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Form Dc-415 - Notice Of Application And Motion For Remission Of Bail Forfeited - Stte Of New York Page 2

DISTRICT COURT OF THE COUNTY OF SUFFOLK

First District

Affidavit of Person Posting Cash Bail, in support

People of the State of New York

of Application for Remission of Bail Forfeited

pursuant to CPL §540.30

‐against‐

Defendant

Docket No.

}

STATE OF NEW YORK

ss.:

COUNTY OF SUFFOLK

______________________________________________, being duly sworn, deposes and says:

That on the ________ day of ________, 20__, the above defendant was arraigned in District Court,

Suffolk County and was charged with the offenses of ________________________________________

______________________________________________________________________________________.

That after the arrest of the defendant, on the ________ day of ________, 20__, I posted cash bail in

the amount of _________________________ ($________) Dollars for his release, upon the condition

that such money would become forfeit to the People of the State of New York if the defendant did

not comply with the directions of the court requiring his attendance at this prosecution or did not

otherwise render himself amenable to the orders and processes of the Court.

That I have now learned that the defendant was directed to appear on ___________________, 20___,

and that the defendant did not appear as directed, whereupon the Court ordered the aforesaid cash

bail forfeited.

That the defendant subsequently appeared on _________________, 20____.

Note: Below, specify the facts that the Judge should consider to grant your request to have the forfeited bail money returned to you ‐

you might include why the defendant did not appear as directed (if you are not the defendant, you might include an

affidavit from the defendant as to the reason for not appearing); and any exceptional circumstances (financial or medical

problems, for instance); and how it is that the prosecutor suffered no prejudice or loss of rights; and references to

additional affidavits or documentation, which will be attached to your application.

That

DC‐415(07/06) page 2of 3

Form Dc-415 - Notice Of Application And Motion For Remission Of Bail Forfeited - Stte Of New York Page 2