Okla. Stat. tit. 22, ch. 18, RULES OF THE COURT OF CRIMINAL APPEALS, XIII, form 13.3

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Current through Laws 2024, c. 453.

Form 13.3 - Pauper's Affidavit

IN THE DISTRICT COURT OF __________ COUNTY

STATE OF OKLAHOMA

STATE OF OKLAHOMA, Plaintiff,

vs.

_________________________, Defendant.

Case No. _________________

PAUPER'S AFFIDAVIT

I, (Name)_________________________,(Soc.Sec.#)______________________________, (Address)___________________________________________________________________, upon oath, do depose and state:

I. PERSONS IN HOUSEHOLD

Is Person a Dependent

Spouse:

Children:

Others:

_________________________________________

Yes() No()

Are you claimed as a dependent by parent or guardian?

Yes() No()

If so, explain: __________________________________________________

________________________________________________________________

II. FINANCIAL STATUS--ASSETS (Defendant or person(s) responsible for defendant's support):

A.	1. Cash on Hand: $ _________________________ 2. Bank Accounts: Bank Name Account # Checking/Savings $ Amount /Address ________________________________________________________________ ________________________________________________________________ 3. Bonds & Securities Description Value ______________________________________________________ ______________________________________________________ 4. All Other Possessions of Value: (including tax refunds, notes, accts. receivable, etc.) Description Value ______________________________________________________ ______________________________________________________
B.	1. Current Employment: _______________________________________________ _____________________________________________________________________ 2. Earnings: __________________________________________________________ _____________________________________________________________________ 3. If not currently employed, last employment: (Place & Date)_______________________________________________________ _____________________________________________________________________ 4. Supplemental Income: (V.A., Soc. Security, Disability, Child Support, etc.) ________________________________________________________________
C.	Home and Other Real Estate: Real Property Value Balance Owed _______________________________________________________________________
D.	Vehicle(s): Description Value Balance Owed _______________________________________________________________________ _______________________________________________________________________
E.	Personal Property: (furniture, appliances, tools, equipment, etc.) Items Market Value Balance Owed _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________
F.	Litigation you or your spouse have pending for recovery of money: Case No. County _______________________________________________________________________
III.	FINANCIAL STATUS--LIABILITIES
A.	Charge or Open Accounts: Description Balance _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________
B.	Housepayment or Rent: Mortgagee/Landlord Monthly Payment _______________________________________________________________________ If own, balance:________________________________________________________
C.	Child Support Obligations Monthly Payment:_____________________________________________________
D.	Other Debts: Creditor Balance _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

IV. OTHER

A.	Have you transferred or sold any assets since charges were filed in this case? Yes() No() If so, describe the buyer and the amount received: _______________________________________________________________________ _______________________________________________________________________
B.	Have you retained counsel in this case or in any other pending criminal case? Yes() No() If so, state the case number, court, attorney and amount paid to attorney for services: _______________________________________________________________________ _______________________________________________________________________
C.	If you have posted bond, who provided the funds for the bond? _______________________________________________________________________
D.	Do you have any friends or relatives who are able and willing to assist you in hiring counsel and paying for transcripts? Yes() No() If so, have those persons been asked to help? Yes() No()
E.	If a friend or relative has given previous financial assistance in this case, including the posting of bond, but is no longer able or willing to do so, an affidavit to that effect from that person shall be attached, stating why such help is no longer available.

I further swear and affirm that I am without funds or other sources of income to pay an attorney or to pay for transcripts and costs associated with this case. I understand I am under a continuing obligation to keep this Court informed of any changes in my financial status and this Court may conduct another hearing to determine my indigent status at any time.

_________________________

Applicant's Signature

Subscribed and sworn to before me this __________ day of __________ 20__________.

State of Oklahoma

County of _________________ OR

_________________________________

Notary Public

My Commission Expires_________

COURT CLERK

By: _________________________

Deputy

Okla. Stat. tit. 22, ch. 18, RULES OF THE COURT OF CRIMINAL APPEALS, XIII, form 13.3