Affidavit Of Indigency
Download a blank fillable Affidavit Of Indigency in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Affidavit Of Indigency with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3AFFIDAVIT OF INDIGENCY
COURT OF APPEALS OF GEORGIA
_________________________,
*
APPELLANT
*
Vs
*
CASE NUMBER
_________________________,
*
___________________
APPELLEE
AFFIDAVIT OF INDIGENCY
Comes now ________________ (Appellant’s name) first being duly sworn, deposes and states I
am financially unable to pay the filing fee required for filing in the Court of Appeals of Georgia,
and I request that I be permitted to file Appellant’s Brief or Appellant’s Application without
having to pay filing fees. I further swear that the responses which I have made to the questions
and instructions below are true.
G Yes
G No
1. Are you presently employed either full or part time?
If the answer is “Yes”, state the amount of your salary or wages per month, and give the
name, address and phone number of your employer:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
If the answer is “No”, state the date of last employment and the amount of the salary and wages
per month which you received: _______________________________________________
_________________________________________________________________________
_________________________________________________________________________
2.
Have you received within the past twelve months any money from any of the following
sources?
Business, profession or form of self-employment? G Yes
G No
G Yes
G No
Pensions, annuities or life insurance payments?
G Yes
G No
Rent payments, interest or dividends?
G Yes
G No
Gifts or inheritances?
G Yes
G No
State or Federal benefit allowances?
G Yes
G No
Any other sources?
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal