t-'erson Out of Prison
\.:lt::C
You will need the followi
. For Entertainment Purposes Only
c
1. A Birth Certificate -and So~~-securit N
2. The Oockf:'tb) for each
,
y umber For Each Pearson You Want Out
And Docket • Inmate # t~ !:c"h <p;r~:n~ase # • If Appealed - Appellate Court Case If
3. Pnson Name and Addrcsc; (not PO 8 ) h
4. Wardon 's Address (PO Box A
tabolx) w ere person(s) are currently incarcerated
ccep
e
5 p
a· M erson who will serve as_~ower of Attorney for the person(s) incarcerated
• oney to cover costs of f1hng and verification paperwork • about $200 to $600.
Order of Filing
(No Staples
Forms mu
st
Only Paper Clips Accepted)
be filed in the court that has jurisdiction to act on them, which is where the case was heard. That's the
court that issued the bonds that you want to pay off
1. STANDARD FORM 28 AFFIDAVIT OF INDIVIDUAL SUERTY
2. POWER OF ATTORNEY
3. OPTIONAL FORM 90 RELEASE OF LIEN ON REAL PROPERTY
4. OPTIONAL FORM 91 RELEASE OF PERSONAL PROPERTY FROM ESCROW
5. STAN OARD FORM 24 BIO BONO
6. STANDARD FORM 25 PERFORMANCE BOND
7 . STANDARD FORM 25A PAYMENT BOND
8.
a. COPY OF BIRTH CERTIFICATE -ATTACHED ( WITH PAPERCLIP) TO FORM 25A
Write copy across colored copy of Birth Certificate diagonally in red ink - if not
A copy but an original BC - do not write anything on it.
9. COPY OF THE DOCKET
First Form SF 28 (Two Pages)
STANDARD FORM 28 AFFIDAVIT OF INDIVIDUAL SURETY (Front Page)
(2 Pages - Front and Back - do not staple but use paper clip)
STATE OF : (State where Notary is from - best to use a notary from the state where the person is incar~e~ated) . If
you are filling out the forms for someone else you can use a notary by your home - you are only venfymg your
signature as Power of Attorney.
COUNTY OF: (Where it was notarized)
ss.:
Leave blank
1
- NAME
AYNE _Must be the name on the Birth certificate . If the
GEARLD
DOVEhP
'ddle name on the Birth Certificate you must put NMN between
Person as no m,
The First and Last Name. Eg.- ERALD NMN PAYNE
2. HOME ADDR~S~ : .
u must use their prison address .
Since the person IS ,n prison -yo NAME and PRISON ADDRESS must be in all CAPS.
The PRISON
pl . FMC ROCHESTER
Exam e. FEDERAL MEDICAL CENTER
2110 EAST CENTER STREET
ROCHESTER, MN 55904
2
3. TYPE ANO DURATION OF OCCUPATION·
SUERTY/LIFETIME
.
4 · NAME AND ADDRESS OF EMPLOYER
The prison name and address_ all caps.
FMC ROCHESTER
FEDERAL MEDICAL CENTER
2110 EAST CENTER STREET
ROCHESTER, MN 55904
5. NAME AND ADDRESS OF INDIVIDUAL SUERTY BROKER USED ·
Box 4 - United States
c/o 55 Water Street, New York City, New York 10041-0099
6 . TELEPHONE NUMBER:
HOME: NIA
BUSINESS - NIA
7. THE FOLLOWING IS A TRUE REPRESENTATION OF THE ASSETS I HAVE PLEGEO TO THE UNITED
STATES IN SUPPORT OF THE ATTACHED BONO:
(a) See CRIMINAL CASE NUMBER: 8:05-cv-259-T-JOW #38293-018, C-1
(If an appeal then typen in· See APPELLATE CASE#------·-····)
See attached OPTIONAL FORM 90 RELEASE OF LIEN ON REAL PROPERTY
See attached OPTIONAL FORM 91 RELEASE OF PERSONAL PROPERTY FROM ESCROW
See attached ST ANO ARD FORM 24 BID BOND
See attached STANDARD FORM 25 PERFORMANCE BOND
See attached STANDARD FORM 25A PAYMENT BOND
(b) Leave Blank In no Appeal. If Appeal then type in both Original Criminal Case # and type in the Appellate
Case # as well.
