For Help Call 954-533-0957 |
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Fields marked (*) are mandatory. |
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Business Type Information | |
Applicant Information |
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Applicant | |
Social Security # | |
Age | |
Marital Status | |
Residence Address | |
City | |
State | |
Zip | |
Business Address | |
City | |
State | |
Zip | |
Email Address | |
Home Phone | |
Work Phone | |
Occupation or Business | |
How long? | |
Previous Surety? | |
If yes, give name and reason for change | |
Type of Bond | |
Amount of Bond ($) | |
Effective Date | |
Complete name and address of Obligee | |
FINANCIAL STATEMENT as of | |
Select one | |
Financial Information |
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ASSETS |
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Cash ($) | |
List Banks below | |
Stocks & Bonds ($) | |
Describe | |
Notes Receivable ($) | |
Merchandise or Material in Stock ($) | |
Accounts Receivable ($) | |
Real Estate, Homestead A ($) | |
Real Estate, Investment B ($) | |
Furniture and Fixtures ($) | |
Other Assets ($) | |
TOTAL ASSETS ($) | |
LIABILITIES |
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Accounts Payable ($) | |
Taxes due & accrued ($) | |
Notes Payable to Bank ($) | |
Notes Payable to Others ($) | |
Mortgage on Real Estate A ($) | |
Mortgage on Real Estate B ($) | |
Other Liabilities ($) | |
Describe | |
TOTAL LIABILITIES ($) | |
Capital Stock (Paid in) ($) | |
NET WORTH OR SURPLUS ($) | |
TOTAL Liabilities / Net Worth ($) | |
Sales / Income |
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GROSS SALES |
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Two Years Ago ($) | |
Last Year ($) | |
NET INCOME |
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Two Years Ago ($) | |
Last Year ($) | |
INDEMNITY |
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Probate Bond Information |
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Name of deceased (Ward) | |
Date of death | |
Date of Appointment | |
(If over 6 months,please explain delay.) | |
Is applicant indebted to the estate or trust? | |
If yes,please explain | |
Name and address of attorney (if none, do not write the bond; sumbit to our underwriters) | |
Will the attorney remain involved throughout the duration of this estate? | |
Assets of estate or trust (describe) | |
Name, age, and health status of |
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Minor(s) | |
Incompetent | |
Applicant's relationship to |
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deceased | |
ward(s) | |
Applicant's Net Worth ($) | |
Are guardianship funds to be used for support of ward? | |
If Yes, approximately how much per month? ($) | |
What is the source of the guardianship funds? (If the insurance settlement, do not execute the bond; instead refer it to an underwriter) | |
Who are the heirs of this estate? | |
Has anyone objected to the applicant's appointment as fiduciary? | |
Will any going business (excluding farms) of the estate be continued by fiduciary? | |
(If Yes, send a copy of court order.) |
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Is this bond required on the demand of an interested person? | |
If Yes, who? | |
Name and address of court | |
What is the applicant's experience in handling fiduciary responsibilities? | |
Additional Comments |
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Additional Comments | |