COLLATERAL RECEIPT





COLLATERAL RECEIPT


Bankers Insurance Company


P.O. Box 15707


St. Petersburg, FL 33733











BondsmanManaging General AgentBankers Insurance Company
For inquiries or complaints contact the Department of Insurance.



Said collateral is deposited as security for the payment of any sums which may become due to the Agency or BANKERS INSURANCE COMPANY by the terms of the Bail Bond Agreement executed for the said Bond(s) by the said Depositor and Indemnitors, all of the terms of which are made a part of this receipt by this reference. Collateral will be returned only to depositor. No collateral will be returned until the Court has furnished written evidence the bond has been exonerated and this receipt is returned.

RECEIPT FOR RETURN OF COLLATERAL

The undersigned hereby acknowledges the return of the above described collateral







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