STATE OF TENNESSEE 20TH JUDICIAL DISTRICT CHANCERY COURT CASE FILE NUMBER APPEAL BOND APPELLANT (Party appealing) APPEAL TO: □ Court of Appeals □ Supreme Court APPELLEE BOND AMOUNT DATE BOND EXECUTED BOND We, the undersigned, agree to pay ________________________________________________________ __________________________________________________________________________________________ An amount not to exceed the bond amount indicated if so ordered. This bond is conditioned to secure: __ Costs (See T.R.A.P. 6.) __ Payment of the judgment, interest, damages for delay, and costs on appeal. (This clause should be checked in bond is for stay of a judgment directing the payment of money; See T.R.C.P. 62.05) __ Obedience to the judgment and payment for the use, occupancy, detention, and damage or waste of the property from the time of appeal until delivery of possession of the property, and costs on appeal. (This clause should be checked if bond is for stay of a judgment ordering the assignment, sale, delivery, or possession of personal or real property; See T.R.C.P. 62.05) PRINCIPAL (Name, Address, Signature) SURETY (Name, Address, Signature) PROPERTY BOND STATEMENT I solemnly swear that I own the following property in the county indicated and that this property is free and unencumbered and is worth approximately the amount indicated. I pledge this property to secure this obligation under the conditions set forth above. COUNTY: _______________________________________ APPROXIMATE VALUE ________________________________ DESCRIPTION OF PROPERTY: (Copy of deed must be attached.) SWORN TO & SUBSCRIBED BEFORE ME THIS DATE BY: (Deputy Clerk & Master) SURETY (Sign) POOR PERSON’S OATH __________________________________________________________________________________________ I, the undersigned appellant, do solemnly swear that I am a resident of the State of Tennessee, and that owing to my poverty, I am not able to bear the expense of an appeal, and I am justly entitled to the relief sought to the best of my belief. Sworn to & subscribed before me this date ______ day of ____________, 200__, By: ___________________________________ (Deputy Clerk & Master or Notary) Appellant’s Signature ____________________________________________________ 2010 Appeal Bond American LegalNet, Inc. www.FormsWorkFlow.com American LegalNet, Inc. www.FormsWorkFlow.com