ASSIGNMENT OF SECURITY INTEREST TO THE STATE OF TENNESSEEASSIGNOR, SECURITY AND FINANCIAL INSTITUTION:
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Assignor's name and name of person executing this assignment: Social Security or FEN/EIN:
Title(s) of person executing this assignment (i.e., owner, partner, president, secretary, etc.):
Assignor's mailing address (Number and Street or P.O. Box, City, State, ZIP Code):
Name of Professional Bondsman in whose behalf the assignment is executed (name as it is used on approved list):
Description of Security: ID Number of CD or other security:
Name of account or payee of Security (as it reads on the CD or other security): First maturity date, if any:
Dollar Amount of Security (in words): Dollar Amount of Security (in numbers):
Name of Financial Institution:
Mailing address of Financial Institution (Number and Street or P.O. Box, City, State, ZIP Code) & telephone number:
In order to provide security to the State of Tennessee (including all future liability), the Assignor specified above, for and on the behalf of the professional bondsman named above, assigns and sets over irrevocably to the State of Tennessee a security interest in and to the Security described above.
Assignor agrees that this assignment gives to the State of Tennessee separately the exclusive right to redeem, collect and withdraw any part of or the full amount of the Security to be applied as a payment to satisfy a final forfeit judgment after the judgment becomes final against the Assignor and/or the professional bondsman named above in accordance with Tenn. Code Ann. § 40-11-101, et seq. The right of the State of Tennessee to apply the Security shall not be affected by a subsequent change in the trade name or business location of the person or entity on whose behalf this assignment is executed.
Assignor understands and agrees that by this assignment, all use of and control over the disposition of the Security is relinquished. The Security is to be held by the financial institution identified above for the sole use and subject to the exclusive control of the State of Tennessee. Interest on the Security shall be paid to the Assignor.
Assignor's Signature: Assignor's name in print: Date:
Sworn to or affirmed before me on this day of 20
Notary stamp or seal:
Signature of Notary Public in and for the State of Tennessee:
My Commission Expires:
This is notification by the assessor to the financial institution of the terms of this assignment.
CONTROL AGREEMENT WITH FINANCIAL INSTITUTION AND NOTICE OF EXCLUSIVE CONTROL:
The Financial Institution acknowledges the assignment of the Security for payment of final judgments of forfeiture to the State of Tennessee. We certify that we have recorded the assignment and have retained a copy. We certify that we do not have, nor do we have knowledge of, anyone else having any lien, encumbrance, right, hold, claim to or obligation of the Security. We accept the Security with knowledge that it has been irrevocably posted as collateral, and we agree to act as the sole agent for the purpose of holding the Security for the State of Tennessee. We agree to comply with the instructions of the Court (on behalf of the State of Tennessee) directing disposition of the Security without further notice to or consent by the Assignor. We further agree not to exercise any set of rights we may have with respect to the Security or to otherwise impede, hinder, delay, prevent, obstruct or interfere with the Court's right to direct payment of, redeem, or collect any part (or the full amount) of the Security promptly.
Name of Financial Institution and Officer Executing this Document
(Type or print): Assignor's name in print:
Officer's Signature Date:
Sworn to or affirmed before me on this day of 20
Notary stamp or seal:
Signature of Notary Public in and for the State of Tennessee:
My Commission Expires:
Structure 2021 Tennessee Code