\.

:lt::C t-'erson Out of Prison

You will need the followi . For Entertainment Purposes Only
1. A Birth Certificate -and So~~-securit N
2. The Oockf:'tb) for each , c
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
5 p ccep e
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 Only Paper Clips Accepted)
st
Forms mu 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
Person as no m,
'ddle name on the Birth Certificate you must put NMN between
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

10. SIGNATURE: ~~@f'~ (9"~~f~~ao rti5(}!}f

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 :

 OPTIONAL FORM 90 RELEASE OF LIEN ON REAL PROPERTY 3
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)

Of ST ATE (IF #NOT HYPENATEO) ./ birth certificate #

(Place of Residence)

by a bond for the pe rf orma nco Of U .s . Government Contract Number ce,rson who 15 1n Rrim SOtkt
Security ,1
and recorded this pledge on CRIMINAL Court en, Nymbt[) {tf Appftl Use Sbt\ f ) Ooo>t1t
#)

in th11 FEDERAL MEDICA L •CENTER

- or MINNESOTA
, held) (Stahl - whore pn.c;on ~ ~)
. ,ts loolte
(l oc.ahty - Name of prison where person s

• I Qerafd Doye payne bY John dot OS eo6

Whrnt J!> , - · - . ·oo last livu<t)
to bO In IM some county wtiero too pot"S
Notary Notarizes ( The notary has • tl'f)...</:r
ffi(!ll()k/ ~ ~,., ;.JM- ~~ A c

(S1gt1iltllrOl
No Notnry S0;:,1

Thumb Ptlnl (Red In~ or pet'S()l'I

whu hu-.. POW!.)! tit AtlOlll(.l)'

-B,u:k p,,,)" . . ~. ~e,enk: ettaoh tofront pagewlt_h P•IMf cflp

-· " ;-Leave
 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 (Social Security Number)

In Account Number Most Recent Case Number Inmate Number

Located at 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.,.

P~l\:C1PA Type in srRAWMAN NAM( - GERALD DOVE PAYNE
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 r,ont of INOIVIOU AL

', TA Tf o, !NCC RPORAl O"t Type m Ow 8W1h CHttftcate Numbtr end Sr ATE WHERE BOAN (Al l CAP'S}

s.mf n 1rs) ss Weter Strfft

New Von. New Yon 10041

Pt N Al s· °'~ Of f30NO LNve blank - If you <»we .-11 who*•• corwlC'-d to gee out
CONlRA., 1 DAH Type in Anatgnment Date

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 :, , · over thts Corporate seal.

INDl\/lDUAL SURETY(l f.S)

1 SIGNATURE(S) ~(!lllak/~ V'r~..,-~~- ~

, NA~/,EfS) & TITLE(S) 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 _ _ _ _ _ _ _ _ __ __ ?