Affidavit Of Indigency printable pdf download

IN THE JUSTICE COURT OF RANKIN COUNTY, MISSISSIPPI

STATE OF MISSISSIPPI

VS.

NO. _______________

______________________________________

AFFIDAVIT OF INDIGENCY

STATE OF MISSISSIPPI

COUNTY OF RANKIN

I, ________________________________________, being first duly sworn, depose and say:

I am a Defendant in the above styled and named cause. If I am now or hereafter released

from custody upon the posting of any bond, I do hereby assign unto Rankin County, Mississippi, all

my right or title to any bond monies so posted to the extent necessary to reimburse said county for all

court costs, court appointed attorneys fees or other funds expended for my defense. I neither own

nor have any rights to any assets, funds, cash, money, bank accounts, stocks, bonds, jewelry,

televisions, automobiles, land, houses, "heir property" or other real or personal property of any kind or

character, other than the following:

________________________________________________________________________________

My employer's name and address is _____________________________________________.

My income is $__________ per _______________.

In my present financial condition, above described, I am unable to obtain and pay counsel to

defend me or pay any incidental expenses which may be incurred in the conduct of my defense. If I

have listed assets above which could be sold or disposed of and the proceeds applied to reimburse

the county for the costs of my court appointed counsel, I agree to do so. I understand any false

statement on this affidavit or any failure to cooperate with the county in disposing of my listed assets

to reimburse the county for the costs of my court appointed attorney, as appropriate will constitute

fraud upon this court and a violation in the terms of my suspended sentence I may receive in this

cause, allowing me to be resentenced or any suspended sentence revoked.

I am desirous of having this court appoint counsel to defend me on the following charges:

_______________________________________________________________________________.

I, therefore, respectfully ask this court to appoint able and conscientious counsel to represent

and defend me herein.

I have made no previous application for this relief.

_________________________________

SWORN TO AND SUBSCRIBED BEFORE ME, this _____ day of ___________, 20____.

Jessica Massey, Justice Court Clerk

By: __________________________ D.C.

Affidavit Of Indigency