Legal Help
FINANCIAL DISCLOSURE / AFFIDAVIT OF INDIGENCY
I. Personal Information
Name: Date of Birth:
Mailing Address: City:: State: Zip:
Phone: Residence
II Other Persons Living in Household
1. Name: Age: Relationship:
2.. Name: Age: Relationship:
3. Name: Age: Relationship:
4. Name: Age: Relationship:
III Monthly Income / Employment Information In Dollars
IV Additional Information
Are you a US citizen? Eligible Alien Status
Cash Assets: Cash on Hand: $ Bank Accts: $ Stocks/Bonds: $
Monthly Expenses: $
Case pending in what Court: Case Number:
Opposing party: Opposing Counsel:
Court date:
Attorney Consulted: Phone: Date:
Briefly describe the issues: