Affidavit Concerning Financial Status - Leave To Appeal Granted By Supreme Court
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Affidavit Concerning Financial Status - Leave To Appeal Granted By Supreme Court Form. This is a Michigan form and can be use in Appeals Statewide.
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Tags: Affidavit Concerning Financial Status - Leave To Appeal Granted By Supreme Court, CC 293, Michigan Statewide, Appeals
Original - Circuit court
1st copy - Prosecutor
2nd copy - Defendant
Approved, SCAO
STATE OF MICHIGAN
CIRCUIT COURT
COUNTY
AFFIDAVIT CONCERNING
FINANCIAL STATUS - LEAVE TO APPEAL
GRANTED BY SUPREME COURT
CASE NO.
COURT OF APPEALS:
CIRCUIT COURT:
Court address
Court telephone no.
Defendant name, address, and telephone no.
v
THE PEOPLE OF THE STATE OF MICHIGAN
The following is information concerning my present financial status.
1. RESIDENCE
Rent
Own
Live with parents
Room/Board
Prison
Number
2. MARITAL STATUS
Single
Married
Divorced
Separated
Dependents:
Number
3. INCOME a. Employer name and address
b. Length of employment
c. Average pay
weekly
Gross: $
monthly
d. Other income (State monthly amount and source, such as DSS, VA, rent, pensions, spouse, unemployment, etc.
every two weeks
Net: $
If no income, state NONE.)
4. ASSETS
(State value of car, home, bank deposits, inmate accounts, bonds, stocks, etc. If no assets, state NONE. Attach an account statement
and certification for assets in prisoner accounts.)
5. OBLIGATIONS (Itemize monthly rent, installment payments, mortgage payments, child support, etc.)
Signature
Subscribed and sworn to before me on
,
County, Michigan
Date
My commission expires:
Date
Signature:
Notary public
Notary public, State of Michigan, County of
Administrative Order 2003-03
CC 293 (5/07)
AFFIDAVIT CONCERNING FINANCIAL STATUS - LEAVE TO APPEAL GRANTED BY SUPREME COURT
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