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BAIL BOND APPLICATION - INDEMNITOR COMPANY ALLEGHENY CASUALTY COMPANY P.O. Box 9810, CALABASAS, CA 91372-9810 TELEPHONE (800) 935-2245 BAIL 2 GO P.O. Box 592643, ORLANDO, FL 32859-2643 TELEPHONE (407) 254-5554 1. Name _ Michelle Williams First Middle Last My friends/family know me as Michelle 2. Residence Address 2205 Johns Lake Court City. Kissimmee _State Fl _Zip 34758 3. How Long at Current Address 5yrs _ Rent Free_N_ Lease _ ~ Own Y Landlord/Mortgagor Name Loan Depot Mortgage 4. Is Mortgage/Lease in your name? Yes X _ No X _ When does Lease Expire N/a _Email Michellewilliamc@gmail.com 5. Cell Phone # 4078663740 Cell Carrier 'erizol iPhone or Android iPhone How Long with Cell No. 3 6. Employer N/A Length Na Position No Work # No Any ownership greater than 20% in any Corporation, LLC, or S-Corp No Any specialized license to work No 7. Social Security No. 431198889 ID# Unknown _Wt Ht other Race_N Eye Color , Br Hair Red 8. Have you ever filed Bankruptcy. Do you have any judgements or liens against you currently If so, where 9. Gender Femal Place of Birth Helena Date of Birth 01-15-1964 US Citizen Wes Marital Status _ How Long 10. Have many years have you lived in FL? 24yrs Are you a convicted felon? No Are you on any type of Probation or Parole? N 11. Vehicle Year _ Vehicle Color Green Vehicle Make Focus Tag No. y485rp Vehicle Miles 15747 Amount Owed 12. Relationship to Defendant Son _ How long have you known Defendant 34 Defendants Home Address 2205 Johns Lake Court Defendants Cell Phone Number (786) 761-3626 13. Emergency Contact Name Michelle Williams Address 2205 Johns Lake Court Phone No. 407-866-3740 13. Children Yes No Amount of children 14. Attorney N/a Ages 000-11122323 Do kids reside with you 15. How did you hear about us? _ Phone No. GOOGLE May we reach out on the defendants behalf YES Personal References First & Last Name Joshua Meredith 1. 2. 3. 4._ 5._ 6. Molly Nisely Caleb Meredith Michelle Williams Joshua Gilbert Patrick Malone Relationship B N M F F City / State Kissimmee Kissimmee Kissimmee Kissimmee Kissimmee Orlando Phone 3214422452 +1 (407) 267-5541 (407) 837-3449 4078663740 6892419162 4077447874 I hereby represent and warrant that the foregoing information is true, complete and correct and is made for the purpose of inducing International Fidelity Insurance Company/Allegheny Casualty Company to issue, or cause to be issued, bail bond(s) for Warning: Any person who knowingly and with intent injure, defraud or deceive any insurer, files a statement of claim or an application containing and false, incomplete or misleading information is guilty of a felony of the third degree. Defendant Sign Michelle Williams (Apr 5, 2024 20:29 EDT) Print Michelle Williams ID# SSN DOB 949587299564838 431198889 01-15-1964 allegheny CASUALTY COMPANY PO Box 5600, Thousand Oaks, CA 91359 800.935.2245 info@aiasurety.com THIS IS A 3-PAGE, DOUBLE SIDED DOCUMENT READ CAREFULLY AND COMPLETE BAIL BOND APPLICATION - INDEMNITOR PRODUCER NAME, ADDRESS, PHONE, EMAIL AND PRODUCER LICENSE NUMBER MUST. BE PREPRINTED. OR STAMPED. HERE: Bail 2 GO - Kissimmee P.O. Box 592643, Orlando, FL 32859 (407) 483-7983 Defendant Info Defendant Name Ethan Blake Nisely Charges Case Number 24MM0883, 23CF3236 Jail Location Birth Date 04/26/1988 Appearance Date BATTERY; TOUCH OR STRIKE, COM DOMES BATTERY BY STRANGULA, PETIT THEFT >$100 <$750 Court Name Osceola County Circuit Court County Booking Number Osceola County Corrections Department Osceola 805267 My friends / family know me as Indemnitor Name Michelle Jean Williams Home Phone Number Cell Phone Number (407) 866-3740 Work Phone Number Relationship to Defendant Mother Current Full Address, City, State and Zip 2205 Johns Lake Ct, Kissimmee, FL 34758 From To Email Landlord Name (if applicable) • Own • Rent Landlord Phone Number Former Full Address, City, State and Zip From To Landlord Name (if applicable) • Own • Rent Landlord Phone Number • M Birth Date * F 01/15/1964 Driver's License / ID Number W452-550-64-515-0 Additional Notes Birth Place Social Security Number 431-19-8889 State Issued FL U.S. citizen? Alien Number • Yes •No How long in US? Employer Position How Long E Supervisor's Name § union Phone Number Local Number Military Branch Active • Yes • No Discharge Date [Facebook Username So Password Twiter Username Linkedin Username Other Account Username Password Password Password Form# ACC.0302 (11/22) Page 1 of 3 Cash on hand ($) Cash in bank ($) Monthly Salary or Wages ($) Real Estate Value($) Real Estate Mortgage ($) Title Name Year Make Model Color Plate Number State Financing company Balance owed • Single Significant Other Name • Married Cohabitating • Separated • Divorced • Widowed Email DOB Significant Other Full Address, City, State and Zip A span one Nona Namo Years together Phone Number DOB Phone Number DOB Phone Number Former Significant Other Name Email DOB Former Significant Other Full Address, City, State and Zip Years together Phone Number Reference Name DOB Relationship to Indemnitor Full Address, City, State and Zip Cell Phone Number Work Phone Number Reference Name DOB Relationship to Indemnitor Full Address, City, State and Zip Cell Phone Number Work Phone Number Reference Name DOB Relationship to Indemnitor Full Address, City, State and Zip Cell Phone Number Work Phone Number I hereby represent that the foregoing information is true, complete and correct and is made for the purpose of inducing Allegheny Casualty Company to issue, or cause to be issued, bail bond(s) for the defendant referred to herein. Signed, sealed and delivered this Signature Authorized Indemnitor Signature Michelle Kates Michelle Williams (Apr 5, 2024 20:29 EDT) Indemnitor Print Name Michelle Jean Williams Driver's License Number W452-550-64-515-0 Social Security Number 431-19-8889 Birth Date 01/15/1964 SEE NEXT PAGE FOR APPLICABLE FRAUD WARNINGS Form# ACC.0302 (11/22) Page 2 of 3 FRAUD WARNIN IMPORT ALABAMA RESIDENTS Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly presents false information in an application for insurance is guilty of a crime and may be subject to restitution fines or confinement in prison, or any combination thereof. ARKANSAS RESIDENTS Any person who knowingly presents a talse or traudulent claim tor pavment tor a loss or benetit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. CALIFORNIA RESIDENTS For your protection California law requires the following to appear on this form: Any person who knowingly presents false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison. FLORIDA RESIDENTS Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. mw. LOUISIANA AND MAINE RESIDENTS t is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines or a denial of insurance benefits. MARYLAND RESIDENTS: Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly or willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. NEW JERSEY RESIDENTS Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties. NEW MEXICO RESIDENTS Any person who knowingly presents a false or fraudulent claim for payment or a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to civil fines and criminal penalties. NEW YORK RESIDENTS Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation. OHIO RESIDENTS Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud. OKLAHOMA RESIDENTS WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony. PENNSYLVANIA RESIDENTS RHODE ISLAND, TENNESSEE, VIRGINIA, WASHINGTON, AND WEST VIRGINIA RESIDENTS defrauding the company. Pendits say nolde imprisonment, fines or a denial of insurance benefiny for the purpose of Form# ACC.0302 (11/22) Page 3 of 3 allegheny CASUALTY COMPANY PO Box 5600, Thousand Oaks, CA 91359 800.935.2245 info@aiasurety.com THIS IS A DOUBLE SIDED DOCUMENT READ ALL SIDES CAREFULLY BAIL BOND AGREEMENT ("Agreement") PRODUCER NAME, ADDRESS, PHONE, EMAIL AND PRODUCER LICENSE NUMBER MUST BE PREPRINTED OR STAMPED HERE: Bail 2 GO - Kissimmee P.O. Box 592643, Orlando, FL 32859 (407) 483-7983 Agreement ¡ Detalls In consideration of Allegheny Casualty Company ("Surety"), through Surety's duly appointed independent bail producer ("Bail Producer"), (Surety and Bail Producer are sometimes together referred to as "Surety"), issuing, or causing to be issued, a criminal appearance bail bond described as: 04/05/2024 Ethan Blake Nisely Indemnitor Name(s) Ethan Nisely, Michelle Williams 6,500.00 Total Premium $ 700.00 Power Number (s AS3K587331, AS3K587332, AS6K954736 ("Bond") I/we represent and warrant that I/we have read, approve and agree to all of the terms and conditions found on following pages (front and back). Signed, sealed and delivered this Defendant Signature Print Name Ethan Blake Nisely Indemnitor Signature Print Name Indemnitor Signature Mill lit Michelle Williams (Apr 5, 2024 20:29 EDT) Print Name Michelle Jean Williams Indemnitor Signature Print Name Indemnitor Signature Indemnitor Signature Print Name Print Name Si no puede leer ni entender Inglés, favor de marcar este cuadro. 5 If you cannot read or understand English, please check this box.) Check box and complete the following if translation is required Translation Certification. The undersigned translator makes this affidavit and hereby certifies, under penalty of perjury, that he/she read verbatim and translated this entire document, including the reverse side, and all related bond application documents including disclosures, promissory notes, security instruments and trust deeds, to the Indemnitor signing below in his/her primary language. Translator Print Name Translator Signature Translator Full Address Date Confirmo por mi colocación de mis iniciales que las dos caras de este acuerdo han sido traducidos completamente a mi satisfacción. (I confirm by my affixing my initials that this contract has been translated to my satisfaction.) INDEMNITOR Initials READ ALL TERMS AND CONDITIONS ON THE FRONT AND BACK OF EACH PAGE Form# ACC.FL.0307 (10/21) Page 1 of 4 And Conditi ons You, the undersigned (referred to herein as "Indemnitor," "Defendant," or together as "you" or "your," as applicable), agree to be bound to the following terms and conditions: 1. The premium for the Bond is fully earned upon the release of Defendant from custody. The premium is not refundable except as stated herein or provided by law. 2. Defendant agrees to appear in any Court as required in connection with the Bond at the dates and times stated in the Bond and/or as may be ordered by the Court. Indemnitor will ensure that Defendant appears in Court as so required or as ordered by the Court. 3. Surety shall have control and jurisdiction over the Defendant during the term for which the Bond is in effect and shall have the right to apprehend, arrest and surrender the Defendant to the proper officials at any time as provided by law and/or this Agreement. It the Detendant Is surrendered betore a tailure to appear in Court, and tor a reason other thar as stated in paragraph 4, you may be entitled to a retuna of the Bond premium it required by applicable law it any) and as may be stated in the Supplemental Terms and Conditions. M.W. 4. Unless otherwise provided by applicable law it any), the tollowing events shall constitute a breach of your obligations o the Surety, and the Surety shall have the right to immediately apprehend, arrest and surrender Defendant to custody. and you shall have no right to the refund of premium whatsoever: a Detendant departs the jurisdiction of the Court without the prior written consent of the Court and the suretv b Detendant moves trom nis/ner current address without prior written consent of the surety, or Detendant tall to notify Surety of any changes in address; (c) Defendant commits any act that constitutes reasonable evidence of the intention to cause a torteiture of the Bond or Detendant's tailure to appear in Court as required; (d Defendant is arrested and incarcerated for any other offense (other than a minor traffic violation); (e) Defendant or an Indemnitor makes any materially talse statement in any material submitted to surety tor the bond cludina the Bail Bond Application and Indemnitor Application; (f The bail for Defendant is increased; (g ndemnitor requests the surrender to custody of the Defendant; and/or (h) There is a material increase in th risk assumed by the Surety (as determined by the Surety in its sole and absolute discretion), including, by way of example, but not limited to, depreciation or impairment of any collateral pledged as security for the Bond. 5. In the event that the apprehension and surrender of Defendant to custody is required for any reason, including the failure to appear by Defendant at any required Court proceeding or hearing, Defendant understands, agrees, and acknowledges that such apprehension and surrender involves risk of harm to Defendant and others, and as such Defendant accepts the risk of such harm that may be caused to Defendant and/or others. Defendant also agrees to defend, indemnify and hold Surety harmless (including all agents and employees thereof) from any injuries, harm, claims, actions, lawsuits, damages, liability, demands, fees and expenses, including attorneys fees and costs, made by any third party against Surety (including all agents and employees thereof) arising out of such apprehension and surrender of Defendant. 6. You, jointly and severally (together and separately) with any other indemnitor, shall indemnify the Surety and keep the Surety indemnitied and hold it harmless from and against any and all claims, lawsuits, damages, losses, liability, demands, actions, judgments, tees, fines, penalties and expenses (including attorneys tees and costs), relating to, or arising out of, Surety's issuance or procurement of the Bond (together, "Liabilities"), including, but not limited to, the following: a the principal amount of anv tortelture ot, or ludament on, the Bond, plus any related court costs, interest anc aal tees incurred; (b any tugitive recovery tee it there is a torteiture of the Bond which tee is typically ten to under this Agreement, reasonable and actual attorney's fees plus any and other costs, expenses and/or assessments that may be incurred as a result thereof the forfeiture of the Bond as subject to applicable law (if any). The voucher, check or other evidence of any payment made by Surety shall be conclusive evidence of such payment in any action against you as to the propriety of such payment and as to the extent of your liability to Surety for such payment hereunder. Further, you will, upon demand, place with Surety the requisite cash funds to meet any Liabilities (including a pending. unpaid judgment or forfeiture demand), whether the demand is made before or after Surety has paid or advanced such funds. . Subiect to applicable law (it anv). anv collateral (real or personal. includina cash or securities) pledaed to or depositec with Suretv as securitv for the obliaations under this Agreement ("Collateral") is held for the pavment or reimbursemen of any and all sums due to Surety for any and all Liabilities sustained, paid or incurred by Surety. You authorize the or any part thereof, in order to pay or reimburse the Surety for any and all sums due to Surety under this Agreement, the Bond and/or to place the Surety in cash funds so as to protect the Surety against the payment of any Liabilities, including any claim, demand, loss, or judgment arising out of the Bond, even if the Suretv has not paid any such Liabilitv. Subiect to applicable law (if anv). the Suretv mav make anv such sale, at its liscretion, at public or private sales, and without demand, notice or advertisement of the time and place of said sale, ano also with the right to purchase said Collateral at such sale or sales, freed and discharged from any equity or redemption, except as otherwise provided by applicable law. 8. The Surety shall not be liable for the depreciation of any Collateral or for any interest thereon. In the event of depreciation of the value of Collateral, or any part thereof, or of any Collateral that may be hereafter pledged to or deposited with the Surety, upon request of the Surety, you shall provide the Surety with additional and satisfactory Collateral so that the total value of the Collateral shall equal the value of the Collateral at the time of the initial pledae or deposit. Subject to applicable law (if any), if you fail to deposit such additional Collateral, the Surety shall have the full right, power and authority, without further demand or notice, to sell, assign and deliver the whole or any part of such Collateral, including any substituted or additional Collateral, at public or private sale, at its option, and without demand, notice or advertisement, and also with the right to purchase said Collateral at any such sale, freed and discharged from any equity or redemption as provided by applicable law. 9. If a Confession of Judgment ("COJ") is taken as security for the Bond, the Surety shall have the right to enter, record and file the COJ at any time, and such COJ shall constitute a lien entitled to a preference against any of your property, Form# ACC.FL.0307 (10/21) Michelles Michelle Williams (Apr 5, 2024 20:29 EDT) Page 2 of 4 whether or not the Surety is entitled to be indemnified at the time of the entry, recording or filing of such COJ. If such COJ is entered, recorded or filed by the Surety against you, the COJ entered shall be effective and available to the Surety against you. 10. You acknowledge and agree that the Surety may foreclose against the Collateral and/or exercise any of the rights or remedies_provided under this Agreement or take any combination of such actions without waiving any other right or remedy. Failure to exercise any rights or remedies of the Surety at any one time shall not constitute a waiver of the right to exercise them at any other time. Any security or Collateral you give may be substituted, subordinated, or released by the Surety without affecting any other rights. The Surety shall not be obligated to entoris rights against any security, Collateral or indemnitor prior to entorcing its rights against you or any other indemnitor t 11. Subject to applicable law (if any), the Surety will return the Collateral to you when all of the following are satisfied: (a) the Surety receives sufficient and competent written legal evidence satisfactory to the Surety for example, written notice from the Court) of the discharge, release or exoneration of the Surety from all liability under the Bond; (b) there are no outstanding Liabilities of any kind arising out of or relating to the Bond or this Agreement; (c) there are no other obligations executed by, for or on behalf of the Defendant for which the Surety may deem t advisable to retain such Collateral for its protection; and d) upon the request by Surety, you shall execute and deliver to Surety a legal release of claims upon the return by Surety of the Collateral to you. † the Surety deems it necessary to make any outlay to protect any Collateral or security in its possession, whether fo real or personal property, you authorize the Suretv to do so. and vou aaree to indemnifv and reimburse the Suretv fol any such outlay as in the judgment of the Surety may be necessary to protect the Collateral, including payment of taxes, liens or mortgages and any attorney's tees, costs and service tees tor time spent and/or special services rendered. Agreement, and/or in the Bond, to the Bail Producer or any other person or entity ("Assignee") without notice to or consent from you. Subject to any limitations imposed upon Assignee by the Surety, Assignee shall have the right to Terms And Conditions (continued from previous page) 13. You hereby acknowledge and agree that neither the Surety nor Bail Producer has recommended or suggested any specitic attorney or firm of attorneys to represent the Defendant in any capacity.- 14. This Agreement may not be terminated or modified orally. Any modification and termination of this Agreement, including any release of liability hereunder, must be in writing and signed by the Surety and you. federal law including, but not limited to, Reporting Act) and any local or state law relating to Surety obtaining, and you consent to and authorize Surety to obtain, any and all private or public information and/or records concerning you from any party or agency, private or governmental (local, state or federal), including, but not limited to, credit reports, Social Security Records, criminal records, cIvil records, driving records, tax records, telephone records, medical records, school records, worker applicable law, any and all private and public information and records in their possession concerning you to the Surety and direct that a copy of this document shall serve as evidence of said authorization. 16. You irrevocably grant to Surety and Bail Producer, and their agents and employees, the right to enter your residence, or any other residence or real property you own or occupy, without notice, at any time, for the purpose of ocating, arresting, and returning the Defendant to custody, and subject to applicable law, you waive and release any and all causes of action in connection therewith, including without limitation, torts of trespass and false imprisonme 17. Defendant agrees that Surety may attach a location tracking device on any vehicle owned or driven by Defendant, at any time, without notice, and monitor the location of the vehicle through any available technology. Defendant further agrees that Surety may use location technologies to locate and track any wireless device of Defendant at any time during the period of the Bond is in force and any applicable Bond remission period, and the Bond is conditioned upon the full compliance by Defendant with the following terms and conditions: (a) Surety, at its discretion, will use network-based location technologies to locate Defendant; (b) This is the only notice Defendant will receive for the collection of location information; (c) Surety will retain location data only while the Bond is in force and during any applicable Bond remission period; (d) Surety may disclose location information as required by Court Order or process; (e) Surety, including its agents and representatives, will be AND ANY APPLICABLE BOND EMISSION PERIOD KING DURING THE PERIOD THE BOND IS IN FORCE and (f) YOU WILL NOT HAVE THE Direct all questions regarding this paragraph to the Surety. 18. If Defendant leaves the state in which the Bond was issued, subject to applicable law, Defendant waives any rights to oppose extradition proceedings. 19. In the event any provision herein shall be deemed to exceed any applicable state or tederal law, then such provision shall automaticallv be deemed to have been revised to complv with such law so as to provide Suretv with the maximum rotection from any Liabilities. The invalidity or unentorceability of any provision herein (or portion thereot) shall in n vay effect the validity or enforceability of any other provision (or portion thereof of this Agreement 20. This Agreement and all documents that are executed in connection with this Agreement set forth all the terms of the agreement between the Surety and you. All statements, representations, promises, agreements, and affirmations made by the Surety or Bail Producer, or any representative, employee or agent, thereof prior to or contemporaneously with the execution of this Agreement are contained within this document, set forth in this Agreement, are of no force or effect whatsoever in determining the rights, obligations and/or liabilities between the Surety and you. You further agree to execute and be bound by any other future documents necessary to carry out and effectuate this Agreement. Form# ACC.FL.0307 (10/21) Michel Kitti Michelle Williams (Apr 5. 202420:29 EDT) Page 3 of 4 1. Surety, as bail, shall have control and jurisdiction over Defendant during the term for which the Bond is executed and shall have the right to apprehend, arrest and surrender Defendant to the proper officials at any time as provided by law. 2. In the event Defendant's surrender is made prior to the time set for Defendant's appearances, and for reasons other than as enumerated below in paragraph 3, then a refund of the Bond premium shall be made to the person whose name appears as Payer on the Premium Receipt. . It Is understood and agreed that the happenina ot anv one of the tollowing events shall constitute a breach c Defendant's obligations to uretv. and suretv shall have the raht to immediatelv apprehend. arrest an Defendant, and no person shall have any right to any refund of premium whatsoever. The events which constitute a breach of Defendant's obligations hereunder are: a It Detendant departs the lurisdiction of the Court without the written consent of the Court and surety or Bal Producer: (b) If Defendant moves from one address to another within the State of Florida without notifyinc Surety or Bail Producer in writing prior to moving; (c) If Defendant commits any act which constitutes reasonable evidence of Detendant's intention to cause a torteiture of the Bond;(a) It Detendant is arrested and incarcerated for any offense other than a minor traffic violation; or (e) If Defendant makes any material false statement in the Agreement. Services, Bail Bond Section, 200 Tallahassee, FL 32399-0322, 1-877-693-5236 (in-state) 5. The person whose name appears as Payer on the Premium Receipt shall be entitled to a refund of premium for the Bond if and when it is found that Surety had no liability under the Bond because Defendant did not come under the jurisdiction of the court to which Defendant is returnable or Defendant is not released from custody, except where the Bond is written to allow Defendant to serve a sentence in another jurisdiction. 6. For good and valuable consideration, vou agree to indemnify and hold harmless the Surety or its agent for all losses not otherwise prohibited by law or by rules of the Department of Financial Services. Supplemental Terms Bond and recommitment of Defendant. 8. The specific fees for which you are required to indemnify Surety in accordance with the Agreement are as follows: (a) Costs necessary to apprehend Defendant in the event Defendant attempts to flee the jurisdiction of the courts; (b) Attorneys tees and court costs associated with filing of motions; (c) Documented transportation and odging expenses outside the jurisdiction of the court; (d for housing, re-arrest, transportation and extradition; and (e) A maximum fee of $100 for a surrender allowed by law when there has been no torteiture of the Bond 9. Collateral will be returned to the person whose name appears as "Depositor" on the Collateral Receipt within 21 days after proof of final termination of liability on the Bond has been provided to the Surety. 10. Surety shall be entitled to deduct from collateral held or any return premium all fees, expenses, and charges authorized by applicable law, including Florida Administrative Code 69B-221.105. a conflict between the terms and conditions of the Agreement and this Supplement, this Supplement shall control. Milki Michflle Williams (Apr 5, 2024 20:29 EDT) Form# ACC.FL.0307 (10/21) Page 4 of 4 allegheny CASUALTY COMPANY PO Box 5600, Thousand Oaks, CA 91359 800.935.2245 info@aiasurety.com BAIL BOND INFORMATION SHEET PRODUCER NAME, ADDRESS, PHONE, EMAIL AND PRODUCER LICENSE NUMBER MUST BE PREPRINTED OR STAMPED HERE: Bail 2 GO - Kissimmee P.O. Box 592643, Orlando, FL 32859 (407) 483-7983 Defendant Name Ethan Blake Nisely Power Number(s) AS3K587331, AS3K587332, AS6K954736 Case Number 24MM0883, 23CF3236 As principal (defendant) and/or indemnitor (guarantor) on a bail bond, you must be given a copy of any collateral documents that you sign relating to the above bond(s). When all agreements have been fulfilled, bond is discharged in writing by the court, and without loss expense on the bond(s), your collateral will be returned to you. BE AWARE: YOUR COLLATERAL IS AT RISK if the principal fails to appear in court or if the principal commits any breach (violation) of agreement. ANY OF THE FOLLOWING HAPPENINGS IS A BREACH OF AGREEMENT: 1. If principal fails to appear in court; 2. If principal shall depart the jurisdiction of the court without the written consent of the court and the Surety, or its agent; 3. If principal shall move from one address to another without notifying the Surety, or its Agent, in writing, prior to said move; 4. If principal shall commit any act which shall constitute reasonable evidence of principal's intention to cause a forfeiture of the bond (s); 5. If principal is arrested and incarcerated for any offence other than a minor traffic violation; 6. If principal shall make any material false statement in the application; 7. If principal shall violate any special restriction or condition of the bond(s) imposed by the Court. For general information regarding your collateral, contact the agency as shown on the top of this sheet. For further inquiry / complaint, contact Department of Financial Services Bail Bond Section 200 East Gaines Street Tallahassee, FL 32399-0320 Phone: (850) 413-5660 **** Read carefully prior to signing **** I/We have received a copy of this information sheet. I/e have received a copy of all collateral documents that I/We signed regarding the above bond(s). Defendant Signature Print Name Date Ethan Blake Nisely Signed original to agent's bond file; Copy to defendant and each indemnitor lemnitor Signatu Michelle Williams (Apr 5, 2024 20:29 EDT) Print Name Michelle Jean Williams Date 4/05/2024 Form# ACC.FL.0028 (10/22) Page 1 of 1 allegheny CASUALTY COMPANY PO Box 5600, Thousand Oaks, CA 91359 800.935.2245 info@aiasurety.com PRIVACY NOTICE PRODUCER NAME, ADDRESS, PHONE, EMAIL AND PRODUCER LICENSE NUMBER MUST BE PREPRINTED OR STAMPED HERE: Bail 2 GO - Kissimmee P.O. Box 592643, Orlando, FL 32859 (407) 483-7983 This Privacy Notice applies to your non-public personal information ("personal information") received by Allegheny Casualty Company and/or AlA Holdings, Inc., as applicable, ("Surety"), through that Surety's duly appointed independent bail producer ("Bail Producer") (Surety and Bail Producer are sometimes together referred to as "Surety"), issuing, or causing to be issued, a criminal appearance bail bond described as: THE INFORMATION WE COLLECT: The Bail Producer is a licensed, independent contractor who is appointed by us to write bail. Prior to issuing a bail bond, the Bail Producer will collect, and in some cases, transmit to us your personal information. Your personal information is obtained from a variety of sources: • Applications and other forms (e.g., name, address, social security number, employment information, family member information, assets, income, and property locations and values) and electronically if you use our website or web-based date - our website uses cookies to collect individual information about you and your website usage); • Transactions and experiences with us and others, (e.g., credit card and account balances, and payment history); and • Consumer reporting agencies, medical providers, or others (e.g., credit score, background checks, and medical and employment information). HOW WE USE & PROTECT PERSONAL INFORMATION: Your personal information will be used to process the bail bond application, underwrite and post the bond and resolve bond claims or breaches of contract. We may provide your personal information to others working with us who need this information for these purposes, such as attorneys and investigators. Your personal information is used to assess the risk of the bail bond transaction, protect against fraud, or generally to effect, administer or enforce the terms of the bail bond transaction. Only authorized personnel are permitted to access your personal information. We convey to our employees and appointed Bail Producers the need to protect your personal information and require our outside vendors and service providers to keep your personal information confidential and to use it only to provide the services we have asked them to perform. PARTIES TO WHOM WE MAY DISCLOSE INFORMATION: We do not disclose your personal information to anyone except as permitted/required by law - for example, to industry regulators, law enforcement agencies, credit bureaus, subpoena, and third parties that assist us in the bail bond process and underwriting. We do not sell your personal information to anyone, and do not share your personal information with any companies or organizations that would use it to contact you about their products and services. CONFIDENTIALITY AND SECURITY: We maintain physical, electronic and procedural safeguards to protect your personal information. We ensure that your personal information is treated responsibly and consistent with our privacy policies. We also restrict access to your personal information within our organization to those persons who must have the information to provide services to you or to conduct our business. Persons who have access to your personal information may use it only for our business purposes. We safeguard your personal information in accordance with applicable laws. You have a right to review your personal information and to request that we correct, amend or delete such information on file. WEB PRIVACY: When you visit AlA's website at (www.aiasurety.com), the Web server automatically collects and maintains statistical information from our site's data logs that concern network traffic flow and volume. The information that is collected does not identify personal information. The collected information is used to improve the usefulness of the web site. We reserve the right to change this Privacy Notice at any time. The most up to date version of our Privacy Notice can be found on AIA's website. CALIFORNIA CONSUMER PRIVACY ACT: For California Residents, please visit www.aiasurety.com/CCPA to access our complete California privacy statement under the CCPA. If you would like a full copy of the policy, please contact the Surety at (818) 223-3308 or privacy@aiasurety.com FURTHER INFORMATION: If you have any questions about how we use the information we collect, please write to us at: AIA Compliance Department, PO Box 5600, Thousand Oaks, CA 91359 Indemnitor / Defendant Signature Michel Thei Michelle Williams (Apr 5, 2024 20:29 EDT) Indemnitor / Defendant Printed Name Michelle Jean Williams Date 04/05/2024 Form# ACC.0027 (10/21) Page 1 of 1 COLLATERAL RECEIPT allegheny CASUALTY COMPANY PO Box 5600, Thousand Oaks, CA 91359 800.935.2245 info@aiasurety.com Receipt No.: ACFL- 6314-5926 PRODUCER NAME, ADDRESS, PHONE, EMAIL AND PRODUCER LICENSE NUMBER MUST BE PREPRINTED OR STAMPED HERE Bail 2 GO - Kissimmee P.O. Box 592643, Orlando, FL 32859 (407) 483-7983 Type Deposit of collateral: Depositor hereby acknowledges receipt of • Return of collateral: Depositor hereby surrenders the original and acknowledg a copy of this document and agrees to the terms on the reverse e return and receipt of collateral listed herein and that the collateral has be side. The collateral identified below is deposited as security for the bail bond(s), premium owed, if any, and all lawful expenses is bai producer from any tute ability responsibily in ration to the lateral. incurred due to underwriting the referenced bail bond(s). Date Received 04/05/2024 Depositor Address 2205 Johns Lake Ct, Kissimmee, FL 34758 Power Number(s) AS3K587331, AS3K587332, AS6K954736 Depositor Name(s) Michelle Jean Williams Depositor Phone Number (407) 866-3740 Defendant Name Ethan Blake Nisely Case Number 24MM0883, 23CF3236 Items) Received - describe below, specify condition Promissory Note Bail Bond Agreement Collateral funds - in form of If applicable, I acknowledge a Credit Card fee of Bond Amount 6,500.00 Amount or Estimated Value $ 6,500.00 $ $ Held By Bail Producer • Surety Bail Producer Surety Bail Producer Surety % in the amount of $ FLORIDA USE ONLY Form# ACC.FL.0304-2 (01/23) Print Name Michelle Jean Williams Signature XAVIER PACHECO W189868 Print Name Xavier Pacheco COLLATERAL RECEIPT Except as otherwise provided by applicable law (if any) as stated in the Bail Bond Agreement ("Agreement"), you are depositing the collateral as security for the payment of any and all monies and sums due to Surety or its Bail Producer, including all liability, claims, demands, debts (including promissory notes), damages, judgments, losses, interest, premiums, expenses, services charges, expenditures, attorneys' fees and costs suffered, sustained, made or incurred by Surety or its Bail Producers on account of, arising out of or relating to the above bail bond and transactions contemplated thereby, your failure to comply with the terms and conditions of the Agreement and any and all debt or other obligations arising out of or evidenced by any agreement executed by you, Defendant or any other indemnitors) for the benefit of Surety or its Bail Producer, all of the terms of which are made a part of this receipt by this reference ("Liabilities"). The Bail Producer will make the collateral available for return to the person whose name appears as Depositor on the Collateral Receipt (or that person's heir, legal representative, or successor in interest) within 10 days, or as stated in the Agreement, after receiving written notice from the court that the Bond and the Surety have been exonerated, and must verify with the court that the obligation has been exonerated before returning the Bond. If the collateral you provided included a document that conveys title to alien on real property and such document was recorded, the Bail Producer or Surety shall deliver a reconveyance of the property, executed in such a