Poverty Affidavit And Order Court Appointed Counsel
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Poverty Affidavit And Order Court Appointed Counsel Form. This is a Ohio form and can be use in Mahoning County (Court Of Common Pleas).
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Tags: Poverty Affidavit And Order Court Appointed Counsel, Ohio County (Court Of Common Pleas), Mahoning
Revised 2/18/09
IN THE COURT OF COMMON PLEAS
DIVISION OF DOMESTIC RELATIONS
MAHONING COUNTY, OHIO
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EMPLOYER:________________________________
PETITIONER/PLAINTIFF
VS.
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EMPLOYER:________________________________
PETITIONER/DEFENDANT/RESPONDENT
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CASE NO._______________________
JUDGE BETH A. SMITH
POVERTY AFFIDAVIT
AND
ORDER
(Court Appointed Counsel in Contempt Actions)
I, _____________________________________________, being duly sworn, says:
1.
I am an indigent person entitled to legal representation in this case.
2.
I have completed the requisite Financial Disclosure/Affidavit of Indigency attached hereto.
3.
Pursuant to Ohio Revised Code 120.36(A), I respectfully request that the Court grant a waiver of the application fee
for legal representation because I am indigent and unable to pay an application fee of $25.00, or because I
will suffer
an undue hardship if the fee is assessed. The reason I am unable to pay is as follows:
___________________________________________________________________________________________________
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___________________________________________________________________________________________________.
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Affiant
Sworn before me and subscribed in my presence this _____ day of _____________________, 20___.
______________________________________
Notary Public
ORDER
Pursuant to ORC 120.36, the $25.00 Application Fee for private appointed counsel shall be:
__________ Paid by the person to the Clerk of Courts.
__________ Waived by the Court due to lack of resources or undue hardship.
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MAGISTRATE/JUDGE
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