8. IDENTIFY ALL MORTGAGES, LIENS, JUDGMENTS, ETC.:
Type in the Criminal Case#; (Type in Appellate Case# if appealed); Then type in the Inmate#
Example:
805-CV-259-T-JDW
#38239-018-C-1
9. IDENTIFY All BONDS, INCLUDING BID GUARANTEES, ETC.:
Type in Case # (Appellate Case # - if one exists) Inmate Number
Remember to type Forms in proper order.
See attachment OPTIONAL FORM 90 RELEASE OF LIEN ON REAL PROPERTY
See attachment OPTIONAL FORM 91 RELEASE OF PERSONAL PROPERTY FROM ESCROW
See attachment STANDARD FORM 25A PAYMENT BOND
See attachment STANDARD FORM 24 BID BOND
See attachment STANDARD FORM 25 PERFORMANCE BOND
DOCUMENTS OF THE PLEDGED ASSET MUST BE ATTACHED
~~@f'~ (9"~~f~~ao rti5(}!}f
10. SIGNATURE:
The Signature must be in blue ink - signed by the person who has Power of Attorney.
11 . BOND AND CONTRACT TO WHICH THIS ADDIDAVIT RELATES :
3
OPTIONAL FORM 90 RELEASE OF LIEN ON REAL PROPERTY
OPTIONAL FORM 91 RELEASE OF PERSONAL PROPERTY FROM ESCROW
12. SUBSCRIBED ANO SWORN TO BETORE ME AS FOLLOWS:
Notary: It is best to use a Notary from the State where the person is incarcerated . If you are filling out the forms
for someone else and have to use a Notary who lives close to you then that is okay but not the best.
-- - -- - ----- --Back Page· Leave blank but attach to Front Page with a Paper Clip (No Staples)
- ----- ------ -- ----- - ---- ---------------
- -- --- -
Second form (Power Of Attorney}
- - - -- -- - - - --- -- - --- ---- -- -Third Form - OF 90 • Two Pages :
OPTIONAL FORM 90 RELEASE
OF LIEN ON REAL PROPERTY
CTWO PAGES - FRONT AND BACK)
Whereas GERALD
DOVE PAYNE.
(STRAWMAN in all caps)
ST ATE (IF #NOT HYPENATEO) ./ birth certificate #
(Place of Residence)
Of
ce,rson who 15 1n Rrim SOtkt
by a bond for the pe rf orma nco Of U .s . Government Contract Number
Security ,1
and recorded this pledge on
CRIMINAL Court en, Nymbt[) {tf Appftl Use Sbt\ f )
Ooo>t1t
#)
in
th11
or
FEDERAL MEDICA L •CENTER
-
MINNESOTA
, held) (Stahl -
(l oc.ahty - Name of prison where person s
•
I Qerafd
Whrnt J!> , - · -
Doye payne bY John dot OS eo6
Notary Notarizes ( The notary has
.
. ,ts loolte
~ ~)
whore pn.c;on
·oo last livu<t)
to bO In IM some county wtiero too pot"S
ffi(!ll()k/ ~
No Notnry
•
tl'f)...</:r
~,., ;.JM- ~~
(S1gt1iltllrOl
S0;:,1
Thumb Ptlnl (Red In~ or pet'S()l'I
whu hu-.. POW!.)! tit AtlOlll(.l)'
-B,u:k p,,,)"
-· " ;-Leave
. . ~. ~e,enk: ettaoh tofront pagewlt_h P•IMf cflp
A
c
4
Fourth Form OPTIONAL FORM 91
P PTIONAL FORM 91 RELEASE OF PERSONAL PROPERTY FROM ESCROW
(2 Pages - Front and Back)
Whereas GERALD DOVE PAYNE of STATE & Birth Certificate number Hyphenated,
(Name)
(Place of Residence)
STRAWMAN
For the performance of U.S. Government Contract Number
In Account Number
Located at
(Social Security Number)
Most Recent Case Number
Inmate Number
address of prison No PO Box
(Address of Financial Institution)
Whereas I, Gerald Dove Payne by John Doe as POA
(Name of natural person in prison)
Claim s arising therefrom.:.
