IN THE CHANCERY COURT FOR HAMILTON COUNTY, TENNESSEE PLAINTIFF(S) APPEAL BOND FOR COSTS1 Rule 6, Tenn.R.App.Pro. PART FILE N0. DEFENDANT(S) Surety Bond APPELLANT/PRINCIPAL, ________________________________________________________, (hereinafter called APPELLANT) and SURETY, __________________________________________________________________________________________, bind ourselves for the costs of appeal in this action. If APPELLANT pays all costs of appeal, then this obligation is void. If APPELLANT fails to pay, then SURETY is obligated to pay all costs of appeal. APPELLANT’S ADDRESS Street addresses only; NO P.O. Boxes; NO “in care of” principal’s attorney: APPELLANT’S DRIVER’S LICENSE NUMBER2 ________________________________________ ________________________________________ APPELLANT’S SIGNATURE APPELLANT’S PRINTED NAME SURETY’S ADDRESS Street addresses only; NO P.O. Boxes APPELLANT’S SOCIAL SECURITY NUMBER2 SURETY’S FEDERAL EMPLOYER IDENTIFICATION NUMBER2 ________________________________________ SURETY’S SIGNATURE ________________________________________ SURETY’S PRINTED NAME Cash Bond IF YOU DO NOT HAVE A SURETY TO SIGN YOUR APPEAL BOND FOR COSTS, except as may be otherwise required by the CLERK & MASTER or the APPELLATE COURT CLERK, a cash deposit of $1,000.00 is deemed sufficient instead of a surety bond. As evidenced by separate receipt dated _______________, a deposit of $______________, in cash, has been made to the CLERK & MASTER as security for costs. Should APPELLANT be required by the Court to pay costs in excess of this cash bond, APPELLANT will within 30 days of the Court’s Order becoming final, pay the balance owed for costs. Should costs due be turned over to an attorney for collection from APPELLANT, APPELLANT agrees to pay a reasonable attorney fee for such effort. APPELLANT’S DRIVER’S LICENSE NUMBER2 ________________________________________ APPELLANT’S SIGNATURE ________________________________________ APPELLANT’S PRINTED NAME APPELLANT’S SOCIAL SECURITY NUMBER2 CLERK & MASTER APPROVED this _________ day of __________________, 20___. _______________________________ Deputy C&M 1 2 This is not a bond for stay of proceedings to enforce a judgment (Supersedeas Bond). See Rule 62, Tenn. R. Civ. Pro. Required by the Court of Appeals pursuant to Tennessee Code Annotated § 25-1-108. Page 1 of 1 page. APPEAL BOND FOR COSTS Form 011, Rev. 2009.01.28 American LegalNet, Inc. www.FormsWorkFlow.com