Affidavit Of Financial Eligibility For Services Of Public Defender | Pdf Fpdf Doc Docx | Wyoming

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Affidavit Of Financial Eligibility For Services Of Public Defender | Pdf Fpdf Doc Docx | Wyoming

Affidavit Of Financial Eligibility For Services Of Public Defender

This is a Wyoming form that can be used for Criminal within Local County, Teton, Justice Of The Peace Court.

Alternate TextLast updated: 4/13/2015

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Circuit Court of the Ninth Judicial District Teton County, State of Wyoming The Honorable James L. Radda STATE OF WYOMING Plaintiff/Demandante Vs. _________________________________, } } } } } } } *WARNING: You must complete this form in English *ADVERTENCIA: Este formulario debe completarse en inglés Case No._____________________ [Número de Causa] Defendant/Acusado(a) AFFIDAVIT OF FINANCIAL ELIGIBILITY FOR THE SERVICES OF THE PUBLIC DEFENDER [DECLARACIÓN JURADA DE ELEGIBILIDAD FINANCIERA PARA SERVICIOS DEL DEFENSOR PÚBLICO] My full name is [Mi nombre completo es] _____________________________. I am the Defendant in the above entitled criminal action, I am charged with [Yo soy el Acusado(a) en la acción penal mencionada arriba, y soy acusado(a) de]: ___________________________________________________________________________. And my next court appearance is on [Y mi próxima cita ante el tribunal es el día] ____________________, 2010. I SWEAR OR AFFIRM THAT THE FOLLOWING INFORMATION IS THE TRUTH, THE WHOLE TRUTH, AND NOTHING BUT THE TRUTH. I FURTHER AUTHORIZE THE COURT AND/OR THE PUBLIC DEFENDER TO VERIFY ALL OR ANY PORTION OF THE FOLLOWING INFORMATION. [YO JURO O AFIRMO SOLEMNEMENTE QUE LA SIGUIENTE INFORMACIÓN ES LA VERDAD, TODA LA VERDAD, Y NADA MÁS QUE LA VERDAD. ADEMÁS, YO AUTORIZO A ESTE TRIBUNAL Y/O AL DEFENSOR PÚBLICO A VERIFICAR TODA O PARTE DE LA SIGUIENTE INFORMACIÓN]. YOU MUST ANSWER EVERY QUESTION [DEBE CONTESTAR TODAS LAS PREGUNTAS] 1. I currently reside at (street address) [Actualmente yo vivo en (domicilio residencial)] ___________________ _________________________________________________________________________________ My mailing address is [Mi dirección postal es] ______________________________________________ _________________________________________________________________________________ Home phone [Teléfono de casa] ___________________________ Other phone [Otro teléfono] ___________________________ (A) I do / do not (circle one) own my own home. [Yo soy / no soy (circule uno) propietario de mi casa]. (B) The house I own could be sold for [Mi casa, de la que soy propietario puede ser vendida por] $_________ (if applicable [si aplica]). I owe [Yo debo] $____________on the mortgage [en la hipoteca de mi casa] (C) I live with [Yo vivo con] ________________________________________________________ (D) I pay [Yo pago] $____________ for rent / mortgage (circle one) per month [de renta/hipoteca (circule uno) al mes] (E) de] I gave the landlord a security deposit of [Yo entregué al arrendador/rentero un depósito de seguridad $__________. 2. My occupation is [Mi ocupación/oficio es] __________________________________________________ (A) I am employed by [Yo trabajo para] ________________________________________________ (B) If unemployed, why? [Si desempleado, por qué?]_______________________________________ (C) I receive my paycheck weekly, every two weeks, twice monthly, monthly (circle one) [Yo (D) (E) (F) recibo mi salario/sueldo -cada semana/ cada otra semana/ dos veces al mes/ una vez al mes/ (circule uno)]. The average amount of my paycheck (actual take home pay) is approximately [La cantidad promedia de mi salario/sueldo (lo que se lleva a casa) es de aproximadamente] $___________. If unemployed, the last time I worked was [Si desempleado, la última vez que trabajé fue] _________ Last place of employment [Último lugar de empleo] ____________________________________ I have the following other sources and amounts of income [Yo tengo las siguientes fuentes y cantidades de ingresos]: ___Social Security [Seguro Social] $________ ___Veterans Benefits [Prestaciones de Veterano] $________ ___Tips [Propinas] $________ ___Worker's Comp [Compensación al Trabajador] $________ ___Welfare [Bienestar Social] $________ ___AFDC [Asistencia a Familias con Menores] $________ ___Bonuses [Bonificaciones] $________ ___Commissions [Comisiones] $________ 3. I have the following cash or other liquid assets on hand [Yo tengo el siguiente dinero en efectivo u otros bienes disponibles] $___________________________________ 1 Revised 05/10 Translated 10/10 By J. Flores American LegalNet, Inc. www.FormsWorkFlow.com 4. I, or my spouse (if married), have the following savings and/or checking accounts [Yo, o mi esposa/o (si casado/a), tenemos las siguientes cuentas bancarias de ahorro y/o chequera]: NAME OF BANK ACCOUNT NUMBER CURRENT BALANCE [NOMBRE DEL BANCO] [NUMERO DE CUENTA] [BALANCE ACTUAL] 5. I own the following vehicles, which are worth the following amounts [Yo soy propietario de los siguientes automóviles, los cuales tienen el siguiente valor]: (A) _______________________________________________, worth [valor] $__________________ (B) _______________________________________________, worth [/valor] $__________________ (C) _______________________________________________, worth [valor] $__________________ 6. I own clothing worth about [Yo soy propietario de ropa con un valor de] $_____________________ I own household furniture worth about [Yo soy propietario de muebles de casa con un valor de] $____ ___________________________ (C) I own jewelry worth about [Yo soy propietario de joyas con un valor de] $_____________________ (D) I own tools/work equipment worth about [Yo soy propietario de herramientas/equipo de trabajo con un valor de] $__________________________ (E) I own guns worth about [Yo soy propietario de armas de fuego con un valor de] $________________ (F) I own the following other property [Yo soy propietario de los siguientes inmuebles]: ___________________________________________________________________________ ___________________________________________________________________________ I could sell this property for about [Yo podría vender estas propiedades por aproximadamente]: $ ___ ___________________________ I expect to receive a tax refund from the IRS in the sum of [Yo espero recibir un reembolso de parte del Departamento de Servicios Internos (IRS) por la cantidad de] $_____________________________________ I, or my spouse (if married), have the following credit cards [Yo, o mi esposa/o (si casado/a), tengo/tenemos las siguientes cartas de crédito]: CREDIT CARD MONTHLY PAYMENT [CARTA DE CRÉDITO] [PAGO MENSUAL] (A) (B) 7. 8. AMOUNT OWING [BALANCE ACTUAL] CREDIT LINE [LIMITE DE CRÉDITO] 9. I have the following monthly payments (including utilities, cable tv, etc.) [Yo tengo las siguientes obligaciones/pagos mensuales (incluyendo servicios públicos, cable etc.)]: PAYABLE TO

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