CASE NUMBER
Kansas
Form
RESET
BOND
6-65
IN THE CIRCUIT COURT OF
COUNTY, DIVISION
DEFENDANT’S NAME, ADDRESS, ZIP CODE TYPE OF BOND
 Unsecured
 Cash
BOND AMOUNT
 10%
 Property
BOND RECEIVED
 Surety
DESCRIPTION OF SECURITIES (IF APPLICABLE)
TELEPHONE
SOCIAL SECURITY NUMBER
DATE OF BIRTH
 Check if Surety Qualifications Filed
NEXT COURT HEARING (DATE, TIME. DIVISION) CHARGES
I/We as principal/sureties agree to pay the State of Kansas the sum of $
abides by the conditions as set out below.
unless the defendant
BOND CONDITIONS AND CONSEQUENCES FOR FAILURE TO MEET CONDITIONS:
Having been (charged with/convicted of) the criminal offense(s) shown above, the defendant (or his surety) has posted this bond in
order to be released from the Sheriff’s custody.
THE DEFENDANT IS REQUIRED TO:
1. Attend all court hearings as set by this court or any court to which this case is transferred or appealed.
2. Submit to any orders, judgments and sentence of this court or any court hearing this case.
3. Inform the court of any change of address.
4. OTHER CONDITIONS:
a. Defendant shall not tamper with a witness or victim nor allow another person on his behalf to tamper with a witness or victim
as described on the reverse of this form.
b.
c.
If the defendant follows the above conditions, he will be released from this bond and any cash or securities deposited will be returned
to the defendant or his assignee after the original receipt is presented to the clerk.
THE DEFENDANT UNDERSTANDS that the consequences for failure to follow any of the above conditions are:
1. Forfeit any cash or securities deposited with the court.
2. The court has the authority to sell the defendant’s property to collect the full amount of the bond.
3. If the defendant fails to abide by condition 1., a warrant will be issued for his arrest and in addition to the above charges, a charge
of failure to appear may be filed.
DEFENDANT’S SIGNATURE DATE WITNESSED BY
FOR PERSONS OTHER THAN THE DEFENDANT WHO POST BOND:
I now assume custody for the defendant. The defendant will appear and abide by the conditions as shown above. If the defendant
fails to do so, I understand that I or the company I represent must forfeit or pay the full amount of the bond or it will be levied against
my property or estate or the property of the company I represent. If the bond concerns a case on appeal from the Circuit Court, I
irrevocably appoint the Clerk of this Court and the Clerk of the Appellate Court as my agent to receive service of any notice or
process in connection with the forfeiture of this bond. If acting as bail bond agent or general bail bond agent, I attest that I have no
unsatisfied judgments against me.
SIGNATURE OF PERSON POSTING BOND ADDRESS APPROVED BY (JUDGE OR CLERK)
LICENSE NO. (IF APPLICABLE) SIGNATURE OF PERSON POSTING BOND
ADDRESS
DATE
Two-Page
Form,
All Three
Copies;
Copy to Court
White
– COURT
CopySign
• Yellow
– AGENT
Copy Original
• PINK – DEFENDANT
Copy
ASC-KS-011 (2/14)
WITNESS/VICTIM TAMPERING
21-5909.Intimidation of a witness or victim; aggravated intimidation of a witness or victim.
(a)Intimidation of a witness or victim is preventing or dissuading, or attempting to prevent or dissuade, with an intent
to vex, annoy, harm or injure in any way another person or an intent to thwart or interfere in any manner with the
orderly administration of justice:
(1)Any witness or victim from attending or giving testimony at any civil or criminal trial, proceeding or inquiry
authorized by law; or
(2)any witness, victim or person acting on behalf of a victim from:
(A)Making any report of the victimization of a victim to any law enforcement officer, prosecutor, probation
officer, parole officer, correctional officer, community correctional services officer or judicial officer,
the secretary of the department of social and rehabilitation services or any agent or representative of
the secretary, or any person required to make a report pursuant to K.S.A. 2013 Supp. 38-2223, and
amendments thereto;
(B)causing a complaint, indictment or information to be sought and prosecuted, or causing a violation
of probation, parole or assignment to a community correctional services program to be reported and
prosecuted, and assisting in its prosecution;
(C)causing a civil action to be filed and prosecuted and assisting in its prosecution; or
(D)arresting or causing or seeking the arrest of any person in connection with the victimization of a victim.
