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Poverty Affidavit Form. This is a Georgia form and can be use in Fulton Local County.
Tags: Poverty Affidavit, Georgia Local County, Fulton
IN THE SUPERIOR COURT OF FULTON COUNTY
STATE OF GEORGIA
FAMILY DIVISION
In re the Family of:
Petitioner: _____________________________
Civil Action File No: ____________________
and
Respondent: ___________________________
POVERTY AFFIDAVIT
Comes now _____________________________ , the Petitioner in the above styled __________________
________________________________ (name of petition), being first duly sworn, deposes and says:
1. That I, by reason of my poverty, am unable to pay the cost required by O.C.G.A. §15-6-77 to file a civil
case, in the Courts of Fulton County.
2. That I am _______________ years of age, and my monthly household income is __________________ .
A copy of my last two pay stubs/unemployment checks is attached.
3. That I live at _______________________________________________ , and pay ________________
____________per month as rent.
4. My household consists of __________________ number of people.
5. That I pay the following bills each month:
Name of Bill
Amount of Bill
6. That I hereby request that I be able to proceed in this action without having to pay filing fees and associated
costs.
This the ________ day of ____________________ , _____ .
(Sign your name here in front of the Notary or Judge )
Address: _____________________________________
Telephone number: (
Sworn to and subscribed before me, this
____ day of _______________________ , _______ .
)
NOTARY PUBLIC/ JUDGE
My Commission Expires:
(Notary Seal)
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Poverty Affidavit Form
©2006 Fulton County Superior Court Family Division
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