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You are welcome .
Here is a form for =
Waiver of Rights / Authorization for Release of Personal Information
Bail Bond Company Name
ADRESS
PHONE #
Date: ________________
I, understand without my authorization XXX Bail Bonds, Inc there in after called XXX, would have to obtain a subpoena / court order to review my record(s) and record(s) will be used for the purpose of securing reimbursement for any expense and/or his/her appearance and or apprehension for court appearance. I hereby waive any and all rights I may have under Title 28 Privacy Act - Freedom of Information Act, Title 6, Fair Credit Reporting Act, and Electronic Communication Privacy Act, Patriot Act, Driver’s Privacy Protection Act (18 USC 123), Financial Responsibility Act, and any such Federal, Local, or State Law. I consent to and authorize without reservation the use of real time vehicle’s local (GPS) tracking system. I consent to and authorize without reservation, any party or agency, private and government (Local, State, Federal), contracted by KBB and / or its Agent. I also authorize KBB, and or its Agent to obtain, examine and to order copies of any and all private or public information and / or records concerning my past and / or present from party or agency, private or government (Local, State, Federal) including, but not limited to, Federal and / or State Welfare and Food Stamps Agencies, Low-Income Rental Public Housing, Rental Assistance Program (RAP), Section 8 Housing Assistance Payments Program, Child Care Services, Immigration & Naturalization Service / Homeland Security, Federal and / or State Department of Disability Insurance, Federal and / or State Department of Labor, wages or unemployment compensation from the State Employment Securities Agencies, Social Security records, Financial institutions, Banker’s Credit Card Company, Credit Reporting Agencies, (Credit Reports), Wireless / Cellular service provider (telephone toll billing records), private or public school(s), School Board of Education, Universities (school records), Hospital and / or Medical Clinic, Doctor, Dentist (Medical and / or admission records), State Motor Vehicles and Driver’s License Department (driving records, vehicle ownership), Worker compensation records, Residence(s) records and application(s), Satellite, Internet and Cable Television Provider(s), Video rental store(s), Federal / State / County / City / Local Law Enforcement Agencies / Police Department and / or Courts, Correction Officials (criminal records, jail records, civil records and / or background check(s)), State Vital Records (birth, marriage, and death records, private and public Utilities Service Provider (gas, water, and / or electric), Voters registration records. I also authorize without reservation and consent to KBB, and / or its Agent, to act on my behalf and utilize Federal and / or State Income Tax records (IRS Form 1040 and / or W-2), check and to obtain any and all State and / or Federal Child Support Collections and / or Enforcement Agency information and / or records concerning me and / or my minor child(ren). I do hereby release any and all parties, person(s) or agency, private or government (Local, State, Federal), from any and all claims, damages, losses and actions resulting from providing such information.
(PHOTOCOPY and / or FAX of this authorization shall have the same force and effect as an original copy)
**** DO NOT SIGN WITHOUT READING THIS CAREFULLY ****
I have read the above release and waiver of my rights form and I understand its contents completely.
Signature of Defendant: ____________________________________
Date of Birth: ___________________________ Social Security Number: ______________________________
Print / Type Defendant’s Full Legal Name: ________________________________________________________
Defendant’s Address: _____________________________________________________ Zip Code: ___________
Signature of Witness: ______________________________________
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JEFF P.
Limited Surety Agent (FL) - License # P_2O8124_
Private Investigator (FL) - License # C_27OOO33_
NABBI Member
"Surprise Sex is the Best Thing to Wake up to, UNLESS, You are in Jail... "
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