Application For Criminal Indigent Status Form PDF Details

Seeking justice in the legal system can be daunting, especially for those with limited financial resources. The Application For Criminal Indigent Status form serves as a crucial tool for individuals in this position, residing in the state of Florida, who find themselves navigating the complexities of the court. This comprehensive form requires applicants to provide detailed information about their financial status, including income, dependents, assets, and liabilities, to determine if they qualify for a public defender or if they are self-represented, to have their indigence status acknowledged for courtroom-related costs. The application underscores the significance of transparency and honesty, as individuals are informed of the potential consequences of providing false information, which could result in misdemeanor charges. Moreover, it highlights the non-exempt nature of court services, indicating that a judgment and lien may be imposed against the applicant's property to cover legal expenses. With a modest application fee and specific criteria for evaluating one's financial capability, this form embodies the justice system's effort to balance accessibility with accountability, ensuring that the right to legal representation is preserved, regardless of one's economic standing.

QuestionAnswer
Form NameApplication For Criminal Indigent Status Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesflorida criminal indigent form, florida application criminal indigent status, application for criminal indigent status fl, criminal indigent status form

Form Preview Example

IN THE CIRCUIT/COUNTY COURT OF THE ____________________ JUDICIAL CIRCUIT

IN AND FOR

_________________ COUNTY, FLORIDA

STATE OF FLORIDA vs.

CASE NO.______________________________________

______________________________________

 

Defendant/Minor Child

 

APPLICATION FOR CRIMINAL INDIGENT STATUS

____ I AM SEEKING THE APPOINTMENT OF THE PUBLIC DEFENDER

OR

____ I HAVE A PRIVATE ATTORNEY OR AM SELF-REPRESENTED AND SEEK DETERMINATION OF INDIGENCE STATUS FOR COSTS

Notice to Applicant: The provision of a public defender/court appointed lawyer and costs/due process services are not free. A judgment and lien may be imposed against all real or personal property you own to pay for legal and other services provided on your behalf or on behalf of the person for whom you are making this application. There is a $50.00 fee for each application filed. If the application fee is not paid to the Clerk of the Court within 7 days, it will be added to any costs that may be assessed against you at the conclusion of this case. If you are a parent/guardian making this affidavit on behalf of a minor or tax-dependent adult, the information contained in this application must include your income and assets.

1.I have ______dependents. (Do not include children not living at home and do not include a working spouse or yourself.)

2. I have a take home income of $_______________ paid ( ) weekly ( ) bi-weekly ( ) semi-monthly ( ) monthly ( ) yearly

(Take home income equals salary, wages, bonuses, commissions, allowances, overtime, tips and similar payments, MINUS deductions required by law and other court-ordered support payments)

3.I have other income paid ( ) weekly ( ) bi-weekly ( ) semi-monthly ( ) monthly ( ) yearly: (Circle “Yes” and fill in the amount if you have this kind of income, otherwise circle “No”)

Social Security benefits…………………….. Yes $_________________

No

Veterans’ benefit……………………….... Yes $_________________

No

Unemployment compensation…………….. Yes $_________________

No

Child support or other regular support

 

Union Funds…………………………………. Yes $_________________

No

from family members/spouse……… Yes $_________________

No

Workers compensation…………………….. Yes $_________________

No

Rental income…………………………… Yes $_________________

No

Retirement/pensions………………..……… Yes $_________________

No

Dividends or interest…………………….. Yes $_________________

No

Trusts or gifts……………………………....... Yes $_________________

No

Other kinds of income not on the list……Yes $_________________

No

4.I have other assets: (Circle “Yes” and fill in the value of the property, otherwise circle “No.” Use the back of this form to provide additional information.)

Cash…………………………………………. Yes $_________________

No

Savings………………………………………… Yes $_________________

No

Bank account(s)…………………………….. Yes $_________________

No

Stocks/bonds………………………………….. Yes $_________________

No

Certificates of deposit or

 

*Equity in Real estate (excluding homestead) Yes $_________________

No

money market accounts…………….. Yes $_________________

No

*Equity means value minus loans. Also list

 

*Equity in Motor Vehicles/Boats/

 

any expectancy in an interest in such property.

 

Other tangible property……………… Yes $_________________

No

List the address of this property:

 

List the year/make/model and tag #: ________________________________

Address

_________________________________________

 

 

 

City, State, Zip

_________________________________________

 

 

 

County of Residence _________________________________________

 

5.

I have a total amount of liabilities and debts in the amount of $___________________,

 

 

 

6.

I receive: (Circle “Yes” or “No”)

 

 

 

 

Temporary Assistance for Needy Families-Cash Assistance…………………………………………………………………………………..………….….

Yes

No

 

Poverty-related veterans’ benefits….……………………………………………………………………………………………………………………..……..

Yes

No

 

Supplemental Security Income (SSI)………………………………………………………………………………………………………………………….….

Yes

No

7.

I have been released on bail in the amount of $________________. Cash _____ Surety _____

Posted by: Self _____ Family _____

Other

______

A person who knowingly provides false information to the clerk or the court in seeking a determination of indigent status under s. 27.52, F.S., commits a misdemeanor of the first degree, punishable as provided in s. 775.082, F.S., or s. 775.083, F.S. I attest that the information I have provided on this Application is true and accurate to the best of my knowledge.

Signed this _________ day of _______________, 20____.

 

 

 

 

 

Signature of Applicant for Indigent Status

Date of Birth ________________________________

Print Full Legal Name

____________________________________

 

Address

__________________________________

Driver’s license or ID number _________________

City, State, Zip

__________________________________

 

Phone number

__________________________________

 

 

CLERK’S DETERMINATION

 

 

 

_Based on the information in this Application, I have determined the applicant to be (

) Indigent ( ) Not Indigent

 

______

 

 

 

_______

The Public Defender is hereby appointed to the case listed above until relieved by the Court.

Dated this _________ day of ______________, 20 ____.

 

 

 

 

_____________________________________

 

 

 

Clerk of the Circuit Court

 

 

This form was completed with the assistance of

_____________________________________

 

 

 

Clerk/Deputy Clerk/Other authorized person

APPLICANTS FOUND NOT INDIGENT MAY SEEK REVIEW BY ASKING FOR A HEARING TIME. Sign here if you want the judge to review the clerk’s decision of not indigent. _____________________________________________________

06/18/10