manner that it may also be recorded, to you or your heir, legal representative or successor in interest within 10 working days, or as stated in the Agreement, after the Bail Producer or Surety receives notice of the exoneration of the Bond in writing by the court. The Bail Producer or Surety shall deliver such reconveyance document to you by making the document available at its principal place of business or mailing it to you upon your request. The Bail Producer or Surety will not return any collateral to you until you provide the written receipt that identifies the Bond, describes the collateral, and shows your signature. For any complaints or inquiries, you may contact the Department of Financial Services, Division of Consumer Services, 200 East Gaines Street, Tallahassee, FL 32399-0322, (877)693-5236 (in-state), (850)413-3089 (all areas), www.MyFloridaCFO.com/Division/Consumers. CONTINGENT PROMISSORY NOTE This Contingent Promissory Note ("Note") is being executed by the undersigned ("Maker") to secure Allegheny Casualty Company, as Surety, upon forfeiture or estreature of the surety bond(s) posted on behalf of defendant: On demands after date, for value received, I/We promise to pay to the order of Allegheny Casualty Company the sum of $ 6,500.00 Dollars, at PO Box 5600, Thousand Oaks, CA 91359, with interest thereon at the rate of eighteen percent (18%), per annum from call date until fully paid. The Maker further agrees to waive demand, notice of non-payment and protest, and in case suit shall be brought for the collection hereof, or the same has to be collected upon demand of an attorney, to pay reasonable attorney's fees and assessable costs, for making such collection. It is further agreed and specifically understood between the parties to this Note that there is presently no outstanding loan or debt represented by this Note, and that this Note is given only to secure future advances. It is further agreed and specifically understood that this Note shall become null and void in the event the said Defendant shall appear in the proper court at all the time or times so directed by the Judge or Judges of competent jurisdiction until the obligations under the appearance bond or bonds posted on behalf of the Defendant have been fulfilled and the Surety discharged or exonerated of all liability thereunder, in writing, otherwise to remain in full force and effect. Case numbers) 24MM0883, 23CF3236 , Osceola COUNTY, FLORIDA P/A number(s) AS3K587331, AS3K587332, AS6K954736 Mill Kaki Michelle Williams (Apr 5, 2024 20:29 EDT) Signature Signature Michelle Jean Williams Maker Name 04/05/2024 Date Maker Name Date Form# ACC.FL.0036 (10/21) *082 1 2* BAIL BOND INFORMATION & SPECIAL CONDITIONS - DEFENDANT ALLEGHENY CASUALTY COMPANY P.O. Box 9810, CALABASAS, CA 91372-9810 TELEPHONE (800) 935-2245 BAIL 2 GO P.O. Box 592643, ORLANDO, FL 32859-2643 TELEPHONE (407) 245-5554 Defendant: Address: Power No (s): Conditions of Bond: Check in Schedule: Call in Ethan Blake Nisely Phone: 2205 Johns Lake Ct Kissimmee, Florida 34758 AS3K587331, AS3K587332, AS6K954736 MUST CHECK-IN EVERY WED BY BVMA TILL CASE IS CLOSED L360 GPS MUST CHECK-IN EVERY WED BY BVMA TILL CASE IS CLOSED BVMA Physical Check In's Failure to keep an updated phone number on file and not Checking In as agreed upon including but not limited to; excessive late check in's or several missed check in's will constitute as a reasonable act to Allegheny Casualty Company and it's Agents reasonable evidence of principle's intention to cause a forfeiture of said bond. ANY OF THE FOLLOWING HAPPENINGS IS A BREACH OF AGREEMENT 1. 2. 3. 4. 5. 6. 7. If principal fails to appear in court. If principal shall depart the jurisdiction of the court without the written consent of the court and Allegheny Casualty company of it Agents. If principal shall move from one address to another without notifying Allegheny Casualty Company, or its Agents in writing prior to said move. If principal shall commit any act which shall constitute reasonable evidence of principal's intention to cause a forfeiture of said bond. If principal is arrested and incarcerated for any offense other than a minor traffic violation If principal shall make any material false statement in the application If principal shall violate any special restriction or condition of the bond(s) imposed by the court Defendant's Signature: Signature: Ethan Blake Nisely Printed: Date: helle Williams (Apr 5, 2024 20:29 El CO Credit Card Authorization form CO 1, MICHELLE JEAN WILLIAMS , give permission to Axiom Surety Corp dba Bail 2 GO to charge Indemnitor my card for the following transaction(s). My card details will be stored under my Bail 2 GO profile and will only be used for approved transaction(s) and incurred expenses. $700.00 Michellewilliamc@gmail.com ETHAN BLAKE NISELY # 805267 Amount Authorized Cardholder E-mail Defendant's Name & Booking # All fields required Card information Card type • MasterCard Discover • VISA • AMEX Truist debit Other MICHELLE JEAN WILLIAMS Cardholder (Name on card) 4634 0512 0559 7361 Card number 05/27 Expiration date (MM/YYYY) 34758 ZIP Code (From credit card billing address) 940 CVV Recurring Payments Information Charge every: Week Bi- Weekly Monthly Other Charge on this date. (For example, the 1st of every month) Hand Delivered Emailed Copies To: Payment Amount Defendant Name / Case # / Power(s) # Terms of agreement: PLEASE REFER TO PROMISSORY NOTE AND INSTALLMENT PAYMENT PLAN FOR UNPAID PREMIUM AND EXPENSES FOR THE DEFENDANT REFRENCED ABOVE. Richle Water Michelle Williams (Apr 5. 2024 20:29 EDT Customer Signature 04-05-2024 Date Nisely, Ethan Blake Bail Bond Agreement Final Audit Report 2024-04-05 Created: 2024-04-05 (Eastern Daylight Time) By: xavier pacheco (xavier.pacheco@bail2go.com) Status: Signed Transaction ID: CBJCHBCAABAAyOujgri8WhR2ROa3dq2JpBpq-4_gwHgO "Nisely, Ethan Blake Bail Bond Agreement" History Document created by xavier pacheco (xavier.pacheco@bail2go.com) 2024-04-05 - 7:04:28 PM EDT- IP address: 24.73.231.206 *, Document emailed to michellewilliamc@gmail.com for signature 2024-04-05 - 7:14:57 PM EDT Email viewed by michellewilliamc@gmail.com 2024-04-05 - 7:41:12 PM EDT- IP address: 172.226.170.7 do Signer michellewilliamc@gmail.com entered name at signing as Michelle Williams 2024-04-05 - 8:29:47 PM EDT- IP address: 107.146.18.82 Do Document e-signed by Michelle Williams (michellewilliamc@gmail.com) Signature Date: 2024-04-05 - 8:29:49 PM EDT - Time Source: server- IP address: 107.146.18.82 • Agreement completed. 2024-04-05 - 8:29:49 PM EDT Bail 2CO Powered by Adobe Acrobat Sign

File	Classified as	Size	Modified	OCR	Links
05012024_POWER OF ATTORNEY flileghenv Casualtv Companv_002.pdf Only the original Power of Attorney POWER OF ATTORNEY POWER will bind this surety. Allegheny Casualty Company AS3K-587332 NUMBER PO Box 5600, Thousand Oaks, CA 91359 THIS POWER VOID IF NOT USED BY: Decembe (800) 935-2245 0 2 4 poa@aiasurety.com POWER AMOUNT $ 3,000 KNOW ALL MEN BY THESE PRESENTS, th… [show full stored text]	Executed Power (PoA)	329.2 KB	2024-06-14 15:24:34 uploaded 44d after created	no	Dropbox · History
05012024_POWER OF ATTORNEY flileghenv Casualty Campany_003.pdf Only the original Power of Attorney will bind this surety. POWER OF ATTORNEY Allegheny Casualty Company POWER NUMBER AS6K-954736 PO Box 5600, Thousand Oaks, CA 91359 THIS POWER VOID IF NOT USED BY: Decembe (800) 935-2245. 02.4 poa@aiasurety.com POWER AMOUNT $ 6,000 KNOW ALL MEN BY THESE PRESENTS, th… [show full stored text]	Executed Power (PoA)	327.2 KB	2024-06-14 15:24:34 uploaded 44d after created	no	Dropbox · History
05012024_POWER OF ATTORNEY flileghenv Casualty Company PO Box 5600, Thousand Oaks, CA 91359 ;- (800)!9^5-2245 ● poa@aiasurety.com.pdf Only the original Power of Attorney will bind this surety. POWER OF ATTORNEY Allegheny Casualty Company POWER NUMBER AS3K-587331 PO Box 5600, Thousand Oaks, CA 91359 THIS POWER VOID IF NOT USED BY: Decembe (800) 935-2245 02 4 poa@aiasurety.com POWER AMOUNT $ 3,000 KNOW ALL MEN BY THESE PRESENTS, tha… [show full stored text]	Executed Power (PoA)	335 KB	2024-06-14 15:24:34 uploaded 44d after created	no	Dropbox · History
Nisely, Ethan Blake Bail Bond Agreement - signed.pdf BAIL BOND APPLICATION - INDEMNITOR COMPANY ALLEGHENY CASUALTY COMPANY P.O. Box 9810, CALABASAS, CA 91372-9810 TELEPHONE (800) 935-2245 BAIL 2 GO P.O. Box 592643, ORLANDO, FL 32859-2643 TELEPHONE (407) 254-5554 1. Name _ Michelle Williams First Middle Last My friends/family know me as Michelle 2. Residence Address 2205 Johns Lake Court City. Kissimmee _State Fl _Zip 34758 3. How Long at Current Address 5yrs _ Rent Free_N_ Lease _ ~ Own Y Landlord/Mortgagor Name Loan Depot Mortgage 4. Is Mortgage/Lease in your name? Yes X _ No X _ When does Lease Expire N/a _Email Michellewilliamc@gmail.com 5. Cell Phone # 4078663740 Cell Carrier 'erizol iPhone or Android iPhone How Long with Cell No. 3 6. Employer N/A Length Na Position No Work # No Any ownership greater than 20% in any Corporation, LLC, or S-Corp No Any specialized license to work No 7. Social Security No. 431198889 ID# Unknown _Wt Ht other Race_N Eye Color , Br Hair Red 8. Have you ever filed Bankruptcy. Do you have any judgements or liens against you currently If so, where 9. Gender Femal Place of Birth Helena Date of Birth 01-15-1964 US Citizen Wes Marital Status _ How Long 10. Have many years have you lived in FL? 24yrs Are you a convicted felon? No Are you on any type of Probation or Parole? N 11. Vehicle Year _ Vehicle Color Green Vehicle Make Focus Tag No. y485rp Vehicle Miles 15747 Amount Owed 12. Relationship to Defendant Son _ How long have you known Defendant 34 Defendants Home Address 2205 Johns Lake Court Defendants Cell Phone Number (786) 761-3626 13. Emergency Contact Name Michelle Williams Address 2205 Johns Lake Court Phone No. 407-866-3740 13. Children Yes No Amount of children 14. Attorney N/a Ages 000-11122323 Do kids reside with you 15. How did you hear about us? _ Phone No. GOOGLE May we reach out on the defendants behalf YES Personal References First & Last Name Joshua Meredith 1. 2. 3. 4._ 5._ 6. Molly Nisely Caleb Meredith Michelle Williams Joshua Gilbert Patrick Malone Relationship B N M F F City / State Kissimmee Kissimmee Kissimmee Kissimmee Kissimmee Orlando Phone 3214422452 +1 (407) 267-5541 (407) 837-3449 4078663740 6892419162 4077447874 I hereby represent and warrant that the foregoing information is true, complete and correct and is made for the purpose of inducing International Fidelity Insurance Company/Allegheny Casualty Company to issue, or cause to be issued, bail bond(s) for Warning: Any person who knowingly and with intent injure, defraud or deceive any insurer, files a statement of claim or an application containing and false, incomplete or misleading information is guilty of a felony of the third degree. Defendant Sign Michelle Williams (Apr 5, 2024 20:29 EDT) Print Michelle Williams ID# SSN DOB 949587299564838 431198889 01-15-1964 allegheny CASUALTY COMPANY PO Box 5600, Thousand Oaks, CA 91359 800.935.2245 info@aiasurety.com THIS IS A 3-PAGE, DOUBLE SIDED DOCUMENT READ CAREFULLY AND COMPLETE BAIL BOND APPLICATION - INDEMNITOR PRODUCER NAME, ADDRESS, PHONE, EMAIL AND PRODUCER LICENSE NUMBER MUST. BE PREPRINTED. OR STAMPED. HERE: Bail 2 GO - Kissimmee P.O. Box 592643, Orlando, FL 32859 (407) 483-7983 Defendant Info Defendant Name Ethan Blake Nisely Charges Case Number 24MM0883, 23CF3236 Jail Location Birth Date 04/26/1988 Appearance Date BATTERY; TOUCH OR STRIKE, COM DOMES BATTERY BY STRANGULA, PETIT THEFT >$100 <$750 Court Name Osceola County Circuit Court County Booking Number Osceola County Corrections Department Osceola 805267 My friends / family know me as Indemnitor Name Michelle Jean Williams Home Phone Number Cell Phone Number (407) 866-3740 Work Phone Number Relationship to Defendant Mother Current Full Address, City, State and Zip 2205 Johns Lake Ct, Kissimmee, FL 34758 From To Email Landlord Name (if applicable) • Own • Rent Landlord Phone Number Former Full Address, City, State and Zip From To Landlord Name (if applicable) • Own • Rent Landlord Phone Number • M Birth Date * F 01/15/1964 Driver's License / ID Number W452-550-64-515-0 Additional Notes Birth Place Social Security Number 431-19-8889 State Issued FL U.S. citizen? Alien Number • Yes •No How long in US? Employer Position How Long E Supervisor's Name § union Phone Number Local Number Military Branch Active • Yes • No Discharge Date [Facebook Username So Password Twiter Username Linkedin Username Other Account Username Password Password Password