( RCr 4.26 )
Date _____
Receipt No. ______________
Case No. ______________
Defendant ______ Address ______ Charge ______
Bond Type ______ Bond Amount $______ Court ______
Court Date ______ Judge ______ Received from ______
the deposit of $ ______________________________
( ) Cash ( ) Check
Surety: __________________ By: __________________
Deposit $______ returned on ______ to ______
Ky. R. Crim. P. Form 13