Licensing Section
Arizona Department of Insurance
100 North 15
th
Avenue, Suite 102, Phoenix, Arizona 85007-2624
Phone: (602) 364-4457 | Toll-free: (877) 660-0964
Web: https://insurance.az.gov | E-mail: Licensing@azinsurance.gov
L-BFP (v. 20180618)
Form L-BFP: Bail Recovery Agent Fingerprint Submission
Filing this form does not authorize a person to conduct any action relating to a bail recovery or apprehension.
In accordance with ARS § 13-3885(C), the bail bond agent utilizing a bail recovery agent must submit
Form L-BRA , Notice of Bail Recovery Utilization, within 24 hours after retaining the bail recovery agent.
A new set of fingerprints accompanied by a FBI Fingerprint Card Processing Fee is required before
September 1 of every third year thereafter.
Include with a completed version of this form all the following:
FBI fingerprint card (Form FD-258) with Form L-FPV (Form L-FPV instructions provide important information).
$22.00 FBI Fingerprint Card Processing Fee (non-refundable; amount subject to change without notice)
Section 1: Bail Recovery Agent information
Full Last Name Full First Name Full Middle Name Date of Birth
Home Street Address City State Zip Code Home Phone
Business Street Address City State Zip Code Business Phone
Section 2: Attestation (pursuant to Arizona Revised Statutes §§ 13-3885 and 20-340.04)
By my signature below, I hereby certify, under penalty of perjury, that I have NEVER been convicted in any
jurisdiction of ►theft, ► any crime involving carrying or the illegal use or possession of a deadly weapon or
dangerous instrument, or ► any felony.
For the purposes of this attestation, “convicted” includes, but is not limited to, having been found guilty by
judge or jury or pled guilty or no contest to any felony charge, regardless of whether
the conviction was dismissed, expunged, pardoned, appealed, set aside or reversed;
civil rights were restored;
a plea was withdrawn;
probation, a suspended sentence or a fine was given; or
a diversion program was successfully completed.
__________________________________________
FULL Signature of bail recovery agent
Section 3: Photograph
Attach a 2” X 3” photograph of your face
To be completed by the
Department of Insurance
Date Received: _____/_____/20_____
FP card received
FBI FP fee received
BRA Team Member: ______________
