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Fields marked (*) are mandatory.
Business Type Information
Applicant Information
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 ($)
Effective Date
Complete name and address of Obligee
FINANCIAL STATEMENT as of
Select one
Financial Information
ASSETS
Cash ($)
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 ($)
LIABILITIES
Accounts Payable ($)
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
GROSS SALES
Two Years Ago ($)
Last Year ($)
NET INCOME
Two Years Ago ($)
Last Year ($)
INDEMNITY
Probate Bond Information
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
Minor(s)
Incompetent
Applicant's relationship to
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.)
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
Additional Comments