Cash Bail - Bail Assignment Application Form printable pdf download

C A S H

NYC DEPARTMENT OF FINANCE

TREASURY DIVISION

BAIL ASSIGNMENT APPLICATION

B A I L

Department of Finance

Mail to: NYC Department of Finance, Treasury/Court Assets Unit, 66 John Street, 12th Floor, New York, NY 10038

Instructions: This form must be completed by the person that paid the Cash Bail (i.e. the Surety). Complete, notarize, and sub-

mit this form along with a valid government picture ID such as a driver’s license, passport, or benefit card. If you do not have a

valid government issued ID you will need to provide copies of two (2) forms of ID to verify your identity. At least one ID must have

a photo and signature such as an employment or school ID. Other types of acceptable identification include a utility bill issued within

60 days, an ATM/Bank Card, or Social Security Card. For additional information visit our Cash Bail/Court & Trust Section at

or contact us at 212-908-7619 or visit us at nyc.gov/contactcashbail.

S E C T I O N I - S U R E T Y / T R A N S F E R I N F O R M A T I O N

A. Surety Information - (Information regarding the person who paid the bail and signed the receipt)

1. Name: _____________________________________________

_________________________________________________

PRINT LAST NAME OF SURETY

PRINT FIRST NAME OF SURETY

2. Current Address:_________________________________________________________________ Apt. #: _________________

NUMBER AND STREET

City: ____________________________________________________________ State: ________ Zip Code: ______________

3. Surety’s Phone Number ___________________________________ Email Address:___________________________________________

4. Defendant’s Name: _________________________________________

_____________________________________________

LAST NAME

FIRST NAME

5. Print Cash Bail amount you paid in this case: $ __________________

6. Print the Docket and/or

Treasury Receipt number: ___________________________________

________________________________________

(

)

DOCKET

INDICTMENT

TREASURY RECEIPT

NUMBER

B. Transfer Information

1. Print the name of the person or business entity you assign, set and transfer your rights, title and interest in this matter to:

___________________________________________________

_________________________________________________

PRINT LAST NAME OF ASSIGNEE

PRINT FIRST NAME OF ASSIGNEE

_______________________________________________________________________________________________________

PRINT NAME OF BUSINESS OR CORPORATION

2. Assignee’s Mailing Address:________________________________________________________ Apt. #: _________________

NUMBER AND STREET

City: ____________________________________________________________ State: ________ Zip Code: ______________

3. Print the amount of Cash Bail you are now assigning: $___________________________________________________________

4. Assignee’s Phone Number: __________________________

5. Email Address: ______________________________________

S E C T I O N I I - C E R T I F I C A T I O N

I certify that I am the above named surety and authorize this assignment. I hereby acknowledge that the information provided is true

and correct to the best of my knowledge.

_________________________________________________

Signature of Surety

Sworn to before me

on __________________________________, 20________

Notary

Affix

Stamp

_________________________________________________

Notary Public/Commissioner of Deeds

Here

F O R O F F I C I A L U S E O N L Y

_________________________________________________

_______________________________________________

Court Assets Member Approval and Date

Supervisor Approval and Date

Visit Finance at nyc.gov/finance

BailApp 12.11.2015

Cash Bail - Bail Assignment Application Form

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