Form DFS-H2-1541 "Designation or Deletion of Primary Bail Bond Agent" - Florida

What Is Form DFS-H2-1541?

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 December 1, 2018;
  • 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;
  • Fill out the form in our online filing application.

Download a printable version of Form DFS-H2-1541 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-H2-1541 "Designation or Deletion of Primary Bail Bond Agent" - Florida

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DEPARTMENT OF FINANCIAL SERVICES
Division of Insurance Agent & Agency Services – Bureau of Investigation - Bail Bond Section
200 East Gaines Street, Larson Building #412, Tallahassee, FL 32399-0320
FILING OF BAIL BOND AGENCY BUSINESS NAME AND
DESIGNATION/DELETION OF PRIMARY BAIL BOND AGENT
This form must be filed with the Department of Financial Services within 10 working days after agency inception,
agency change of address or change of primary bail bond agent designation, pursuant to ss. 648.387 & 648.421, FS
Is this a new bail bond agency?
Yes
No
AGENCY INFORMATION
Is this a change of address for the agency?
Yes
No
A
GENCY
E
MAIL:
N
:
AME
A
:
DDRESS
Florida
C
Z
C
ITY
IP
ODE:
P
:
F
:
HONE
AX
I
,
F THIS IS A CHANGE OF ADDRESS
PLEASE LIST THE PREVIOUS ADDRESS BELOW
A
:
DDRESS
Florida
C
Z
C
ITY
IP
ODE:
The primary bail bond agent is responsible for the overall
PRIMARY BAIL BOND AGENT
operation and management of this bail bond agency location.
L
#
N
(Last, First)
E
ICENSE
AME
MAIL
D
:
ESIGNATE
D
:
ELETE
OWNER INFORMATION
L
#
N
(Last, First)
E
ICENSE
AME
MAIL
O
WNER:
SIGNATURES
I attest that the above information is correct. The change is effective as of the date listed below.
I understand I must file a new form within ten (10) working days after a change in the information provided on this form.
O
S
:
D
:
WNER
S
IGNATURE
ATE
P
B
B
RIMARY
AIL
OND
D
:
ATE
A
S
:
GENT
S
IGNATURE
P
N
:
All questions will be directed to the primary bail bond agent listed on this form.
LEASE
OTE
P
R
T
F
T
T
A
L
A
T
T
O
P
,
LEASE
ETURN
HIS
ORM
O
HE
DDRESS
ISTED
T
HE
OP
F
AGE
OR
: Bail.Bond@MyFloridaCFO.com,
EMAIL TO
OR
F
: (850) 488-5951.
AX TO
DFS-H2-1541
Rule 69B-221.051, F.A.C.
Revised 12/18
DEPARTMENT OF FINANCIAL SERVICES
Division of Insurance Agent & Agency Services – Bureau of Investigation - Bail Bond Section
200 East Gaines Street, Larson Building #412, Tallahassee, FL 32399-0320
FILING OF BAIL BOND AGENCY BUSINESS NAME AND
DESIGNATION/DELETION OF PRIMARY BAIL BOND AGENT
This form must be filed with the Department of Financial Services within 10 working days after agency inception,
agency change of address or change of primary bail bond agent designation, pursuant to ss. 648.387 & 648.421, FS
Is this a new bail bond agency?
Yes
No
AGENCY INFORMATION
Is this a change of address for the agency?
Yes
No
A
GENCY
E
MAIL:
N
:
AME
A
:
DDRESS
Florida
C
Z
C
ITY
IP
ODE:
P
:
F
:
HONE
AX
I
,
F THIS IS A CHANGE OF ADDRESS
PLEASE LIST THE PREVIOUS ADDRESS BELOW
A
:
DDRESS
Florida
C
Z
C
ITY
IP
ODE:
The primary bail bond agent is responsible for the overall
PRIMARY BAIL BOND AGENT
operation and management of this bail bond agency location.
L
#
N
(Last, First)
E
ICENSE
AME
MAIL
D
:
ESIGNATE
D
:
ELETE
OWNER INFORMATION
L
#
N
(Last, First)
E
ICENSE
AME
MAIL
O
WNER:
SIGNATURES
I attest that the above information is correct. The change is effective as of the date listed below.
I understand I must file a new form within ten (10) working days after a change in the information provided on this form.
O
S
:
D
:
WNER
S
IGNATURE
ATE
P
B
B
RIMARY
AIL
OND
D
:
ATE
A
S
:
GENT
S
IGNATURE
P
N
:
All questions will be directed to the primary bail bond agent listed on this form.
LEASE
OTE
P
R
T
F
T
T
A
L
A
T
T
O
P
,
LEASE
ETURN
HIS
ORM
O
HE
DDRESS
ISTED
T
HE
OP
F
AGE
OR
: Bail.Bond@MyFloridaCFO.com,
EMAIL TO
OR
F
: (850) 488-5951.
AX TO
DFS-H2-1541
Rule 69B-221.051, F.A.C.
Revised 12/18