Form# ACC.0302 (11/22) Page 1 of 3 Cash on hand ($) Cash in bank ($) Monthly Salary or Wages ($) Real Estate Value($) Real Estate Mortgage ($) Title Name Year Make Model Color Plate Number State Financing company Balance owed • Single Significant Other Name • Married Cohabitating • Separated • Divorced • Widowed Email DOB Significant Other Full Address, City, State and Zip A span one Nona Namo Years together Phone Number DOB Phone Number DOB Phone Number Former Significant Other Name Email DOB Former Significant Other Full Address, City, State and Zip Years together Phone Number Reference Name DOB Relationship to Indemnitor Full Address, City, State and Zip Cell Phone Number Work Phone Number Reference Name DOB Relationship to Indemnitor Full Address, City, State and Zip Cell Phone Number Work Phone Number Reference Name DOB Relationship to Indemnitor Full Address, City, State and Zip Cell Phone Number Work Phone Number I hereby represent that the foregoing information is true, complete and correct and is made for the purpose of inducing Allegheny Casualty Company to issue, or cause to be issued, bail bond(s) for the defendant referred to herein. Signed, sealed and delivered this Signature Authorized Indemnitor Signature Michelle Kates Michelle Williams (Apr 5, 2024 20:29 EDT) Indemnitor Print Name Michelle Jean Williams Driver's License Number W452-550-64-515-0 Social Security Number 431-19-8889 Birth Date 01/15/1964 SEE NEXT PAGE FOR APPLICABLE FRAUD WARNINGS Form# ACC.0302 (11/22) Page 2 of 3 FRAUD WARNIN IMPORT ALABAMA RESIDENTS Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly presents false information in an application for insurance is guilty of a crime and may be subject to restitution fines or confinement in prison, or any combination thereof. ARKANSAS RESIDENTS Any person who knowingly presents a talse or traudulent claim tor pavment tor a loss or benetit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. CALIFORNIA RESIDENTS For your protection California law requires the following to appear on this form: Any person who knowingly presents false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison. FLORIDA RESIDENTS Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. mw. LOUISIANA AND MAINE RESIDENTS t is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines or a denial of insurance benefits. MARYLAND RESIDENTS: Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly or willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. NEW JERSEY RESIDENTS Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties. NEW MEXICO RESIDENTS Any person who knowingly presents a false or fraudulent claim for payment or a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to civil fines and criminal penalties. NEW YORK RESIDENTS Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation. OHIO RESIDENTS Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud. OKLAHOMA RESIDENTS WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony. PENNSYLVANIA RESIDENTS RHODE ISLAND, TENNESSEE, VIRGINIA, WASHINGTON, AND WEST VIRGINIA RESIDENTS defrauding the company. Pendits say nolde imprisonment, fines or a denial of insurance benefiny for the purpose of Form# ACC.0302 (11/22) Page 3 of 3 allegheny CASUALTY COMPANY PO Box 5600, Thousand Oaks, CA 91359 800.935.2245 info@aiasurety.com THIS IS A DOUBLE SIDED DOCUMENT READ ALL SIDES CAREFULLY BAIL BOND AGREEMENT ("Agreement") PRODUCER NAME, ADDRESS, PHONE, EMAIL AND PRODUCER LICENSE NUMBER MUST BE PREPRINTED OR STAMPED HERE: Bail 2 GO - Kissimmee P.O. Box 592643, Orlando, FL 32859 (407) 483-7983 Agreement ¡ Detalls In consideration of Allegheny Casualty Company ("Surety"), through Surety's duly appointed independent bail producer ("Bail Producer"), (Surety and Bail Producer are sometimes together referred to as "Surety"), issuing, or causing to be issued, a criminal appearance bail bond described as: 04/05/2024 Ethan Blake Nisely Indemnitor Name(s) Ethan Nisely, Michelle Williams 6,500.00 Total Premium $ 700.00 Power Number (s AS3K587331, AS3K587332, AS6K954736 ("Bond") I/we represent and warrant that I/we have read, approve and agree to all of the terms and conditions found on following pages (front and back). Signed, sealed and delivered this Defendant Signature Print Name Ethan Blake Nisely Indemnitor Signature Print Name Indemnitor Signature Mill lit Michelle Williams (Apr 5, 2024 20:29 EDT) Print Name Michelle Jean Williams Indemnitor Signature Print Name Indemnitor Signature Indemnitor Signature Print Name Print Name Si no puede leer ni entender Inglés, favor de marcar este cuadro. 5 If you cannot read or understand English, please check this box.) Check box and complete the following if translation is required Translation Certification. The undersigned translator makes this affidavit and hereby certifies, under penalty of perjury, that he/she read verbatim and translated this entire document, including the reverse side, and all related bond application documents including disclosures, promissory notes, security instruments and trust deeds, to the Indemnitor signing below in his/her primary language. Translator Print Name Translator Signature Translator Full Address Date Confirmo por mi colocación de mis iniciales que las dos caras de este acuerdo han sido traducidos completamente a mi satisfacción. (I confirm by my affixing my initials that this contract has been translated to my satisfaction.) INDEMNITOR Initials READ ALL TERMS AND CONDITIONS ON THE FRONT AND BACK OF EACH PAGE Form# ACC.FL.0307 (10/21) Page 1 of 4 And Conditi ons You, the undersigned (referred to herein as "Indemnitor," "Defendant," or together as "you" or "your," as applicable), agree to be bound to the following terms and conditions: 1. The premium for the Bond is fully earned upon the release of Defendant from custody. The premium is not refundable except as stated herein or provided by law. 2. Defendant agrees to appear in any Court as required in connection with the Bond at the dates and times stated in the Bond and/or as may be ordered by the Court. Indemnitor will ensure that Defendant appears in Court as so required or as ordered by the Court. 3. Surety shall have control and jurisdiction over the Defendant during the term for which the Bond is in effect and shall have the right to apprehend, arrest and surrender the Defendant to the proper officials at any time as provided by law and/or this Agreement. It the Detendant Is surrendered betore a tailure to appear in Court, and tor a reason other thar as stated in paragraph 4, you may be entitled to a retuna of the Bond premium it required by applicable law it any) and as may be stated in the Supplemental Terms and Conditions. M.W. 4. Unless otherwise provided by applicable law it any), the tollowing events shall constitute a breach of your obligations o the Surety, and the Surety shall have the right to immediately apprehend, arrest and surrender Defendant to custody. and you shall have no right to the refund of premium whatsoever: a Detendant departs the jurisdiction of the Court without the prior written consent of the Court and the suretv b Detendant moves trom nis/ner current address without prior written consent of the surety, or Detendant tall to notify Surety of any changes in address; (c) Defendant commits any act that constitutes reasonable evidence of the intention to cause a torteiture of the Bond or Detendant's tailure to appear in Court as required; (d Defendant is arrested and incarcerated for any other offense (other than a minor traffic violation); (e) Defendant or an Indemnitor makes any materially talse statement in any material submitted to surety tor the bond cludina the Bail Bond Application and Indemnitor Application; (f The bail for Defendant is increased; (g ndemnitor requests the surrender to custody of the Defendant; and/or (h) There is a material increase in th risk assumed by the Surety (as determined by the Surety in its sole and absolute discretion), including, by way of example, but not limited to, depreciation or impairment of any collateral pledged as security for the Bond. 5. In the event that the apprehension and surrender of Defendant to custody is required for any reason, including the failure to appear by Defendant at any required Court proceeding or hearing, Defendant understands, agrees, and acknowledges that such apprehension and surrender involves risk of harm to Defendant and others, and as such Defendant accepts the risk of such harm that may be caused to Defendant and/or others. Defendant also agrees to defend, indemnify and hold Surety harmless (including all agents and employees thereof) from any injuries, harm, claims, actions, lawsuits, damages, liability, demands, fees and expenses, including attorneys fees and costs, made by any third party against Surety (including all agents and employees thereof) arising out of such apprehension and surrender of Defendant. 6. You, jointly and severally (together and separately) with any other indemnitor, shall indemnify the Surety and keep the Surety indemnitied and hold it harmless from and against any and all claims, lawsuits, damages, losses, liability, demands, actions, judgments, tees, fines, penalties and expenses (including attorneys tees and costs), relating to, or arising out of, Surety's issuance or procurement of the Bond (together, "Liabilities"), including, but not limited to, the following: a the principal amount of anv tortelture ot, or ludament on, the Bond, plus any related court costs, interest anc aal tees incurred; (b any tugitive recovery tee it there is a torteiture of the Bond which tee is typically ten to under this Agreement, reasonable and actual attorney's fees plus any and other costs, expenses and/or assessments that may be incurred as a result thereof the forfeiture of the Bond as subject to applicable law (if any). The voucher, check or other evidence of any payment made by Surety shall be conclusive evidence of such payment in any action against you as to the propriety of such payment and as to the extent of your liability to Surety for such payment hereunder. Further, you will, upon demand, place with Surety the requisite cash funds to meet any Liabilities (including a pending. unpaid judgment or forfeiture demand), whether the demand is made before or after Surety has paid or advanced such funds. . Subiect to applicable law (it anv). anv collateral (real or personal. includina cash or securities) pledaed to or depositec with Suretv as securitv for the obliaations under this Agreement ("Collateral") is held for the pavment or reimbursemen of any and all sums due to Surety for any and all Liabilities sustained, paid or incurred by Surety. You authorize the or any part thereof, in order to pay or reimburse the Surety for any and all sums due to Surety under this Agreement, the Bond and/or to place the Surety in cash funds so as to protect the Surety against the payment of any Liabilities, including any claim, demand, loss, or judgment arising out of the Bond, even if the Suretv has not paid any such Liabilitv. Subiect to applicable law (if anv). the Suretv mav make anv such sale, at its liscretion, at public or private sales, and without demand, notice or advertisement of the time and place of said sale, ano also with the right to purchase said Collateral at such sale or sales, freed and discharged from any equity or redemption, except as otherwise provided by applicable law. 8. The Surety shall not be liable for the depreciation of any Collateral or for any interest thereon. In the event of depreciation of the value of Collateral, or any part thereof, or of any Collateral that may be hereafter pledged to or deposited with the Surety, upon request of the Surety, you shall provide the Surety with additional and satisfactory Collateral so that the total value of the Collateral shall equal the value of the Collateral at the time of the initial pledae or deposit. Subject to applicable law (if any), if you fail to deposit such additional Collateral, the Surety shall have the full right, power and authority, without further demand or notice, to sell, assign and deliver the whole or any part of such Collateral, including any substituted or additional Collateral, at public or private sale, at its option, and without demand, notice or advertisement, and also with the right to purchase said Collateral at any such sale, freed and discharged from any equity or redemption as provided by applicable law. 9. If a Confession of Judgment ("COJ") is taken as security for the Bond, the Surety shall have the right to enter, record