Criminal Case Number (Appeal Case # if applicable)
See STANDARD FORM 28 AFFIDAVIT OF INDIVIDUAL SURETY
See OPTIONAL FORM 90 RELEASE OF LIEN ON REAL PROPERTY
NAME OF FINANCIAL INSTITUTION: Type in Name of Prison
Name of Financial Institution: Type in Name of Prison
Example: FMC ROCHESTER
FEDERAL MEDICAL CENTER
2110 EAST CENTER STREET
ROCHESTER, MN 55904
No teri1ed No Notary Necessary ( TK says have it notarized - KH says it is not necessary)
[Date} ????????
seal
The person who is Power of Attorney must put their thumb print
in
- ---- -·- -- - - - - -----------
red ink - to right of Seal in blank space .
----- - --
Back p ,1 gc· Leave Blank and attach to the front page with a paperclip.
------- - ---- - ----- ---- - - - - - - ---- -- --- --- -- --
5
Fifth Form STANDARD FORM 24
STANDARD FORM 24 BID BONQ
(2 Pages - Front and back)
DAT E. BONO EXECUTED: Arraignment Date . Example: January 30, 2005
PRINCIPAL : GERALD DOVE PAYNE - The All Capital Letter Person as it appears on Social Security Card. If
no middle name put NMN between 1s t and last name.
Under the name in all caps put the current PRISON NAME in all CAPS:
Example:
GERALD DOVE PAYNE
FMC ROCHESTER
FEDERAL MEDICAL CENTER
2110 EAST CENTER STREET
ROCHESTER, MN S5904
TYPE OF ORGANIZATION: Check • INDIVIDUAL
STATE OF INCORPORATION: Type in the Birth Certificate Number and STATE WHERE BORN (ALL CAPS)
SURETY(IES):
GERALD DOVE PAYNE
55 Water Street
New York, New York 10041
PENAL SUM OF BOND: Leave blank - if you desire all who were convicted to get out.
BID DATE · Type in Arraignment Date
INVITATION NO.: Type in Case Number
CONDITIONS: Leave blank
WITNWSS : You need the Notary or someone who is in their office sign off as a witness and date it.
(Today's Date)
PRINCIPAL: 1. SIGNATURE(S)
~~&~ @'"1~
~Joh;n; ~
a&
{fjf()!}f
1. NAMES AND TITLES TYPED: GERALD DOVE PAYNE by John Doe as POA
Leave 2. & 3. blank POA's have put their thumb print in red in space 2. before (Seal)
Corporate Seal: The person who is POA must put their thumb print in red ink over this Corporate seal.
INDIVIDUAL SURETY(IES)
1. SIGNATURE(S):
~tJMld[j}F~ {[j>1~~fo/m, ~ « & @V~
Rrd Thumb Print of PO \I
1. NAME(S) & TITLE(S) : GERALD DOVE PAYNE by John Doe as POA
Leave 2. & 2. blank
CO RPORATE SURE fV(IES). Leave all blank.
PAGE BOTTOM · Do not notarize
B~-ck p; ge-:- Le~;~-Bl;nk and attach to front page with paperclip)
- - - - - - - - - - -
6
Sixth Form - Standard Form 25
STANDARD FORM 25 PERFORMANCE BOND
DATE BOND EXECUTED· Type in Arraignment date.
