Form DFS-H2-1542 "Statement of Surrender Form" - Florida

What Is Form DFS-H2-1542?

This is a legal form that was released by the Florida Department of Financial Services - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2011;
  • The latest edition provided by the Florida Department of Financial Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form DFS-H2-1542 by clicking the link below or browse more documents and templates provided by the Florida Department of Financial Services.

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Download Form DFS-H2-1542 "Statement of Surrender Form" - Florida

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Statement of Surrender Form
This form must be completed at the time of the surrender of a defendant by a bail bond agent with a copy provided to the defendant,
pursuant to §648.4425, Florida Statutes. If a jail has a separate surrender form; this form must be completed and attached to that form.
Defendant’s full name:
Criminal court case number:
Surrender Date:
Reason for surrender:
Please check one of the following:
Bail bond agent physically surrendered defendant
Defendant already in custody on other charges
Will premium be returned?
Yes
No
(If no, explain below)
Was a surrender fee charged?
Yes
No
If yes, state the amount and reason for the fee:
Charge
Date of Bond
Amount of Bond
Power Number
I
I
648,
DO HEREBY CERTIFY THAT
AM A LICENSED AND APPOINTED BAIL BOND AGENT PURSUANT TO CHAPTER
F
. I
LORIDA STATUTES
FURTHER CERTIFY THE SURRENDER OF THE ABOVE LISTED DEFENDANT IS FOR THE REASON
. I
STATED ABOVE
UNDERSTAND THAT WHOEVER KNOWINGLY MAKES A FALSE STATEMENT IN WRITING WITH THE
INTENT TO MISLEAD A PUBLIC SERVANT IN THE PERFORMANCE OF HIS OR HER OFFICIAL DUTIES IS GUILTY OF A
,
§837.06, F
S
.
MISDEMEANOR OF THE SECOND DEGREE
PURSUANT TO
LORIDA
TATUTES
Bail Bond Agent Signature:
Bail Bond Agent Printed Name:
Bail Bond Agent License Number:
Bail Bond Agency Name:
Bail Bond Agency Address:
Signature of Receiving Officer
(if applicable)
Original: Attach to jail surrender form (if applicable)
Copy:
Defendant
Copy:
Bail bond agent’s file
DFS-H2-1542
69B-221.100 (2), F.A.C.
Revised 06/11
Statement of Surrender Form
This form must be completed at the time of the surrender of a defendant by a bail bond agent with a copy provided to the defendant,
pursuant to §648.4425, Florida Statutes. If a jail has a separate surrender form; this form must be completed and attached to that form.
Defendant’s full name:
Criminal court case number:
Surrender Date:
Reason for surrender:
Please check one of the following:
Bail bond agent physically surrendered defendant
Defendant already in custody on other charges
Will premium be returned?
Yes
No
(If no, explain below)
Was a surrender fee charged?
Yes
No
If yes, state the amount and reason for the fee:
Charge
Date of Bond
Amount of Bond
Power Number
I
I
648,
DO HEREBY CERTIFY THAT
AM A LICENSED AND APPOINTED BAIL BOND AGENT PURSUANT TO CHAPTER
F
. I
LORIDA STATUTES
FURTHER CERTIFY THE SURRENDER OF THE ABOVE LISTED DEFENDANT IS FOR THE REASON
. I
STATED ABOVE
UNDERSTAND THAT WHOEVER KNOWINGLY MAKES A FALSE STATEMENT IN WRITING WITH THE
INTENT TO MISLEAD A PUBLIC SERVANT IN THE PERFORMANCE OF HIS OR HER OFFICIAL DUTIES IS GUILTY OF A
,
§837.06, F
S
.
MISDEMEANOR OF THE SECOND DEGREE
PURSUANT TO
LORIDA
TATUTES
Bail Bond Agent Signature:
Bail Bond Agent Printed Name:
Bail Bond Agent License Number:
Bail Bond Agency Name:
Bail Bond Agency Address:
Signature of Receiving Officer
(if applicable)
Original: Attach to jail surrender form (if applicable)
Copy:
Defendant
Copy:
Bail bond agent’s file
DFS-H2-1542
69B-221.100 (2), F.A.C.
Revised 06/11