Tri-County Bonding Association 

 

Proxy Form 

 

Tri-County Bonding Association members, who are the primary designated bail bond agent for their respective agency, 
may vote in person or by proxy for the election of officers per Section 7 of the By-Laws. The proxy designation must 
be presented prior to the distribution of ballots for officer elections. Only a member of the Association shall serve as a 
proxy for another member. Each proxy must be notarized and state the date of the election and shall expire after such 
date. 

 

If you wish to designate a member of the Tri-County Bonding Association to serve as your proxy for the election of 
officers, please complete the information below. Thank you for your participation. 

 

Date of meeting for officer elections: _______________________ 

 

Member’s Name: ________________________________________________________________________________ 

 

Member’s Signature: _____________________________________________________________________________ 

 

Member’s Contact Information: 

Bail Bond Agency: _______________________________________________________________________________ 

Address: _______________________________________________________________________________________ 

Phone/FAX: _________________________________ E-Mail: __________________________________________ 

 

Proxy Member’s Contact Information: 

Bail Bond Agency: _______________________________________________________________________________ 

Address: _______________________________________________________________________________________ 

Phone/FAX: _________________________________ E-Mail: __________________________________________ 

 

 

 

State of Florida 

County of __________________ 

 

Sworn to and subscribed before me on this ______ day of ____________, 200____, by ________________________ 

_______________________, who is personally know to me or produced _________________________________ 
as identification. 

 Signature of Notary Public: _______________________________________ 

 Printed Name of Notary Public: ____________________________________ 

 My Commission Expires: _________________________________________