and file the COJ at any time, and such COJ shall constitute a lien entitled to a preference against any of your property, Form# ACC.FL.0307 (10/21) Michelles Michelle Williams (Apr 5, 2024 20:29 EDT) Page 2 of 4 whether or not the Surety is entitled to be indemnified at the time of the entry, recording or filing of such COJ. If such COJ is entered, recorded or filed by the Surety against you, the COJ entered shall be effective and available to the Surety against you. 10. You acknowledge and agree that the Surety may foreclose against the Collateral and/or exercise any of the rights or remedies_provided under this Agreement or take any combination of such actions without waiving any other right or remedy. Failure to exercise any rights or remedies of the Surety at any one time shall not constitute a waiver of the right to exercise them at any other time. Any security or Collateral you give may be substituted, subordinated, or released by the Surety without affecting any other rights. The Surety shall not be obligated to entoris rights against any security, Collateral or indemnitor prior to entorcing its rights against you or any other indemnitor t 11. Subject to applicable law (if any), the Surety will return the Collateral to you when all of the following are satisfied: (a) the Surety receives sufficient and competent written legal evidence satisfactory to the Surety for example, written notice from the Court) of the discharge, release or exoneration of the Surety from all liability under the Bond; (b) there are no outstanding Liabilities of any kind arising out of or relating to the Bond or this Agreement; (c) there are no other obligations executed by, for or on behalf of the Defendant for which the Surety may deem t advisable to retain such Collateral for its protection; and d) upon the request by Surety, you shall execute and deliver to Surety a legal release of claims upon the return by Surety of the Collateral to you. † the Surety deems it necessary to make any outlay to protect any Collateral or security in its possession, whether fo real or personal property, you authorize the Suretv to do so. and vou aaree to indemnifv and reimburse the Suretv fol any such outlay as in the judgment of the Surety may be necessary to protect the Collateral, including payment of taxes, liens or mortgages and any attorney's tees, costs and service tees tor time spent and/or special services rendered. Agreement, and/or in the Bond, to the Bail Producer or any other person or entity ("Assignee") without notice to or consent from you. Subject to any limitations imposed upon Assignee by the Surety, Assignee shall have the right to Terms And Conditions (continued from previous page) 13. You hereby acknowledge and agree that neither the Surety nor Bail Producer has recommended or suggested any specitic attorney or firm of attorneys to represent the Defendant in any capacity.- 14. This Agreement may not be terminated or modified orally. Any modification and termination of this Agreement, including any release of liability hereunder, must be in writing and signed by the Surety and you. federal law including, but not limited to, Reporting Act) and any local or state law relating to Surety obtaining, and you consent to and authorize Surety to obtain, any and all private or public information and/or records concerning you from any party or agency, private or governmental (local, state or federal), including, but not limited to, credit reports, Social Security Records, criminal records, cIvil records, driving records, tax records, telephone records, medical records, school records, worker applicable law, any and all private and public information and records in their possession concerning you to the Surety and direct that a copy of this document shall serve as evidence of said authorization. 16. You irrevocably grant to Surety and Bail Producer, and their agents and employees, the right to enter your residence, or any other residence or real property you own or occupy, without notice, at any time, for the purpose of ocating, arresting, and returning the Defendant to custody, and subject to applicable law, you waive and release any and all causes of action in connection therewith, including without limitation, torts of trespass and false imprisonme 17. Defendant agrees that Surety may attach a location tracking device on any vehicle owned or driven by Defendant, at any time, without notice, and monitor the location of the vehicle through any available technology. Defendant further agrees that Surety may use location technologies to locate and track any wireless device of Defendant at any time during the period of the Bond is in force and any applicable Bond remission period, and the Bond is conditioned upon the full compliance by Defendant with the following terms and conditions: (a) Surety, at its discretion, will use network-based location technologies to locate Defendant; (b) This is the only notice Defendant will receive for the collection of location information; (c) Surety will retain location data only while the Bond is in force and during any applicable Bond remission period; (d) Surety may disclose location information as required by Court Order or process; (e) Surety, including its agents and representatives, will be AND ANY APPLICABLE BOND EMISSION PERIOD KING DURING THE PERIOD THE BOND IS IN FORCE and (f) YOU WILL NOT HAVE THE Direct all questions regarding this paragraph to the Surety. 18. If Defendant leaves the state in which the Bond was issued, subject to applicable law, Defendant waives any rights to oppose extradition proceedings. 19. In the event any provision herein shall be deemed to exceed any applicable state or tederal law, then such provision shall automaticallv be deemed to have been revised to complv with such law so as to provide Suretv with the maximum rotection from any Liabilities. The invalidity or unentorceability of any provision herein (or portion thereot) shall in n vay effect the validity or enforceability of any other provision (or portion thereof of this Agreement 20. This Agreement and all documents that are executed in connection with this Agreement set forth all the terms of the agreement between the Surety and you. All statements, representations, promises, agreements, and affirmations made by the Surety or Bail Producer, or any representative, employee or agent, thereof prior to or contemporaneously with the execution of this Agreement are contained within this document, set forth in this Agreement, are of no force or effect whatsoever in determining the rights, obligations and/or liabilities between the Surety and you. You further agree to execute and be bound by any other future documents necessary to carry out and effectuate this Agreement. Form# ACC.FL.0307 (10/21) Michel Kitti Michelle Williams (Apr 5. 202420:29 EDT) Page 3 of 4 1. Surety, as bail, shall have control and jurisdiction over Defendant during the term for which the Bond is executed and shall have the right to apprehend, arrest and surrender Defendant to the proper officials at any time as provided by law. 2. In the event Defendant's surrender is made prior to the time set for Defendant's appearances, and for reasons other than as enumerated below in paragraph 3, then a refund of the Bond premium shall be made to the person whose name appears as Payer on the Premium Receipt. . It Is understood and agreed that the happenina ot anv one of the tollowing events shall constitute a breach c Defendant's obligations to uretv. and suretv shall have the raht to immediatelv apprehend. arrest an Defendant, and no person shall have any right to any refund of premium whatsoever. The events which constitute a breach of Defendant's obligations hereunder are: a It Detendant departs the lurisdiction of the Court without the written consent of the Court and surety or Bal Producer: (b) If Defendant moves from one address to another within the State of Florida without notifyinc Surety or Bail Producer in writing prior to moving; (c) If Defendant commits any act which constitutes reasonable evidence of Detendant's intention to cause a torteiture of the Bond;(a) It Detendant is arrested and incarcerated for any offense other than a minor traffic violation; or (e) If Defendant makes any material false statement in the Agreement. Services, Bail Bond Section, 200 Tallahassee, FL 32399-0322, 1-877-693-5236 (in-state) 5. The person whose name appears as Payer on the Premium Receipt shall be entitled to a refund of premium for the Bond if and when it is found that Surety had no liability under the Bond because Defendant did not come under the jurisdiction of the court to which Defendant is returnable or Defendant is not released from custody, except where the Bond is written to allow Defendant to serve a sentence in another jurisdiction. 6. For good and valuable consideration, vou agree to indemnify and hold harmless the Surety or its agent for all losses not otherwise prohibited by law or by rules of the Department of Financial Services. Supplemental Terms Bond and recommitment of Defendant. 8. The specific fees for which you are required to indemnify Surety in accordance with the Agreement are as follows: (a) Costs necessary to apprehend Defendant in the event Defendant attempts to flee the jurisdiction of the courts; (b) Attorneys tees and court costs associated with filing of motions; (c) Documented transportation and odging expenses outside the jurisdiction of the court; (d for housing, re-arrest, transportation and extradition; and (e) A maximum fee of $100 for a surrender allowed by law when there has been no torteiture of the Bond 9. Collateral will be returned to the person whose name appears as "Depositor" on the Collateral Receipt within 21 days after proof of final termination of liability on the Bond has been provided to the Surety. 10. Surety shall be entitled to deduct from collateral held or any return premium all fees, expenses, and charges authorized by applicable law, including Florida Administrative Code 69B-221.105. a conflict between the terms and conditions of the Agreement and this Supplement, this Supplement shall control. Milki Michflle Williams (Apr 5, 2024 20:29 EDT) Form# ACC.FL.0307 (10/21) Page 4 of 4 allegheny CASUALTY COMPANY PO Box 5600, Thousand Oaks, CA 91359 800.935.2245 info@aiasurety.com BAIL BOND INFORMATION SHEET PRODUCER NAME, ADDRESS, PHONE, EMAIL AND PRODUCER LICENSE NUMBER MUST BE PREPRINTED OR STAMPED HERE: Bail 2 GO - Kissimmee P.O. Box 592643, Orlando, FL 32859 (407) 483-7983 Defendant Name Ethan Blake Nisely Power Number(s) AS3K587331, AS3K587332, AS6K954736 Case Number 24MM0883, 23CF3236 As principal (defendant) and/or indemnitor (guarantor) on a bail bond, you must be given a copy of any collateral documents that you sign relating to the above bond(s). When all agreements have been fulfilled, bond is discharged in writing by the court, and without loss expense on the bond(s), your collateral will be returned to you. BE AWARE: YOUR COLLATERAL IS AT RISK if the principal fails to appear in court or if the principal commits any breach (violation) of agreement. ANY OF THE FOLLOWING HAPPENINGS IS A BREACH OF AGREEMENT: 1. If principal fails to appear in court; 2. If principal shall depart the jurisdiction of the court without the written consent of the court and the Surety, or its agent; 3. If principal shall move from one address to another without notifying the Surety, or its Agent, in writing, prior to said move; 4. If principal shall commit any act which shall constitute reasonable evidence of principal's intention to cause a forfeiture of the bond (s); 5. If principal is arrested and incarcerated for any offence other than a minor traffic violation; 6. If principal shall make any material false statement in the application; 7. If principal shall violate any special restriction or condition of the bond(s) imposed by the Court. For general information regarding your collateral, contact the agency as shown on the top of this sheet. For further inquiry / complaint, contact Department of Financial Services Bail Bond Section 200 East Gaines Street Tallahassee, FL 32399-0320 Phone: (850) 413-5660 ** Read carefully prior to signing ** I/We have received a copy of this information sheet. I/e have received a copy of all collateral documents that I/We signed regarding the above bond(s). Defendant Signature Print Name Date Ethan Blake Nisely Signed original to agent's bond file; Copy to defendant and each indemnitor lemnitor Signatu Michelle Williams (Apr 5, 2024 20:29 EDT) Print Name Michelle Jean