The Defendant hereby affirms that the foregoing declarations made and answers given are the truth without reservation and are made for the purpose of inducing O’Shaughnahill Surety & Insurance, Inc. (the “Surety”) to become surety or to procure suretyship on the bond or undertaking applied for herein, with the intent and purpose that they be relied on fully.
In addition, the Defendant hereby authorizes and directs his relatives, employers, bankers, the Federal Social Security Administration, the Internal Revenue Service, Enforcement Agencies and any other persons or organizations having information concerning the Defendant’s whereabouts to give such information to the Surety and its assigns and/or duly authorized representatives. The Defendant understands that any information obtained will be used for the purpose of securing his or her appearance and/or apprehension for Court appearance, and for the purpose of securing reimbursement for any expenses incurred as a result of Defendant’s non-appearance. The Defendant hereby waives his or her rights with respect to all applicable federal and state privacy laws and authorizes the use of copies of this document by the Surety and its assigns and/or duly authorized representatives. In addition, if the Defendant escapes from the custody of the Surety, and is subsequently captured in a State of the United States other than the one in which the original charge was files, or in a foreign country, the Defendant does hereby agree to return voluntarily to the State of original jurisdiction, and does hereby waive extradition proceedings and further consents to the application of such force as may be necessary to effect such return.
Signed and delivered this____________ day of ______________________, 20__________