(b)Aggravated intimidation of a witness or victim is intimidation of a witness or victim, as defined in subsection (a),
when the:
(1)Act is accompanied by an expressed or implied threat of force or violence against a witness, victim or other
person or the property of any witness, victim or other person;
(2)act is in furtherance of a conspiracy;
(3)act is committed by a person who has been previously convicted of corruptly influencing a witness or has been
convicted of a violation of this section or any federal or other state’s statute which, if the act prosecuted was
committed in this state, would be a violation of this section;
(4)witness or victim is under 18 years of age; or
(5)act is committed for pecuniary gain or for any other consideration by a person acting upon the request of
another person.
(c) (1)Intimidation of a witness or victim is a class B person misdemeanor.
(2)Aggravated intimidation of a witness or victim is a severity level 6, person felony.
History: L. 2010, ch. 136, § 134; L. 2012, ch. 157, § 3; July 1.
Two-Page Form, Sign All Three Copies; Original Copy to Court
CASE NUMBER
Kansas
Form
BOND
6-65
IN THE CIRCUIT COURT OF
COUNTY, DIVISION
DEFENDANT’S NAME, ADDRESS, ZIP CODE TYPE OF BOND
 Unsecured
 Cash
BOND AMOUNT
 10%
 Property
BOND RECEIVED
 Surety
DESCRIPTION OF SECURITIES (IF APPLICABLE)
TELEPHONE
SOCIAL SECURITY NUMBER
DATE OF BIRTH
 Check if Surety Qualifications Filed
NEXT COURT HEARING (DATE, TIME. DIVISION) CHARGES
I/We as principal/sureties agree to pay the State of Kansas the sum of $
abides by the conditions as set out below.
unless the defendant
BOND CONDITIONS AND CONSEQUENCES FOR FAILURE TO MEET CONDITIONS:
Having been (charged with/convicted of) the criminal offense(s) shown above, the defendant (or his surety) has posted this bond in
order to be released from the Sheriff’s custody.
THE DEFENDANT IS REQUIRED TO:
1. Attend all court hearings as set by this court or any court to which this case is transferred or appealed.
2. Submit to any orders, judgments and sentence of this court or any court hearing this case.
3. Inform the court of any change of address.
4. OTHER CONDITIONS:
a. Defendant shall not tamper with a witness or victim nor allow another person on his behalf to tamper with a witness or victim
as described on the reverse of this form.
b.
c.
If the defendant follows the above conditions, he will be released from this bond and any cash or securities deposited will be returned
to the defendant or his assignee after the original receipt is presented to the clerk.
THE DEFENDANT UNDERSTANDS that the consequences for failure to follow any of the above conditions are:
1. Forfeit any cash or securities deposited with the court.
2. The court has the authority to sell the defendant’s property to collect the full amount of the bond.
3. If the defendant fails to abide by condition 1., a warrant will be issued for his arrest and in addition to the above charges, a charge
of failure to appear may be filed.
DEFENDANT’S SIGNATURE DATE WITNESSED BY
FOR PERSONS OTHER THAN THE DEFENDANT WHO POST BOND:
I now assume custody for the defendant. The defendant will appear and abide by the conditions as shown above. If the defendant
fails to do so, I understand that I or the company I represent must forfeit or pay the full amount of the bond or it will be levied against
my property or estate or the property of the company I represent. If the bond concerns a case on appeal from the Circuit Court, I
irrevocably appoint the Clerk of this Court and the Clerk of the Appellate Court as my agent to receive service of any notice or
process in connection with the forfeiture of this bond. If acting as bail bond agent or general bail bond agent, I attest that I have no
unsatisfied judgments against me.