Williams Date 4/05/2024 Form# ACC.FL.0028 (10/22) Page 1 of 1 allegheny CASUALTY COMPANY PO Box 5600, Thousand Oaks, CA 91359 800.935.2245 info@aiasurety.com PRIVACY NOTICE PRODUCER NAME, ADDRESS, PHONE, EMAIL AND PRODUCER LICENSE NUMBER MUST BE PREPRINTED OR STAMPED HERE: Bail 2 GO - Kissimmee P.O. Box 592643, Orlando, FL 32859 (407) 483-7983 This Privacy Notice applies to your non-public personal information ("personal information") received by Allegheny Casualty Company and/or AlA Holdings, Inc., as applicable, ("Surety"), through that Surety's duly appointed independent bail producer ("Bail Producer") (Surety and Bail Producer are sometimes together referred to as "Surety"), issuing, or causing to be issued, a criminal appearance bail bond described as: THE INFORMATION WE COLLECT: The Bail Producer is a licensed, independent contractor who is appointed by us to write bail. Prior to issuing a bail bond, the Bail Producer will collect, and in some cases, transmit to us your personal information. Your personal information is obtained from a variety of sources: • Applications and other forms (e.g., name, address, social security number, employment information, family member information, assets, income, and property locations and values) and electronically if you use our website or web-based date - our website uses cookies to collect individual information about you and your website usage); • Transactions and experiences with us and others, (e.g., credit card and account balances, and payment history); and • Consumer reporting agencies, medical providers, or others (e.g., credit score, background checks, and medical and employment information). HOW WE USE & PROTECT PERSONAL INFORMATION: Your personal information will be used to process the bail bond application, underwrite and post the bond and resolve bond claims or breaches of contract. We may provide your personal information to others working with us who need this information for these purposes, such as attorneys and investigators. Your personal information is used to assess the risk of the bail bond transaction, protect against fraud, or generally to effect, administer or enforce the terms of the bail bond transaction. Only authorized personnel are permitted to access your personal information. We convey to our employees and appointed Bail Producers the need to protect your personal information and require our outside vendors and service providers to keep your personal information confidential and to use it only to provide the services we have asked them to perform. PARTIES TO WHOM WE MAY DISCLOSE INFORMATION: We do not disclose your personal information to anyone except as permitted/required by law - for example, to industry regulators, law enforcement agencies, credit bureaus, subpoena, and third parties that assist us in the bail bond process and underwriting. We do not sell your personal information to anyone, and do not share your personal information with any companies or organizations that would use it to contact you about their products and services. CONFIDENTIALITY AND SECURITY: We maintain physical, electronic and procedural safeguards to protect your personal information. We ensure that your personal information is treated responsibly and consistent with our privacy policies. We also restrict access to your personal information within our organization to those persons who must have the information to provide services to you or to conduct our business. Persons who have access to your personal information may use it only for our business purposes. We safeguard your personal information in accordance with applicable laws. You have a right to review your personal information and to request that we correct, amend or delete such information on file. WEB PRIVACY: When you visit AlA's website at (www.aiasurety.com), the Web server automatically collects and maintains statistical information from our site's data logs that concern network traffic flow and volume. The information that is collected does not identify personal information. The collected information is used to improve the usefulness of the web site. We reserve the right to change this Privacy Notice at any time. The most up to date version of our Privacy Notice can be found on AIA's website. CALIFORNIA CONSUMER PRIVACY ACT: For California Residents, please visit www.aiasurety.com/CCPA to access our complete California privacy statement under the CCPA. If you would like a full copy of the policy, please contact the Surety at (818) 223-3308 or privacy@aiasurety.com FURTHER INFORMATION: If you have any questions about how we use the information we collect, please write to us at: AIA Compliance Department, PO Box 5600, Thousand Oaks, CA 91359 Indemnitor / Defendant Signature Michel Thei Michelle Williams (Apr 5, 2024 20:29 EDT) Indemnitor / Defendant Printed Name Michelle Jean Williams Date 04/05/2024 Form# ACC.0027 (10/21) Page 1 of 1 COLLATERAL RECEIPT allegheny CASUALTY COMPANY PO Box 5600, Thousand Oaks, CA 91359 800.935.2245 info@aiasurety.com Receipt No.: ACFL- 6314-5926 PRODUCER NAME, ADDRESS, PHONE, EMAIL AND PRODUCER LICENSE NUMBER MUST BE PREPRINTED OR STAMPED HERE Bail 2 GO - Kissimmee P.O. Box 592643, Orlando, FL 32859 (407) 483-7983 Type Deposit of collateral: Depositor hereby acknowledges receipt of • Return of collateral: Depositor hereby surrenders the original and acknowledg a copy of this document and agrees to the terms on the reverse e return and receipt of collateral listed herein and that the collateral has be side. The collateral identified below is deposited as security for the bail bond(s), premium owed, if any, and all lawful expenses is bai producer from any tute ability responsibily in ration to the lateral. incurred due to underwriting the referenced bail bond(s). Date Received 04/05/2024 Depositor Address 2205 Johns Lake Ct, Kissimmee, FL 34758 Power Number(s) AS3K587331, AS3K587332, AS6K954736 Depositor Name(s) Michelle Jean Williams Depositor Phone Number (407) 866-3740 Defendant Name Ethan Blake Nisely Case Number 24MM0883, 23CF3236 Items) Received - describe below, specify condition Promissory Note Bail Bond Agreement Collateral funds - in form of If applicable, I acknowledge a Credit Card fee of Bond Amount 6,500.00 Amount or Estimated Value $ 6,500.00 $ $ Held By Bail Producer • Surety Bail Producer Surety Bail Producer Surety % in the amount of $ FLORIDA USE ONLY Form# ACC.FL.0304-2 (01/23) Print Name Michelle Jean Williams Signature XAVIER PACHECO W189868 Print Name Xavier Pacheco COLLATERAL RECEIPT Except as otherwise provided by applicable law (if any) as stated in the Bail Bond Agreement ("Agreement"), you are depositing the collateral as security for the payment of any and all monies and sums due to Surety or its Bail Producer, including all liability, claims, demands, debts (including promissory notes), damages, judgments, losses, interest, premiums, expenses, services charges, expenditures, attorneys' fees and costs suffered, sustained, made or incurred by Surety or its Bail Producers on account of, arising out of or relating to the above bail bond and transactions contemplated thereby, your failure to comply with the terms and conditions of the Agreement and any and all debt or other obligations arising out of or evidenced by any agreement executed by you, Defendant or any other indemnitors) for the benefit of Surety or its Bail Producer, all of the terms of which are made a part of this receipt by this reference ("Liabilities"). The Bail Producer will make the collateral available for return to the person whose name appears as Depositor on the Collateral Receipt (or that person's heir, legal representative, or successor in interest) within 10 days, or as stated in the Agreement, after receiving written notice from the court that the Bond and the Surety have been exonerated, and must verify with the court that the obligation has been exonerated before returning the Bond. If the collateral you provided included a document that conveys title to alien on real property and such document was recorded, the Bail Producer or Surety shall deliver a reconveyance of the property, executed in such a manner that it may also be recorded, to you or your heir, legal representative or successor in interest within 10 working days, or as stated in the Agreement, after the Bail Producer or Surety receives notice of the exoneration of the Bond in writing by the court. The Bail Producer or Surety shall deliver such reconveyance document to you by making the document available at its principal place of business or mailing it to you upon your request. The Bail Producer or Surety will not return any collateral to you until you provide the written receipt that identifies the Bond, describes the collateral, and shows your signature. For any complaints or inquiries, you may contact the Department of Financial Services, Division of Consumer Services, 200 East Gaines Street, Tallahassee, FL 32399-0322, (877)693-5236 (in-state), (850)413-3089 (all areas), www.MyFloridaCFO.com/Division/Consumers. CONTINGENT PROMISSORY NOTE This Contingent Promissory Note ("Note") is being executed by the undersigned ("Maker") to secure Allegheny Casualty Company, as Surety, upon forfeiture or estreature of the surety bond(s) posted on behalf of defendant: On demands after date, for value received, I/We promise to pay to the order of Allegheny Casualty Company the sum of $ 6,500.00 Dollars, at PO Box 5600, Thousand Oaks, CA 91359, with interest thereon at the rate of eighteen percent (18%), per annum from call date until fully paid. The Maker further agrees to waive demand, notice of non-payment and protest, and in case suit shall be brought for the collection hereof, or the same has to be collected upon demand of an attorney, to pay reasonable attorney's fees and assessable costs, for making such collection. It is further agreed and specifically understood between the parties to this Note that there is presently no outstanding loan or debt represented by this Note, and that this Note is given only to secure future advances. It is further agreed and specifically understood that this Note shall become null and void in the event the said Defendant shall appear in the proper court at all the time or times so directed by the Judge or Judges of competent jurisdiction until the obligations under the appearance bond or bonds posted on behalf of the Defendant have been fulfilled and the Surety discharged or exonerated of all liability thereunder, in writing, otherwise to remain in full force and effect. Case numbers) 24MM0883, 23CF3236 , Osceola COUNTY, FLORIDA P/A number(s) AS3K587331, AS3K587332, AS6K954736 Mill Kaki Michelle Williams (Apr 5, 2024 20:29 EDT) Signature Signature Michelle Jean Williams Maker Name 04/05/2024 Date Maker Name Date Form# ACC.FL.0036 (10/21) 082 1 2 BAIL BOND INFORMATION & SPECIAL CONDITIONS - DEFENDANT ALLEGHENY CASUALTY COMPANY P.O. Box 9810, CALABASAS, CA 91372-9810 TELEPHONE (800) 935-2245 BAIL 2 GO P.O. Box 592643, ORLANDO, FL 32859-2643 TELEPHONE (407) 245-5554 Defendant: Address: Power No (s): Conditions of Bond: Check in Schedule: Call in Ethan Blake Nisely Phone: 2205 Johns Lake Ct Kissimmee, Florida 34758 AS3K587331, AS3K587332, AS6K954736 MUST CHECK-IN EVERY WED BY BVMA TILL CASE IS CLOSED L360 GPS MUST CHECK-IN EVERY WED BY BVMA TILL CASE IS CLOSED BVMA Physical Check In's Failure to keep an updated phone number on file and not Checking In as agreed upon including but not limited to; excessive late check in's or several missed check in's will constitute as a reasonable act to Allegheny Casualty Company and it's Agents reasonable evidence of principle's intention to cause a forfeiture of said bond. ANY OF THE FOLLOWING HAPPENINGS IS A BREACH OF AGREEMENT 1. 2. 3. 4. 5. 6. 