Co-Signer Info for Bail Bonds | Goggins Bail Bonds

1

Personal Information

Full Legal Name

AKA / Alias

Date of Birth

Age

Race

Sex

Twin?

Height

Weight

Hair Color

Eye Color

Glasses?

SSN

DL / ID Number

Birthplace

2

Address & Contact

Current Address

ZIP Code

How Long (Yrs/Mos)

Who Do You Live With?

Name Utilities Are In

Email Address

Home Phone

Cell Phone

High School Attended

Vehicle Color

Year

Make

Model

Tag #

3

Employment Information

Employer Name

Employer Address

Employer Phone

Occupation / Job Title

Supervisor Name

How Long

Hours

4

Spouse / Partner & Additional Info

Spouse / Partner Name

Address

Phone

SSN

DOB

Height

Weight

Race

Spouse Employer

Employer Address

Phone

Probation Officer Name

DHS Worker Name

Filing for Bankruptcy?

5

Family Contacts

Relation Name Address Phone

Mother

Father

Sister/Brother

Mother-in-Law

Father-in-Law

Children

Ex-Spouse

6

Financial Info & References

Type Name / Company Details Phone / Account

Bank

Auto Financing

Rent / Mortgage

Other Credit

Personal References

Reference Name Address Phone

Reference 1

Reference 2

Reference 3

7

Authorization & Signature

IMPORTANT: Please have defendant come in within 48 hours of release to complete required paperwork for bond.

I authorize the release of information to or from ANY source, public or private, including but not limited to: law enforcement, medical, mental or drug rehab facilities, probation officers, doctors, lawyers, counselors, schools, employment, Oklahoma Employment Security Commission, housing, credit reports, creditors, utility companies, online media accounts, Facebook, banking, social security, I.R.S., TANF, O.H.S or any state program, unemployment, workers compensation, phone records, use of GPS tracking, electronic mail tracking, OnStar system, and ANY other source holding information to discover the location of the defendant or co-signers, their residence, place of employment or appointment schedule.

⚠ WARNING: It is a misdemeanor to provide false information on any indemnification agreement with a punishment of up to one year in jail and up to a $1,000 fine or both.

I have read and understand the above authorization and warnings. I certify that all information provided on this form is true and accurate to the best of my knowledge. I understand that providing false information is a misdemeanor offense.

Signature (Type Full Legal Name)

Date

Notary Name

Commission #

Expires

Goggins Bail Bond