Fill and Sign the Appellant Having Appealed from a Judgment of This Court Rendered on 2 Form

________________ ________________________________ APPELLANT VS. _____ ___ ________________________________________ APPELLEE The Appellant having appealed from a judgment of this Court rendered on ___________________________, 2______, for $________________ and costs, we, ______________________________________________________________, as principal, and _____________________________________________________________, as surety, bind ourselves and our estates to Appellee in the amount of $______________________ to satisfy the judgment together with interest, costs and damages for delay if for any reason the appeal is dismissed or the judgment is affirmed, and to satisfy in full such modification of the judgment and such interest and costs, including costs of the appeal, as the appellate court may adjudge. I, as surety, agree that my liability may be enforced by Notice and Motion as provided in CR 5 and CR 73.07. Principal’s Signature: ____________________________________________________________________________ Address: _______________________________________________________________________________________ _______________________________________________________________________________________________ _____________________ __________________________________________________________________________ Surety’s Signature: _ ___________________________________________________________________________ Address: _______________________________________________________________________________________ _______________________________________________________________________________________________ __________________ _____________________________________________________________________________ BOND APPROVED: ____________________, 2______. _____ ______________________________________ Title: __ ________ _____ _______________________ I certify I have served notice of the approval of this bond on all Appellees as required by CR 62.03. Date: ________________________________, 2______. ___ __________________________ __________Clerk By: ____________________________________ D.C. Case No. ____________________ Court _______________________ County _______ _______________ AOC- 155 Doc. Code: BSU Rev. 12-10 Page 1 of 1 Commonwealth of Kentucky CR 73.04, 73.07, 62.03(1) SUPERSEDEAS BOND l e xe \b j u s \b i \b i a COMMONWEALTHOFKENTUCKY COURTOFJUSTICE AFFIDAVIT OF SURETY I, as surety, swear (or affirm) I am a resident of _ _____ ________________________ County, Kentucky; I own property worth double the amount to be secured by this bond beyond the amount of my debts; and I own property in Kentucky subject to execution equal to the amount of this bond. Surety Signature: ____ _____________________________________ Sworn to before me this _____________________, 2______. __________________________________ Clerk By: _________________________________ D.C. Court of Justice