Form 13.3. Pauper's Affidavit
Oklahoma Statutes AnnotatedTitle 22. Criminal Procedure
T. 22, Ch. 18, App., Form 13.3
Form 13.3. Pauper's Affidavit
IN THE DISTRICT COURT OF _________________________ COUNTY |
STATE OF OKLAHOMA |
STATE OF OKLAHOMA, Plaintiff, | |||
vs. | Case No. | ||
, Defendant. |
PAUPER'S AFFIDAVIT |
I, (Name) | , (Last four digits of Soc.Sec.#) | , |
(Address) , | upon oath, do depose and |
state: | |||
I. PERSONS IN HOUSEHOLD |
Is Person a Dependent | ||
Spouse: | Yes( ) No( ) | |
Children: | Yes( ) No( ) | |
Yes( ) No( ) | ||
Yes( ) No( ) | ||
Yes( ) No( ) | ||
Others: | ||
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/Address | Last four digits of Account # | Checking/Savings: | $ Amount |
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 | COURT CLERK | ||
County of | OR | ||
By: |
Deputy | ||
Notary Public | ||
My Commission Expires |
Credits
Amended effective May 21, 2003; October 5, 2016.
Court of Criminal Appeals Form 13.3, 22 O. S. A. Ch. 18, App., OK ST CR A CT Form 13.3
Current with amendments received through April 15, 2024. Some rules may be more current, see credits for details.
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