SIGNATURE OF PERSON POSTING BOND ADDRESS APPROVED BY (JUDGE OR CLERK)
LICENSE NO. (IF APPLICABLE) SIGNATURE OF PERSON POSTING BOND
ADDRESS
DATE
Two-Page
Form,
Sign All– AGENT
ThreeCopy
Copies;
Producer
CopyCopy
White
– COURT Copy
• Yellow
• PINK
– DEFENDANT
ASC-KS-011 (2/14)
WITNESS/VICTIM TAMPERING
21-5909.Intimidation of a witness or victim; aggravated intimidation of a witness or victim.
(a)Intimidation of a witness or victim is preventing or dissuading, or attempting to prevent or dissuade, with an intent
to vex, annoy, harm or injure in any way another person or an intent to thwart or interfere in any manner with the
orderly administration of justice:
(1)Any witness or victim from attending or giving testimony at any civil or criminal trial, proceeding or inquiry
authorized by law; or
(2)any witness, victim or person acting on behalf of a victim from:
(A)Making any report of the victimization of a victim to any law enforcement officer, prosecutor, probation
officer, parole officer, correctional officer, community correctional services officer or judicial officer,
the secretary of the department of social and rehabilitation services or any agent or representative of
the secretary, or any person required to make a report pursuant to K.S.A. 2013 Supp. 38-2223, and
amendments thereto;
(B)causing a complaint, indictment or information to be sought and prosecuted, or causing a violation
of probation, parole or assignment to a community correctional services program to be reported and
prosecuted, and assisting in its prosecution;
(C)causing a civil action to be filed and prosecuted and assisting in its prosecution; or
(D)arresting or causing or seeking the arrest of any person in connection with the victimization of a victim.
(b)Aggravated intimidation of a witness or victim is intimidation of a witness or victim, as defined in subsection (a),
when the:
(1)Act is accompanied by an expressed or implied threat of force or violence against a witness, victim or other
person or the property of any witness, victim or other person;
(2)act is in furtherance of a conspiracy;
(3)act is committed by a person who has been previously convicted of corruptly influencing a witness or has been
convicted of a violation of this section or any federal or other state’s statute which, if the act prosecuted was
committed in this state, would be a violation of this section;
(4)witness or victim is under 18 years of age; or
(5)act is committed for pecuniary gain or for any other consideration by a person acting upon the request of
another person.
(c) (1)Intimidation of a witness or victim is a class B person misdemeanor.
(2)Aggravated intimidation of a witness or victim is a severity level 6, person felony.
History: L. 2010, ch. 136, § 134; L. 2012, ch. 157, § 3; July 1.
Two-Page Form, Sign All Three Copies; Producer Copy
CASE NUMBER
Kansas
Form
BOND
6-65
IN THE CIRCUIT COURT OF
COUNTY, DIVISION
DEFENDANT’S NAME, ADDRESS, ZIP CODE TYPE OF BOND
 Unsecured
 Cash
BOND AMOUNT
 10%
 Property
BOND RECEIVED
 Surety
DESCRIPTION OF SECURITIES (IF APPLICABLE)
TELEPHONE
SOCIAL SECURITY NUMBER
DATE OF BIRTH
XXXXXXXXXXXXXX XXXXXXXXXXXXXXX
NEXT COURT HEARING (DATE, TIME. DIVISION)  Check if Surety Qualifications Filed
CHARGES
I/We as principal/sureties agree to pay the State of Kansas the sum of $
abides by the conditions as set out below.
unless the defendant
BOND CONDITIONS AND CONSEQUENCES FOR FAILURE TO MEET CONDITIONS:
Having been (charged with/convicted of) the criminal offense(s) shown above, the defendant (or his surety) has posted this bond in
order to be released from the Sheriff’s custody.
THE DEFENDANT IS REQUIRED TO:
1. Attend all court hearings as set by this court or any court to which this case is transferred or appealed.
2. Submit to any orders, judgments and sentence of this court or any court hearing this case.
3. Inform the court of any change of address.
4. OTHER CONDITIONS:
a. Defendant shall not tamper with a witness or victim nor allow another person on his behalf to tamper with a witness or victim
as described on the reverse of this form.
b.
c.
