Ohio > County (Court Of Common Pleas) > Clermont > Domestic Relations
Poverty Affidavit DR-105 - Ohio
| Poverty Affidavit Form. This is a Ohio form and can be used in Domestic Relations Clermont County (Court Of Common Pleas) . |
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COURT OF COMMON PLEAS DIVISION OF DOMESTIC RELATIONS CLERMONT COUNTY, OHIO _____________________ CASE NO. _______________ Plaintiff/Petitioner _____________________ Address _____________________ City ST ZIP _____________________ SS# DOB VS. POVERTY AFFIDAVIT _____________________ Defendant/Respondent _____________________ Address _____________________ City ST ZIP _____________________ SS# DOB ______________________, after being first duly sworn according to law, is financially and otherwise unable either to give security or to make a cash deposit for costs in the above-entitled action. 1. I currently reside at:______________________________________________ 2. I live with:______________________________________________________ 3. My source(s) of income is/are:______________________________________ 4. The households total monthly income is:_____________________________ 5. I have $__________ in savings or other financial account. 6. I believe I have good grounds to bring or defend this action. _____________________ AFFIANT SWORN to before me and SUBSCRIBED in my presence this ______ day of ______________, 20____. _____________________ NOTARY PUBLIC Form DR-105 American LegalNet, Inc. www.USCourtForms.com
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