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Financial Affidavit For Court Appointed Attorney Form. This is a Kansas form and can be use in 3rd Judicial District (Shawnee County) Local District Court.
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Tags: Financial Affidavit For Court Appointed Attorney, Kansas Local District Court, 3rd Judicial District (Shawnee County)
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
Financial Affidavit :
Calendar No.
For Court-Appointed Attorney
:
JUDICIAL
Plaintiff(s)
Obligor Name:
-against-
Last
:
First
Spouse if Married:
SUBPOENA
MI
Age
:
Last
First
MI
Phone: (
Street
Emergency Contact:
City
)
MI
Phone: (
:
Address:
Age
)
State/Zip
Defendant(s)
:
......................................................
Last
First
Address:
Street
City
THE PEOPLE OF THE STATE OF NEW YORK
State/Zip
Monthly Income
EMPLOYMENT: Are you (check one): ___Employed ___Unemployed ___Self-employed
TO
Complete the information below for the past 12 months:
EMPLOYER
EMPLOYMENT (YOUR)
ADDRESS
DATES OF
SPOUSE)
GREETINGS:
I
N
C
O
M
E
__
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
If living with your parents or others to whom you look for support, enter their monthly income. . . . . . . .
the Honorable
at the
Court TOTAL
$
X 12
located at
County of
$
Estimated Annual Income
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date,Have you received within the past 12 months any other action on the part of a
OTHER INCOME: to testify and give evidence as a witness in this income, including from the
business, rent payments, public assistance, support or other sources? ___ Yes ___No
If yes, give the amount received and identify sources
$
$
Total Annual Income
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
O
T
H
E
R
O
B
L
I
G
A
T
I
O
N
S
A
S
S
E
T
S
CASH: Have you any available cash or money in savings or checking accounts, certificates of deposit or
other funds? ____ Yes ____ No
Value
$
Witness, Honorable
, one of the Justices of the
Court in
County,
day of
20
PROPERTY: Do you own a home, land or other property? (Do, not include any household furnishings or
clothing)
____ Yes
____ No
$
A. If yes, approximately how much is it worth?
$
B. How much is still owed on it?
$
C. Net value of property (Amust sign above and type name below)
(Attorney - B)
$
Total Income, Other Income, Cash, and Property:
DEPENDENTS: Check one: ___Single ___Married ___Widowed ___Separated ___Divorced
Total Number of Dependents ______. List their names, ages, and relationship to you:
Attorney(s) for
&
D
E
B
T
S
Debts/Monthly Bills: List
your expenses for each of the following categories:
Rent/House payment. . . . . . . .
Food/Clothing/Medicine . . . .
$
Office and P.O. Address
Utilities. . . . . . . . . . . . . . . . . .
Alimony/Child Support . . . . .
Installment Payments . . . . . .
Other Payments . . .Telephone No.:
.......
TOTAL MONTHLY EXPENSES
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
$
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