Unsworn Declaration of Indigency at a glance
What it is: Filing the Unsworn Declaration of Indigency in place of an Affidavit of Indigency is allowed by Section 132.001 of the Texas Civil Practices and Remedies Code.
Who signs: You sign the form with Your Signature, formally signed under penalty of perjury.
A filled-in Unsworn Declaration of Indigency example: an unmarried worker declares her income
How to fill out Unsworn Declaration of Indigency, box by box
Cause Number
The Clerk's office will fill in the Cause Number when you file this form.
My name, date of birth, address and email address
Enter your name (First, Middle, Last), your date of birth (Month, Day, Year), your address (Street Address, City, State, Zip, Country) and your email address.
Government Entitlements
Check one: I do not currently receive any government entitlements based on indigency (poverty), or I currently receive the following government entitlements based on indigency (poverty).
List all government entitlements based on indigency received by you or your dependents and the dollar amount of the benefit if applicable, under Name of Public Benefit, Person Getting the Benefit and Dollar Amount.
Attach proof of the government entitlements received to this form.
Income
a. Enter your net monthly income from employment (after taxes), or check I am not currently employed or self-employed.
b. Enter your spouse's net monthly income (after taxes), or check I am not married, or check My spouse's income is not available to me.
c. List the source of income (i.e. unemployment, retirement, social security, interest, dividends, child support, spousal support) and the monthly amount you receive for all other income.
Dependents
List the people who depend on you financially under Name, Age and Relationship to Me.
Property
List the property and its value - the amount the property would sell for less the amount you still owe on it. If there is no property in a particular category, write “none.”
Property: Bank Accounts (list bank, type of account and amount of $ in account), Vehicles (list make and year), Real Estate - House or Land (do not list the house you live in) and Other Property of Value (like boats, jewelry, stocks, etc.).
Monthly Expenses
Enter each monthly expense you have: Rent / Mortgage, Insurance (auto, life, health, etc.), Food, Vehicle payments, Utilities (electric/gas), Gas, bus fare, auto repair, Telephone, Child support / spousal support, Clothing and laundry, Other expenses/debts: (describe) and Medical, dental expenses.
Also enter Child care, school tuition and Household supplies, then Total monthly expenses.
Signing under penalty of perjury
You declare under penalty of perjury that the statements made in this Unsworn Declaration of Indigency are true and correct, and that you are unable to pay court costs.
List any other facts you want the court to know, such as unusual medical expenses, family emergencies, etc.
Enter Your Signature, the County, Texas and the date on which the form is formally signed.
Sources
[1] Unsworn Declaration of Indigency (December 2014), TexasLawHelp.org, Texas Rules of Civil Procedure, Rule 145 (the Official source link on this page).