Poverty Affidavit
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Poverty Affidavit Form. This is a Ohio form and can be use in Summit County (Court Of Common Pleas).
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Tags: Poverty Affidavit, Ohio County (Court Of Common Pleas), Summit
IN THE COURT OF COMMON PLEAS
DOMESTIC RELATIONS DIVISION
SUMMIT COUNTY, OHIO
Name
___________________________
Address
___________________________
Date of Birth
___________________________
Social Security Number
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CASE NO.
MOTION NO.
CSEA NO.
JUDGE
MAGISTRATE
POVERTY AFFIDAVIT
Plaintiff/Petitioner
-vs.-
Name
____________________________
Address
____________________________
Date of Birth
____________________________
Social Security Number
Defendant/Respondent
______________________________, after being first duly sworn according to law, says
(Print Name)
he/she is financially and otherwise unable either to give security or to make a cash deposit for
costs in the above-entitled action.
_________________________________
AFFIANT
SWORN to before me and SUBSCRIBED in my presence this _____ day of
_______________, 2000.
________________________________
NOTARY PUBLIC
September 8, 2000
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