Disposition Of Cash Bail Regarding Restitution

JUSTICE COURT, LAS VEGAS TOWNSHIP CLARK COUNTY, NEVADA THE STATE OF NEVADA, ) ) Plaintiff, ) ) vs. ) CASE NO.: _________________________ ) DEPT. NO.: ____ ______________________________________, ) ) DISPOSITION OF CASH BAIL Defendant. ) REGARDING RESTITUTION ______________________________________________) Please check one of the boxes below: [ ] I do not authorize any of my cash bail to be applied to restitution in the above-entitled case. However, I do understand that my cash bail may be forfeited and used by the Court, without my authorization, to satisfy any fines, fees, or other Court-ordered costs assessed against the Defendant. Pursuant to NRS 53.045, I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct. ______________________________ PRINTED NAME _____________________________ SIGNATURE _________________________ DATE EXECUTED _________________________________________________________________________________________________ [ ] I do authorize Defendant's restitution requirements to be satisfied from my cash bail in the above-entitled case. (1) The total amount of cash bail that I posted is $_______________________________. (2) If the total restitution amount is greater than or equal to the amount above, I will not be entitled to any refund from my cash bail. If the total restitution amount is less than the amount above, and if the Court orders a refund from my remaining cash bail after fines and other obligations have been satisfied, then, upon completion of the case, I wish to have any balance of my cash bail returned to: [ ] Me [ ] The Defendant above. [ ] Other: ___________________________ Pursuant to NRS 53.045, I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct. ______________________________ _____________________________ _________________________ PRINTED NAME SIGNATURE DATE EXECUTED ====================================================================================== Revision Date--January 13, 2013--Website Form American LegalNet, Inc. www.FormsWorkFlow.com