United States Fire Insurance Company (Surety)

11490 Westheimer Rd., Suite 300 • Houston, TX 77077

P.O. Box 2807 • Houston, Texas 77252-2807

(713) 954-8100 • (713) 954-8389 FAX

Email: CourtNotices@cfins.com

Form #1

DEFENDANT BAIL BOND APPLICATION AND AGREEMENT

You, the undersigned Defendant (“Defendant” or “you”), hereby represent and warrant that the following declarations made and answers given are true, complete and correct and are made for the purpose of inducing United States Fire Insurance Company (“Surety”) to issue, or cause to be issued, a bail bond or undertaking for you, using power of attorney number(s) (if known):

in the total amount of

in the

Court of

("Bond").

DEFENDANT'S NAME AND ADDRESS