7. If principal fails to appear in court. If principal shall depart the jurisdiction of the court without the written consent of the court and Allegheny Casualty company of it Agents. If principal shall move from one address to another without notifying Allegheny Casualty Company, or its Agents in writing prior to said move. If principal shall commit any act which shall constitute reasonable evidence of principal's intention to cause a forfeiture of said bond. If principal is arrested and incarcerated for any offense other than a minor traffic violation If principal shall make any material false statement in the application If principal shall violate any special restriction or condition of the bond(s) imposed by the court Defendant's Signature: Signature: Ethan Blake Nisely Printed: Date: helle Williams (Apr 5, 2024 20:29 El CO Credit Card Authorization form CO 1, MICHELLE JEAN WILLIAMS , give permission to Axiom Surety Corp dba Bail 2 GO to charge Indemnitor my card for the following transaction(s). My card details will be stored under my Bail 2 GO profile and will only be used for approved transaction(s) and incurred expenses. $700.00 Michellewilliamc@gmail.com ETHAN BLAKE NISELY # 805267 Amount Authorized Cardholder E-mail Defendant's Name & Booking # All fields required Card information Card type • MasterCard Discover • VISA • AMEX Truist debit Other MICHELLE JEAN WILLIAMS Cardholder (Name on card) 4634 0512 0559 7361 Card number 05/27 Expiration date (MM/YYYY) 34758 ZIP Code (From credit card billing address) 940 CVV Recurring Payments Information Charge every: Week Bi- Weekly Monthly Other Charge on this date. (For example, the 1st of every month) Hand Delivered Emailed Copies To: Payment Amount Defendant Name / Case # / Power(s) # Terms of agreement: PLEASE REFER TO PROMISSORY NOTE AND INSTALLMENT PAYMENT PLAN FOR UNPAID PREMIUM AND EXPENSES FOR THE DEFENDANT REFRENCED ABOVE. Richle Water Michelle Williams (Apr 5. 2024 20:29 EDT Customer Signature 04-05-2024 Date Nisely, Ethan Blake Bail Bond Agreement Final Audit Report 2024-04-05 Created: 2024-04-05 (Eastern Daylight Time) By: xavier pacheco (xavier.pacheco@bail2go.com) Status: Signed Transaction ID: CBJCHBCAABAAyOujgri8WhR2ROa3dq2JpBpq-4_gwHgO "Nisely, Ethan Blake Bail Bond Agreement" History Document created by xavier pacheco (xavier.pacheco@bail2go.com) 2024-04-05 - 7:04:28 PM EDT- IP address: 24.73.231.206 *, Document emailed to michellewilliamc@gmail.com for signature 2024-04-05 - 7:14:57 PM EDT Email viewed by michellewilliamc@gmail.com 2024-04-05 - 7:41:12 PM EDT- IP address: 172.226.170.7 do Signer michellewilliamc@gmail.com entered name at signing as Michelle Williams 2024-04-05 - 8:29:47 PM EDT- IP address: 107.146.18.82 Do Document e-signed by Michelle Williams (michellewilliamc@gmail.com) Signature Date: 2024-04-05 - 8:29:49 PM EDT - Time Source: server- IP address: 107.146.18.82 • Agreement completed. 2024-04-05 - 8:29:49 PM EDT Bail 2CO Powered by Adobe Acrobat Sign	Booking Report	1.5 MB	2024-06-14 15:24:34 uploaded 70d after created	no	Dropbox · History
Nisely, Ethan Blake Def TLOxp Report.pdf Your Current Reference ID: NONE 1 Result Found for people named ETHAN NISELY born on 4/26/1988 in the United States. ETHAN BLAKE NISELY SR, 35 Years Old (Florida, California, North Carolina) ETHAN BLAKE NISELY SR Possible Relatives Cities (06/18/2003 to 02/03/2024) Molly Pia Nisely 1986 Age: 38 Vill… [show full stored text]	Unclassified	170.9 KB	2024-06-14 15:24:34 uploaded 70d after created	no	Dropbox · History
Nisely, Ethan Blake Email Screenshot 2024-04-05 at 6.43.01 PM.png • Inbox - Bail 2 GO 6:35 PM Michelle Williams DL and email To: Xavier@bail2go.com MW Hi Xavier Here's the info you requested. Email Michellewilliamc@gmail.com BANG & OLUFSEN intel CORe intel iRISx® GRAPHICS Florida DRIVER LICENSE * W452-550-64-515-0*° WILLIAMS MICHELLE JEAN 2205 JOHNS LAKE CT. KISSI… [show full stored text]	State ID	1.8 MB	2024-06-14 15:24:34 uploaded 70d after created	no	Dropbox · History
Nisely, Ethan Blake Google Map Screenshot 2024-04-05 at 6.55.37 PM.png Saved Recents 2205 Johns L... 2205 Johns Lk Ct cor teet Diningham X app W\| Restaurants P• Hotels • Things to do • Transit P Parking # Pharmacies ятт ATM JELD-WEN Doors Sign in 2205 Johns Lk Ct Directions Save Nearby Send to phone Share 2205 Johns Lk Ct, Kissimmee, FL 34758 •i. 6GQ7+4H Kissimmee, Flo… [show full stored text]	Image (unclassified)	1.8 MB	2024-06-14 15:24:34 uploaded 70d after created	no	Dropbox · History
Nisely, Ethan Blake Ind ID.jpg BANG & OLUFSEN intel CORe 17 intel iRISx° GRAPHICS Florida DRIVER LICENSE W452-550-64-515-0 CLASSE LUAMS ELLELEAN JOHNS LAKE CT SIMMEE, FL 34758 ров 01/15/1964 # 01/15/2030 18 нGт 5-06" 12 REST NONE SEND NONE 11/30/2021 [show full stored text]	State ID	100.6 KB	2024-06-14 15:24:34 uploaded 70d after created	no	Dropbox · History
Nisely, Ethan Blake Ind TLOxp Report.pdf Your Current Reference ID: NONE 1 Result Found for people with TLO Person ID RG7T-NJ32 in the United States. MICHELLE JEAN WILLIAMS, 60 Years Old (Florida, South Dakota, New York, Arkansas, Georgia) MICHELLE JEAN WILLIAMS Possible Relatives Cities 05/27/1994 to 02/03/2024) Miranda J Lewis 1964 Age: … [show full stored text]	Unclassified	175.6 KB	2024-06-14 15:24:34 uploaded 70d after created	no	Dropbox · History
Nisely, Ethan Blake Appearance Bond.pdf allegheny CASUALTY COMPANY PO Box 5600, Thousand Oaks, CA 91359 800.935.2245 info@aiasurety.com FOR FURTHER ACTION ON THIS BOND NOTIFY: Bail 2 GO - Kissimmee P.O. Box 592643, Orlando, FL 32859 (407) 483-7983 DOA - 4/4/2024 DOB- 4/261988 Transfer agent BLACK / MALE General Surety Appearance Bond STAT… [show full stored text]	Executed Power (PoA)	311.6 KB	2024-06-14 15:24:34 uploaded 70d after created	no	Dropbox · History
Nisely, Ethan Blake Bookingsheet.pdf Name: ETHAN BLAKE NISELY Name: AKA: DOB: Inmate ID: Booking: Category: Offense 801643 801645 801652 Booking 24002801 24002801 24002801 Statute 784.03-1A1 - BATTERY; TOUCH OR STRIKE 784.041-2A ! - COM DOMES BATTERY BY STRANGULA 812.014-2E - PETIT THEFT >$100 <$750 04/26/1988 805267 24002801 ADULT Bon… [show full stored text]	Unclassified	396.5 KB	2024-06-14 15:24:34 uploaded 70d after created	no	Dropbox · History
Nisely, Ethan Blake BV EDP-Flat.pdf allegheny CASUALTY COMPANY PO Box 5600, Thousand Oaks, CA 91359 800.935.2245 info@aiasurety.com THIS IS A 4-PAGE, DOUBLE SIDED DOCUMENT READ CAREFULLY AND COMPLETE BAIL BOND APPLICATION - DEFENDANT PRODUCER NAME, ADDRESS, PHONE, EMAIL AND PRODUCER LICENSE NUMBER MUST. BE PREPRINTED OR STAMPED HERE: … [show full stored text]	Booking Report	985.6 KB	2024-06-14 15:24:34 uploaded 68d after created	no	Dropbox · History
Nisely, Ethan Blake BV EDP.pdf allegheny CASUALTY COMPANY PO Box 5600, Thousand Oaks, CA 91359 800.935.2245 info@aiasurety.com THIS IS A 4-PAGE, DOUBLE SIDED DOCUMENT READ CAREFULLY AND COMPLETE BAIL BOND APPLICATION - DEFENDANT PRODUCER NAME, ADDRESS, PHONE, EMAIL AND PRODUCER LICENSE NUMBER MUST. BE PREPRINTED OR STAMPED HERE: … [show full stored text]	Booking Report	1015.4 KB	2024-06-14 15:24:34 uploaded 68d after created	no	Dropbox · History
Nisely, Ethan Blake BV Premium Receipt.pdf PREMIUM RECEIPT and STATEMENT OF CHARGES allegheny CASUALTY COMPANY PO Box 5600, Thousand Oaks, CA 91359 800.935.2245 info@aiasurety.com Receipt No.: AP- 6314-3810 PRODUCER NAME, ADDRESS, PHONE, EMAIL AND. PRODUCER LICENSE NUMBER MUST. BE PREPRINTED. OR STAMPED. HERE Bail 2 GO - Kissimmee P.O. Box 5… [show full stored text]	Unclassified	110.4 KB	2024-06-14 15:24:34 uploaded 70d after created	no	Dropbox · History
Nisely, Ethan Blake BVMA Screenshot 2024-04-05 at 9.26.43 PM.png Active Ethan Nisely is scheduled to check-in Weekly starting 04/10/2024 Next check-in due 04/10/2024 Acceptable types of check-ins are: 0 Mobile App C Phone Call-in Mobile Tracing: Enable Disable Device NOT connected Online Check-in Code:WPTXXWEYZY Eula NOT signed Send App Download Link Print Schedu… [show full stored text]	Image (unclassified)	103.7 KB	2024-06-14 15:24:34 uploaded 70d after created	no	Dropbox · History
Nisely, Ethan Blake Def ID.pdf USA Florida DRIVER LICENSE *doiaN240-202-88-146-0°CLASSE 2 NIHAN BLAKE 82205 JOHNS LAKE CT KISSIMMEE, FL 34758-2306 3 DOB 04/26/1988 15SEX M 46 EXP 04/26/2026 16HGT 6-00" 12 REST NONE 9a END NONE 4a ISS 03/10/2018 5DD H701907220273 REPLACED 07/22/2019 Operation of a motor vehicle constitutes consent… [show full stored text]	State ID	294.2 KB	2024-06-14 15:24:34 uploaded 68d after created	no	Dropbox · History
Nisely, Ethan Blake Defendant EDP-Flat.pdf BAIL BOND APPLICATION - DEFENDANT COMPANY ALLEGHENY CASUALTY COMPANY P.O. Box 9810, CALABASAS, CA 91372-9810 TELEPHONE (800) 935-2245 BAIL 2 GO P.O. Box 592643, ORLANDO, FL 32859-2643 TELEPHONE (407) 245-5554 1. Name _ Ethan First Middle My friendstfamily know me as Ethan Last 2. Residence Address 2… [show full stored text]	Defendant app (digital)	133 KB	2024-06-14 15:24:34 uploaded 68d after created	no	Dropbox · History
Nisely, Ethan Blake Defendant EDP.pdf BAIL BOND APPLICATION - DEFENDANT COMPANY ALLEGHENY CASUALTY COMPANY P.O. Box 9810, CALABASAS, CA 91372-9810 TELEPHONE (800) 935-2245 BAIL 2 GO P.O. Box 592643, ORLANDO, FL 32859-2643 TELEPHONE (407) 245-5554 1. Name _ Ethan First Middle My friendstfamily know me as Ethan Last 2. Residence Address 2… [show full stored text]	Defendant app (digital)	274.5 KB	2024-06-14 15:24:34 uploaded 68d after created	no	Dropbox · History
Nisely, Ethan Blake File Checklist.pdf Completed File CheckList Folder Named Properly - (Last-Name, First - 10/19/22 - NZ) All Files are named correctly in Folder, - (Doe, John - Booking report etc....) Booking Sheet Mugshot (Current or Previous) TLO's for all parties involved Clerk Search for "ALL" Relevant Counties State ID's for all s… [show full stored text]	Unclassified	360.3 KB	2024-06-14 15:24:34 uploaded 68d after created	no	Dropbox · History
Nisely, Ethan Blake Mamba Screenshot 2024-04-05 at 9.29.00 PM.png Booking Date = Apr 04 2024 #Booking Number Name 805267 ETHAN BLAKE NISELY DOB Apr 26 1988 36 years ago Charges 784.03-1A1 - BATTERY; TOUCH OR STRIKE,784.041-2A! - COM DOMES BATTERY BY STRANGULA,812.014-2E - PETIT THEFT >$100 <$750 Total Bond $6,500.00 County osceola Hot Don't Bond Client Operations … [show full stored text]	Image (unclassified)	184.7 KB	2024-06-14 15:24:34 uploaded 70d after created	no	Dropbox · History
Nisely, Ethan Blake Mugshot.jpg	Court/case doc reason: low-text-confidence	59.3 KB	2024-06-14 15:24:34 uploaded 70d after created	yes	Dropbox · History
Nisely, Ethan Blake Notifaction Screenshot 2024-04-05 at 10.22.11 PM.png Notification Settings & Ethan Blake Nisely (Defendant, Indemnitor) Turn Notifications On? Yes No Types Appearance Date: N/A Checkin Due Standard Check-In Payment Due : N/A [show full stored text]	Notifications screenshot	94.8 KB	2024-06-14 15:24:34 uploaded 70d after created	no	Dropbox · History
Nisely, Ethan Blake Prem CC Payment Receipt.pdf Transaction Successful Customer Added to Vault Successfully Transaction Receipt Void Refund Transaction Information Merchant: Axiom Surety Corp - (Orlando, FL) Transaction ID: 9388438018 Amount: $700.00 Date: 04/05/2024 8:48:01 PM EDT Transaction Type: Card Sale Entry Method: Keyed Credit Card Infor… [show full stored text]	Unclassified	46.3 KB	2024-06-14 15:24:34 uploaded 70d after created	no	Dropbox · History
Nisely, Ethan Blake Premium Receipt - signed.pdf PREMIUM RECEIPT and STATEMENT OF CHARGES allegheny CASUALTY COMPANY PO Box 5600, Thousand Oaks, CA 91359 800.935.2245 info@aiasurety.com Receipt No.: AP- 6314-3810 PRODUCER NAME, ADDRESS, PHONE, EMAIL AND. PRODUCER LICENSE NUMBER MUST. BE PREPRINTED. OR STAMPED. HERE Bail 2 GO - Kissimmee P.O. Box 5… [show full stored text]	Premium Receipt	256.3 KB	2024-06-14 15:24:34 uploaded 69d after created	no	Dropbox · History
Nisely, Ethan Blake Special Conditions.pdf BAIL BOND INFORMATION & SPECIAL CONDITIONS - DEFENDANT ALLEGHENY CASUALTY COMPANY P.O. Box 9810, CALABASAS, CA 91372-9810 TELEPHONE (800) 935-2245 BAIL 2 GO P.O. Box 592643, ORLANDO, FL 32859-2643 TELEPHONE (407) 245-5554 Defendant: Address: Power No (s): Conditions of Bond: Ethan Blake Nisely Phone… [show full stored text]	Unclassified	589.7 KB	2024-06-14 15:24:34 uploaded 68d after created	no	Dropbox · History
SERVICE OF COURT DOCUMENT – 2023 CF 003236, STATE OF FLORIDA vs. NISELY, ETHAN BLAKE Wed, 5 Jun 2024 185344 +0000.PDF IN THE CIRCUIT COURT OF THE NINTH JUDICIAL CIRCUIT IN AND FOR OSCEOLA COUNTY, FLORIDA CERTIFICATE OF BOND DISCHARGE Case No: 2023 CF 003236 Bond Power Number AS6K-954736 BAIL 2 GO PO BOX 592643 ORLANDO, FL 32859 Bond Amount $5,000.00 Discharge Date 6/5/2024 Defendant: ETHAN BLAKE NISELY In accordanc… [show full stored text]	Unclassified	102 KB	2024-06-14 15:24:34 uploaded 9d after created	no	Dropbox · History
SERVICE OF COURT DOCUMENT – 2024 MM 000883, STATE OF FLORIDA vs. NISELY, ETHAN BLAKE Fri, 18 Oct 2024 125422 +0000.PDF IN THE COUNTY COURT OF THE NINTH JUDICIAL CIRCUIT IN AND FOR OSCEOLA COUNTY, FLORIDA CERTIFICATE OF BOND DISCHARGE Case No: 2024 MM 000883 Bond Power Number AS3K-587331 AS3K-587332 Bond Amount $1,000.00 $500.00 Discharge Date 10/18/2024 10/18/2024 BAIL 2 GO PO BOX 592643 ORLANDO, FL 32859 Defendant:… [show full stored text]	Unclassified	99 KB	2024-10-28 12:34:35 uploaded 10d after created	no	Dropbox · History

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