If the defendant follows the above conditions, he will be released from this bond and any cash or securities deposited will be returned
to the defendant or his assignee after the original receipt is presented to the clerk.
THE DEFENDANT UNDERSTANDS that the consequences for failure to follow any of the above conditions are:
1. Forfeit any cash or securities deposited with the court.
2. The court has the authority to sell the defendant’s property to collect the full amount of the bond.
3. If the defendant fails to abide by condition 1., a warrant will be issued for his arrest and in addition to the above charges, a charge
of failure to appear may be filed.
DEFENDANT’S SIGNATURE DATE WITNESSED BY
FOR PERSONS OTHER THAN THE DEFENDANT WHO POST BOND:
I now assume custody for the defendant. The defendant will appear and abide by the conditions as shown above. If the defendant
fails to do so, I understand that I or the company I represent must forfeit or pay the full amount of the bond or it will be levied against
my property or estate or the property of the company I represent. If the bond concerns a case on appeal from the Circuit Court, I
irrevocably appoint the Clerk of this Court and the Clerk of the Appellate Court as my agent to receive service of any notice or
process in connection with the forfeiture of this bond. If acting as bail bond agent or general bail bond agent, I attest that I have no
unsatisfied judgments against me.
SIGNATURE OF PERSON POSTING BOND ADDRESS APPROVED BY (JUDGE OR CLERK)
LICENSE NO. (IF APPLICABLE) SIGNATURE OF PERSON POSTING BOND
ADDRESS
DATE
Two-Page
Form, Copy
Sign All
Three –Copies;
Defendant
Indemnitor
Copy
White – COURT
• Yellow
AGENT Copy
• PINK –or
DEFENDANT
Copy
ASC-KS-011 (2/14)
WITNESS/VICTIM TAMPERING
21-5909.Intimidation of a witness or victim; aggravated intimidation of a witness or victim.
(a)Intimidation of a witness or victim is preventing or dissuading, or attempting to prevent or dissuade, with an intent
to vex, annoy, harm or injure in any way another person or an intent to thwart or interfere in any manner with the
orderly administration of justice:
(1)Any witness or victim from attending or giving testimony at any civil or criminal trial, proceeding or inquiry
authorized by law; or
(2)any witness, victim or person acting on behalf of a victim from:
(A)Making any report of the victimization of a victim to any law enforcement officer, prosecutor, probation
officer, parole officer, correctional officer, community correctional services officer or judicial officer,
the secretary of the department of social and rehabilitation services or any agent or representative of
the secretary, or any person required to make a report pursuant to K.S.A. 2013 Supp. 38-2223, and
amendments thereto;
(B)causing a complaint, indictment or information to be sought and prosecuted, or causing a violation
of probation, parole or assignment to a community correctional services program to be reported and
prosecuted, and assisting in its prosecution;
(C)causing a civil action to be filed and prosecuted and assisting in its prosecution; or
(D)arresting or causing or seeking the arrest of any person in connection with the victimization of a victim.
(b)Aggravated intimidation of a witness or victim is intimidation of a witness or victim, as defined in subsection (a),
when the:
(1)Act is accompanied by an expressed or implied threat of force or violence against a witness, victim or other
person or the property of any witness, victim or other person;
(2)act is in furtherance of a conspiracy;
(3)act is committed by a person who has been previously convicted of corruptly influencing a witness or has been
convicted of a violation of this section or any federal or other state’s statute which, if the act prosecuted was
committed in this state, would be a violation of this section;
(4)witness or victim is under 18 years of age; or
(5)act is committed for pecuniary gain or for any other consideration by a person acting upon the request of
another person.
(c) (1)Intimidation of a witness or victim is a class B person misdemeanor.
(2)Aggravated intimidation of a witness or victim is a severity level 6, person felony.
History: L. 2010, ch. 136, § 134; L. 2012, ch. 157, § 3; July 1.
Two-Page Form, Sign All Three Copies; Defendant or Indemnitor Copy