When drivers in New Mexico face the daunting prospect of their driver's license being revoked under the Implied Consent Act, Section 66-8-112 NMSA 1978, financial hardship should not add to their burden. For this reason, the State of New Mexico - Taxation & Revenue Department provides a form of relief through the MVD-10813 form, a Statement of Indigency. This form is a crucial tool for drivers seeking a waiver of the $25 hearing fee, a step necessary to contest the revocation of their driver's license. Detailed and vital, the form requires the applicant to be thorough and honest, emphasizing the need for accuracy under the penalty of perjury as outlined in Section 66-5-38 NMSA 1978. It presents two clear pathways for demonstrating financial need: presumptive eligibility for those already receiving certain public aid, and a more detailed financial disclosure for others not on public assistance. This includes a comprehensive look at income, assets, and extraordinary expenses, alongside an eligibility table to objectively assess indigency. By mandating completion and submission to the Motor Vehicle Division Drivers Services Bureau, the form embodies a blend of statutory requirements and compassion for those in financial hardship, ensuring that every driver has a fair chance to reclaim their driving privileges without the burden of additional financial strain.
| Question | Answer |
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| Form Name | Mvd 10813 Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | mvd 10813, new mexico indigency search, new mexico indigent form, mvd10813 statement indigency |
MVD - 10813 REV. 07/02
State of New Mexico - Taxation & Revenue Department
STATEMENT OF INDIGENCY
This statement is for use only by drivers seeking a waiver of the $25 fee for the hearing on the revocation of their driver's license under the Implied Consent Act under Section
Please complete and mail to: |
Motor Vehicle Division |
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Drivers Services Bureau |
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P.O. Box 1028 |
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Santa Fe, NM |
Or deliver to any New Mexico Motor Vehicle Field Office |
In the matter of the proposed revocation of the driver's license of:
Name |
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D.O.B. |
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Address |
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SSN# |
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City |
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State |
Zip Code |
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Martial |
No. of |
Case No. (top lefthand corner |
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Status |
Dependents |
of your Notice of Revocation) |
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Driver will fill out either Part One or Part Two. Do not fill out both parts. A Driver currently receiving some form of public aid will automatically qualify for the waiver by filling out only Part One. A driver not receiving public aid may qualify for the waiver by filling out only Part Two.
PART ONE - PRESUMPTIVE ELIGIBILITY
I currently receive ❑ AFDC ❑ Food Stamps ❑ Medicaid ❑ DSI ❑ Public Housing in _________________ County.
❑ I have been assigend a Public Defender.
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PART TWO - OTHER ELIGIBILITY FACTORS |
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1. |
Federal adjusted gross income, most recent tax year (first line on the New Mexico personal income tax form): |
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Tax Year __________ Total Amount Income ____________________ |
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Total Assets: |
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Cash on Hand |
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_________________________ |
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Bank Accounts |
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_________________________ |
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Real Estate |
(loan value on equity) |
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_________________________ |
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Vehicles (loan value on equity) |
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_________________________ |
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Other |
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_________________________ |
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Total Amount Assets |
____________________ |
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Add Totals from # 1 and # 2 |
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Total Resources |
____________________ |
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Extraordinary Expenses: |
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Medical (not covered by insurance) |
_________________________ |
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_________________________ |
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_________________________ |
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Other (describe) |
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_________________________ |
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Total Exceptional Expenses |
____________________ |
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Total Available Funds (subtract # 3 Total Exceptional Expenses from # 2 Total Resources) |
____________________ |
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ELIGIBILITY TABLE |
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If Total Available Funds |
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Household Size |
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6 |
(above) is more than your |
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correct Eligibility Table |
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Available Funds |
$8,512 |
$11,487 |
$14,462 |
$17,437 |
$20,412 |
$23,387 |
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column at left, you do not |
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(Add $2975 for each additional family member over six.) |
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qualify for the waiver. |
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I declare under penalty of perjury that the foregoing information is true and correct to the best of my knowledge and that my total available funds qualifies me as indigent under the eligibility table.
Signature |
Date |
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STANDARDS FOR DETERMINING INDIGENCY
Pursuant to Section
I. PRESUMPTION OF INDIGENCY
An applicant is presumed indigent if the person is a current recipient of state or federally administered public assistance programs for the indigent: aid to families of dependent (AFDC), food stamps, medicaid, disability security income (DSI), public assisted housing or department of health case management services (DHMS). Proof of assistance must be attached to the application and no further inquiry is necessary.
II. FINANCIAL RESOURCES
If the applicant is not presumptively indigent, the Applicant shall list:
A.Income
B.Assets
C.Exceptional Expenses
Section A. Net Income
The applicant shall provide information relating to federal adjusted gross income (listed as the first line of the New Mexico Personal Income Tax Return) for the most recent tax year.
Section B. Assets
The applicant shall provide information about all assets owned which are convertible into cash within a reasonable period of time. Assets include all cash on hand as well as in checking and savings accounts, stocks, bonds, certificates of deposit and tax refunds. All real estate shall be considered in terms of the amounts which could be raised by a loan on the property.
Section C. Exceptional Expenses
The applicant shall provide information about any unusual expenses which will affect the applicant's financial condition. The following expenses are not exceptional expenses: rent, food, utilities, gas money, consumer loans and student loans. Exceptional expenses shall include, but not be limited to costs for medical care, family support obligations, child care payments, payroll garnishments, internal revenue service claims, court ordered payments and funeral expenses not covered by insurance.
III. INDIGENCY FORMULA
The total for net income for the applicant (Section A) together with the total for assets (Section B) minus the total for exceptional expenses (Section C). If the available funds exceed the amounts in the indigency table, the applicant is not indigent and must pay the $25.00 fee.