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CARROLL COLLINS BONDING
207 Atlantic Ave.
Fort Pierce, Fla 33450
COLLATERAL SECURITY RECEIPT AND AGREEMENT
B11-A014216 10,000.00
, Bond No.g55-A001108 ~~t of Bond 0,000.08xecution Date Feb. 25, 1981
Principal 1 leman 109 Germani Dr. Ft. Pierce, FL 33450
ame an ~ress
Owner of Security John Coleman and Carol Coleman, His Wife
ame an ress
IMPORTANT! This security will be returned when all cases secured by
t s co ateral have been disposed of. No exchange of collateral will
be made.
The owner must bring this receipt and a Certificate of Dis osition*
8nd also proper identification at time o co atera re ease.
The owner may receive the released collateral via mail by forwarding
this receipt, a Certificate of Disposition* and a~~ten request to
the above address.
All cash deposits returnable by check only. No checks shall be cashed
or authorized for cash by this company.
NOTE: The court Certificate of Dis osition may be obtained from the
clerk of t e appropriate court. this se~urity pertains to
more than one case, a certificate must be obtained for each
case.
DESCRIPTION OF COLLATERAL:
1971 RITZC Mobil Home ID~~ 45GR15312 Title.~~4484274 Florida
1980 Chevy Truck ID~~ CLN14A8243496 Florida
' 1979 Chevy 4DR ID~~ 1B68E9Y289195 Florida
AGREEMENTS AND CONDITIONS OF DEPOSIT:
Carro]_1 Collins Bonding, (hereinafter called Surety) acknowledges
receipt of the above security from the party designated above as
Owner, deposited with Surety for the benefit of Surety and its co-
sureties,~reinsurers, successors and assigns, for a good consider-
ation and under the agreements and upon the condition hereinafter
stated ~~ .
The collateral security is pledged and deposited with Surety as
security:
(a) Against any and~all liability, loss, costs damages, expenses,
g~~K 350 Pa~E 9:3
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