PRINCIPAL: Type in STRAWMAN NAME -GEARAL DOVE PAYNE
Under the name type in all CAPS the PRISON where the person is and
The prison's address.
TYPE OF ORGANIZATION : X the box labeled INDIVIDUAL
STATE OF INCORPRO ATION: Type in Birth Certificate number- if B.C. number is not
Hyphenated then just type in the State Name in all Caps.
SURET V(IES): Type in:
DEPOSOITOTY TRUST COMPANY
55 Water Street
New York, New York 10041
PENAL SUM OF BOND: Leave blank - so everyone in the group can get out.
CONT RACT DATE: Type in Arraignment Date
CONTRACT NUMBER: Type in the Case Number
O BLIG ATIONS : (Leave Blank)
CONDITIONS : (Leave Blank)
THEREFORE: (Leave Blank)
WITN ESS: Have the Notary or someone in their office sign off as witness.
PRINCIPAL:
SIGNATURE(S) 1.
~tJtrald{?Jf'ott<, ~~~f~~«ti rf15l'}9f
Leave 2. & 3. Blank
NAME S(S) & TITLES: GERALD DOVE PAYNE by John Doeas POA
Leave 2. & 3. Blank
Corp o rate Seal : The person who is POA must put their thumb print in red ink right over the
Corporate Seal
INDIVIDUAL SURETY(IES)
SIGNATURE(S) 1.
fg~{5JF~ @1"'~~..,.--~~aJ ({j?>()!}f
Leave 2. Blank
NAMES TYPED : 1. GERALD DOVE PAYNE by John Doe as POA
Leave 2. Blank
SEAL: The person who is POA must put their thumb print in red ink right over the Seal
CORPORATE SURETV(IES): Leave everything blank in this section.
NOT ARY : The bottom of this page must be Notarized by a Notary living in
7
Seventh f Q!!ll 25A
S'L\I\Jl \HO 1 ORM 25 \ P.\YM J'Nl HO'w!]
uAH
l3 ONO L xt t; u rt
,
Type "'
Atr.-gnnwnc
o.,.
Type in srRAWMAN NAM( - GERALD DOVE PAYNE
P~l\:C1PA
PRtSION NAME (All CAPS)
PRISION AOORE:.SS (All CAPS)
l ' P( Of O ll r. ANI l Al I " Plac• an X w, the bo• in
', TA Tf o, !NCC RPORAl O"t Type
r,ont of INOIVIOU AL
m Ow 8W1h CHttftcate Numbtr end Sr ATE WHERE BOAN (Al l CAP'S}
ss Weter Strfft
s.mf n 1rs)
New Von. New Yon 10041
Pt N Al
s·
°'~ Of f30NO LNve blank - If you <»we .-11 who*•• corwlC'-d to gee out
Type in Anatgnment Date
CONlRA., 1 DAH
CONHU\CT NO Tn-
in
Caw
~f
08l GAllO\ leave B&ri
CON D llONS· Leave tMmt
\VITr-:ws
You need the Notary Of someone who is in their office s,gn off as a wtt.nHs Ind
~c. • ·
(Toda,y'I Date>
rR1Nc1PAL
i SlGNAruRE
d}t"llaltl~ Vurty..fM,.[:k.. g'fJ..Jtf
1 NA'.1f.S A.... :) TJlLt.S TVPCO GERALD DOVE PAYNE by John Doe
a:s POA
LNYe 2. & 3. blank
Corporate Sea
The person who ,s POA must put their thumb print in
:, , ·
INDl\/lDUAL SURETY(l f.S)
1 SIGNATURE(S) ~(!lllak/~
, NA~/,EfS) & TITLE(S)
V'r~..,-~~- ~
Gerald Dove Payne by Jotv, Doe IS POA
Leave 2. & 3. blank
CORPORATE SURETY(IES) : Leave aH blank.
PAGE BOTTOM
Notarize bottom by Notary who lives _ _ _ _ _ _ _ _ __ __
?
over thts Corporate seal.