Indemnitor Application and Agreement
Brazoria County

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INDEMNITOR APPLICATION AND AGREEMENT

You, the undersigned indemnitor (“Indemnitor” or “you”), hereby represent and warrant that the following declarations made and answers given are true, complete and correct and are made for the purpose of inducing Lexington National Insurance Corporation (“Surety”) to issue, or cause to be issued, bail bond(s) or undertaking(s) (singularly or collectively the “Bond”) for for FIRST - MIDDLE - LAST NAME (“Defendant”), using power of attorney (if known) , in the total amount of Dollars ( DOLLARS FIELD) in the IN THE FIELD Court of COURT OF FIELD

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