Affidavit Of Indigency And Application For Counsel Form
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1
2
3STATE OF SOUTH CAROLINA
)
IN THE FAMILY COURT
)
_____JUDICIAL CIRCUIT
COUNTY OF ______________________
)
)
)
AFFIDAVIT OF INDIGENCY
A JUVENILE
)
AND
)
APPLICATION FOR COUNSEL
)
(Defense of Indigency Act, Form No.2)
)
)
A Child under Seventeen (17) Years of Age ) Docket No. ____________________________
NAME OF APPLICANT
ADDRESS
(
)
TELEPHONE NUMBER
S
DATE OF BIRTH
.
SOCIAL SECURITY NO
-
NAMES OF CO
DEFENDANTS
1.
Are you presently employed?
Yes
No
a. If “yes”, state the amount of your salary or wages per month, and give the name and address
of your employer.
SALARY OR WAGES
NAME AND ADDRESS OF EMPLOYER
PER MONTH
If “no”, state the name and address of last employment, date of termination of employment, and
amount of your salary or wages per month.
SALARY OR WAGES
TERMINATION
NAME AND ADDRESS OF EMPLOYER
PER MONTH
DATE
2.
Include employment information for the spouse, if applicable.
SALARY OR WAGES
NAME AND ADDRESS OF EMPLOYER
PER MONTH
If the spouse is not currently employed, state the name and address of last employment, date of
termination of employment, and amount of salary or wages per month.
SALARY OR WAGES
TERMINATION
NAME AND ADDRESS OF EMPLOYER
PER MONTH
DATE
SCACRVIFORM02JU (12/2009)
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