IN THE COURT OF APPEALS FIRST APPELLATE DISTRICT OF OHIO HAMILTON COUNTY, OHIO APPEAL NO. ___________________ STATE OF OHIO Plaintiff vs AFFIDAVIT OF INDIGENCY ____________________________ Defendant _______________________________, the undersigned, being first duly sworn and cautioned, deposes and states 1. That he is the defendant in the above styled case; 2. That he is a citizen of the State of Ohio; 3. That he is indigent and unable to pay the costs and charges involved in the within matter, 4. That he is entitled to the redress that is sought in the above styled action to the best of his knowledge and belief. FURTHER AFFIANT SAYETH NAUGHT. _______________________________ Defendant/Appellant-Indigent SWORN TO AND SUBSCRIBED BEFORE ME, A NOTARY PUBLIC IN AND FOR THE COUNTY AND STATE THIS __________ DAY OF ________, ________. _______________________________ NOTARY PUBLIC American LegalNet, Inc. www.FormsWorkFlow.com