12890 Lebanon Road
Mt. Juliet, TN 37122
Phone: 615-553-9500
Fax: 615-553-9502
JUDICIAL / COURT
BOND APPLICATION
Http://www.LexonSurety.com
BOND INFORMATION
TYPE OF BOND
CAUSE/CASE #
STATE CODE # (IF APPLICABLE)
AMOUNT
COURT
STATE
COUNTY
Select Bond Type From List
ATTACH COPY OF COMPLAINT/JUDGMENT AND DETAILS OF LITIGATION
PLAINTIFF
PRINCIPAL
DEFENDANT
PRINCIPAL
PRINCIPAL'S ADDRESS
DATE BUSINESS BEGAN
SSN OR TAX ID#
CITY
STATE
PHONE #
OCCUPATION OR INDUSTRY
ZIP
CITY
STATE
IS APPLICANT A PRIVATELY HELD COMPANY; OWNERS FULL NAME
OWNERS HOME ADDRESS
EMAIL ADDRESS
ZIP
OWNER PHONE #
SSN
DOES THE BUSINESS OR ANY PRINCIPAL INVOLVED: IF YES, ATTACH AN EXPLANATION
HAVE ANY OUTSTANDING COLLECTION ITEMS OR LIENS?
YES
NO
HAD ANY LAWSUITS OR JUDGMENTS AGAINST THEM?
YES
NO
EVER FAILED IN BUSINESS OR DECLARED BANKRUPTCY?
YES
NO
EVER HAD A BOND CANCELLED OR DENIED?
YES
NO
APPLICANTS ATTORNEY
ATTORNEY PHONE #
ATTORNEY ADDRESS
CITY
BOND TO BE FILED IN THE
COURT OF
COUNTY OF
AMOUNT OF LIABILITY, CLAIM JUDGMENT AND/OR VALUE OF PROPERTY IN CONTROVERSY
DOES THE CASE INVOLVE A DOMESTIC DISPUTE?
YES
ZIP
STATE
STATE OF
EXPLAIN PURPOSE OF BOND
NO
RECEIVER, BANKRUPTCY, TRUSTEE, ASSIGNEE BONDS
DEBTOR
ADDRESS
TYPE OF ACTION
LIQUIDATION
DO YOU CARRY FIDELITY COVERAGE?
REORGANIZATION
RECEIVER OF RENTS
YES
NO
YES
NO
CARRIER:
IF YES, WHAT AMOUNT?
DO YOU CARRY PROFESSIONAL LIABILITY OR E&O COVERAGE?
IF YES, WHAT AMOUNT?
OTHER
OTHER, PLEASE EXPLAIN:
CARRIER:
PLAINTIFF'S BONDS
FOR REPLEVIN, ATTACHMENT, GARNISHMENT, SEQUESTRATION, DISTRESS FOR RENT - State amount and character of plaintiffs claim, the grounds for attachment, a description of the property seized and the disposition that will be
made of same during the litigation. State nature and amounts of counter-claims, if any.
FOR INJUNCTION, TEMPORARY RESTRAINING ORDER - State briefly what complainant seeks to enjoin, defend from doing or to compel defendant to do. Also state what property is invlved and what damages may be claimed if injunction
is held improperly made.
FOR ALL OTHER CASES - State fully and particularly all the facts of the case having any bearing upon the risk involved, attaching copy of other important papers or pleadings.
DEFENDANT'S BONDS
FOR COUNTER REPLEVIN, RELEASE OF GARNISHMENT, RELEASE OF ATTACHMENT, RELEASE OF MECHANICS LIEN - Provide a statement of the character of the Defendants defense, Description of the seized property and state the nature
and amounts of the initial claim and provide a copy of the initial Judgment/Lien.
FOR INJUNCTION, TEMPORARY RESTRAINING ORDER - State briefly what complainant seeks to enjoin, defend from doing or to compel defendant to do. Also state what property is invlved and what damages may be claimed if injunction
is held improperly made.
ATTORNEY'S RECCOMENDATION