IN THE COURT OF COMMON PLEAS PORTAGE COUNTY, OHIO DOMESTIC RELATIONS DIVISION CASE NO. PLAINTIFF vs. JUDGE PAULA C. GIULITTO DEFENDANT AFFIDAVIT OF INDIGENCY *** Now comes , being duly sworn, and says that he/she is the PLAINTIFF in the above captioned action and that he/she is financially and otherwise unable to either give security or to make a cash deposit for the costs in this action. Respectfully Submitted, /s/Filing Party's Signature Filing Party's Name Address: Telephone: Email: Fax: STATE OF OHIO PORTAGE COUNTY ) ) ) SS BE IT REMEMBERED that on this _________ day of __________________, 20___, before me, the subscriber, a notary public in and for said county and state, personally appeared __________________________________ and acknowledged the signing of the foregoing Affidavit to be his/her free and voluntary act and deed, for the uses and purposes therein mentioned. IT WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notary seal on the date and year aforesaid. __________________________ Notary Public X/Appendices[Index]/1 ­ Affidavit of Indigency American LegalNet, Inc. www.FormsWorkFlow.com