STATE OF SOUTH CAROLINA,	)
)	IN THE COURT OF
COUNTY/MUNICIPALITY OF	)
)

)	AFFIDAVIT OF SURRENDER OF

DEFENDANT BY SURETY
STATE OF SOUTH CAROLINA	)
)	Amount of Bond:
vs.	)	S.S.N.:
)	D.O.B.:
)	By:
Defendant.

IN RE:

Surety	)

)

)

)	Date of Bond:
PERSONALLY APPEARED BEFORE ME, the undersigned surety/deponent, who being duly sworn, states that he is a duly authorized representative of Surety Company, who is contractually acting as surety for the above named defendant on the following ticket warrant indictment number(s) and charges: .

Defendant was incarcerated by surety/deponent for a violation or imminent violation of a specific term(s) of the bail bond as sworn to below. Surety/deponent states under penalty of perjury that the information contained in this Affidavit constitutes good cause for the immediate incarceration of defendant.

Defendant was incarcerated by surety/deponent law enforcement as the result of a bench warrant for a violation of a specific term(s) of the bail bond as stated in the bench warrant and sworn to below.

(Attach additional sheets if necessary.)

Sworn to and Subscribed before me	)
this	day of	,	2	)
)	Signature of Surety/Deponent
Notary Public for South Carolina	)
My Commission expires	)	Surety Company

I have received custody of the above named defendant pursuant to immediate incarceration by surety bench warrant and the defendant will remain in custody until such time as notice concerning defendant is received from a clerk of court or court of competent jurisdiction.

Officer: Date:
Detention Facility for the: County Municipality of

SCCA/636 (07/2008)

STATE OF SOUTH CAROLINA,

cyon

2008-08-01

drosengrant

SC Judicial Dept