodged in prison until new bail is posted. In consideration of the granting of Bail Piece, I acknowledge that the bail posted by me shall remain in effect until the defendant is incarcerated or new bail is posted. ____________________________________ Subscribed and sworn before me this______ day of ___________, _______ __________________________________ Deputy Clerk of Courts Authorized Bail Piece AND NOW, this ________ day of ____________________________, 20 ___ being satisfied that a Bail Piece is required in this matter, same is hereby issued to _______________________, Surety, and/or to his duly authorized agent,__________________, authorizing the aforementioned to apprehend and detain the above-named defendant whenever and wherever he may be found and to bring said defendant before the Court without unnecessary delay. ____________________________________ Judge Bucks County Prison Authority to Complete: Defendant detained at:_______________________________ Date_______________________ Signature of Records Officer: _____________________________________________________ Update: April 2012 American LegalNet, Inc. www.FormsWorkFlow.com