IN THE ______________________
(Justice Court, Justice Court of Record, Municipal Court, City Court, City Court of Record)
 COUNTY OF _____________________, STATE OF MONTANA
                  (County)   

State of Montana

vs. 

________________________________
		Defendant.	
Case No:   	_____________________

BOND AFFIDAVIT 

	I, _______________________________________________, state that:
1.	I posted the Defendant’s bond in the amount of $___________________________.
2.	I agree that the bond may be used in the following manner:
  The entire bond may be forfeited and used to pay fines, restitution, court costs and surcharge or any other monies owed to the court by the Defendant.
  $ _______________________  may be forfeited and used to pay pay fines, restitution, court costs and surcharge or any other monies owed to the court by the Defendant.
  $ _______________________  may NOT be forfeited and should be refunded to:		(your name)	___________________________________________________
(your mailing address) _____________________________________________
(city, state, zip code) _____________________________________________
(your phone number) ______________________________________________

I declare under penalty of perjury and under the laws of the state of Montana that the foregoing is true and correct. I understand that giving false information in this affidavit is a crime.

Date:  _______________________________

Place of Signature:  City _______________	State _________________________

Your Signature:  ________________________________________________