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Client Corner
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Contact

Fiduciary Bond Application

Please provide all of the requested information. Any missing information may cause a delay in processing. If you have questions please contact us at 503.977.5624 or jtuomi@jdfulwiler.com.

Fiduciary Bond Application

Please provide all of the requested information. Any missing information may cause a delay in processing. If you have questions please contact us at 503.977.5624 or jtuomi@jdfulwiler.com.

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Applicant Information
Applicant Name*
First Last
Applicant's Address*
Street Address City State ZIP Code
Phone Number*
Date of Birth*
Month
Day
Year
Social Security Number*
Occupation*
Annual Income*
Net Worth*
Marital Status*
- Married
- Single
- Registered Domestic Partner
Spouse Occupation*
Spouse Annual Income*
Spouse Net Worth*

Attorney Representing the Applicant
Attorney Name*
First Last
Firm Name*
Firm Address*
Street Address City State ZIP Code
Contact Person
First Last
Phone Number for Contact Person
Email Address for Contact Person
Fax Number for Contact Person
Bond Details
Bond Amount*
What County is the Case Located In?*
Case #

Request Type
Request For:*
- Pre-Approval (no cost)
- Issue Bond (checking this box will result in a bond to be issued as applied)
Fully Earned Premium*
I understand the first year premium on this bond is fully earned when the bond is issued. I also understand there will not be any return premium if the bond is cancelled in less than one year. NOTE: Premium is charged ONLY if a bond is issued. There is no cost for pre-approval.
- Yes, I understand that premium is fully earned for one year when the bond is issued and there is not any return premium if the bond is cancelled in less than one year.
Requester Is:*
- Conservator
- Trustee
- Guardian
- Personal Representative

Protected Person Information
Respondent Name*
First Last
Address*
Street Address City State ZIP Code
Date of Birth*
Month
Day
Year
What is the Applicant's Relationship to the Protected Person?*
Respondents Condition/Diagnosis:*
Is the applicant a debtor or creditor to the Protected Person?*
- Yes
- No
If yes, please explain:
Asset Values for the Protected Person
Real Property
Is the Real Property Restricted from sale by the Court?
- Yes
- No
Cash/Accounts
Personal Property (other than cash/accounts)
Annual Income
Source of Income:
Other (please explain)

Estate Information
Name of Decedent*
First Last
Date of Death*
Month
Day
Year
What is the Applicant's Relationship to the Decedent?*
Is there a Will?*
- Yes
- No
Please list the Heirs/Devisees (if known):
Is the applicant a debtor or creditor to the Estate?*
- Yes
- No
If yes, please explain:
Asset Values for the Estate
Real Property
Is the Real Property Restricted from sale by the Court?
- Yes
- No
Cash/Accounts
Personal Property (other than cash/accounts)
Other (please explain)

General Information
Has there ever been a prior bond for this case?*
- Yes
- No
If yes, please explain:
Are any of the assets connected to a business?*
- Yes
- No
If yes, please explain:
Are the assets a result of an insurance claim?*
- Yes
- No
If yes, has full settlement been paid?
- Yes
- No
Has the applicant EVER been convicted of a felony?*
- Yes
- No
Has the applicant EVER filed bankruptcy?*
- Yes
- No
By checking yes, I hereby certify that I am the applicant shown above.*
- Yes
By checking yes, I hereby certify that I understand I must maintain attorney representation for myself in this matter as long as the court requires a bond.*
- Yes
By checking yes, I hereby certify that all of the information provided within this application is true and correct.*
- Yes
Authorization for Credit Report
By checking yes, I (the applicant stated above), agree to and grant Court Bonds (a division of JD Fulwiler & Co. Insurance) and any authorized representative or a surety companies represented by Court Bonds/JD Fulwiler permission to obtain a credit report at the time of application, during any review of a bond issued or renewal of a bond issued. I understand the purpose of obtaining a credit report is to evaluate my application for a court bond to be issued or renewal and that the credit report will not be used for any other reason.*
- Yes
Email Confirmation
Email Confirmation*
Please provide the email address where you would like us to send your copy of this application.
Signature*

Portland

5727 S Macadam Ave
Portland, OR 97239
Tel: 503.293.8325
Fax: 503.293.5418
800.735.8325
info@jdfulwiler.com

Vancouver

330 E Mill Plain Blvd., Ste 403
Vancouver, WA 98660
Tel: 503.293.8325
Fax: 503.293.5418
800.735.8325
info@jdfulwiler.com

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