Free Process Packet

4-222. Application for free process and affidavit of indigency. FIRST JUDCIAL DISTRICT COURT STATE OF NEW MEXICO COUNTY OF Petitioner, v. Respondent. APPLICATION FOR FREE PROCESS AND AFFIDAVIT OF INDIGENCY I request that the court enter an order permitting me to file this case without prepayment of fees and costs and give upon my oath or affirmation the following statement. My marital status is: Single Married Divorced Separated Widowed yes no (If yes, please describe what you need): . INFORMATION ABOUT MY FINANCES (check all that apply to you and fill in the blanks): A. PUBLIC ASSISTANCE I do not receive public assistance (if you check this blank, go directly to Section B, EMPLOYMENT/UNEMPLOYMENT). I currently receive the following public assistance in (Please check all applicable public assistance programs): Temporary Assistance for Needy Families (TANF) Food Stamps Medicaid General Assistance (GA) Supplemental Security Income (SSI) Public Housing Disability Security Income (DAI) Department of Health Case Management Services (DHMS) Other (please describe): County No. I request interpretation services: American LegalNet, Inc. www.FormsWorkFlow.com B. EMPLOYMENT/UNEMPLOYMENT I am currently unemployed and have been unemployed for: months in the past year. I am unemployed because . I receive unemployment benefits in the amount of $ per month. I have no income because I am unemployed. I am employed. I am paid $ per hour and work per week. My employer= s name, address and phone number is: hours I am married, and my spouse is unemployed and has been unemployed for months in the past year because . My spouse receives unemployment benefits in the amount of $ of per month. I am married, and my spouse is employed. My spouse is paid $ per hour and works per week. My spouse= s employer= s name, address and phone number is: C. OTHER SOURCES OF INCOME (Check all that apply) I have income from another source not mentioned above. Child Support $ Alimony $ Investments $ Community property from my spouse $ Other $ I do not have any other sources of income. I am married, and my spouse has income from another source not mentioned above. Child Support $ American LegalNet, Inc. www.FormsWorkFlow.com Alimony $ Investments $ Other Other $ $ I am married, and my spouse does not have any other sources of income. _____ Another adult contributes to household income in the following amount $ . D. OTHER ASSETS (Please list other assets owned by you or your spouse that can be turned into cash. Do not include money you have in retirement accounts.) Cash on hand Bank accounts Income tax refund Other assets (describe below): $ $ $ $ $ IF YOU DO NOT HAVE ACCESS TO YOUR OWN OR YOUR SPOUSES INCOME OR ASSETS, EXPLAIN WHY. E. MONTHLY EXPENSES House Payment/Rent Utilities Telephone Groceries (after food stamps) Car Payment(s) Gasoline Insurance Child Care Student and Consumer Loans Court-ordered family support obligations Other court-ordered payments Medical expenses Other $ $ $ $ $ $ $ $ $ $ $ $ $ American LegalNet, Inc. www.FormsWorkFlow.com F. HOUSEHOLD and the head of the household I live at is . Other than myself, the other members of the household are: Name Age Employment I Support () () () () () () This statement is made under oath. I hereby state that the above information regarding my financial condition is correct to the best of my knowledge. I hereby authorize the Court to obtain information from financial institutions, employers, relatives, the federal internal revenue service and other state agencies. If at any time the Court discovers that information in this application for free process was false, misleading, inaccurate, or incomplete at the time the application was submitted, the Court may require me to pay for any costs or fees that were waived under an order of free process that was granted based on the information of this application. (Signature) (Print Name) Petitioner (Street Address) (City, State, Zip Code) (Telephone) State of County of ) ) ss (date) (name of applicant). Respondent (Pro Se) Signed and sworn to (or affirmed) before me on by Notary My Commission expires: American LegalNet, Inc. www.FormsWorkFlow.com IF YOU ARE REPRESENTED BY AN ATTORNEY, YOUR ATTORNEY MUST SIGN THE FOLLOWING CERTIFICATE I, (Name of Attorney) , hereby certify that I have not received . (Name of applicant) Any attorney fee to represent If any attorney fee is paid to me, I understand that I shall pay to the court clerk from such attorney fee any court fees and costs that may be waived by the court. (Attorney signature) Address City, State, Zip Code Telephone/Fax Number American LegalNet, Inc. www.FormsWorkFlow.com 4-223. Order for free process. [For use with Supreme Court General Rule 23-114] FIRST JUDICIAL DISTRICT COURT STATE OF NEW MEXICO COUNTY OF Petitioner, vs. No. Respondent. ORDER ON APPLICATION FOR FREE PROCESS THIS MATTER having come before the court on Petitioner's application for free process and affidavit of indigency, or upon Petitioner's attorney's certificate supporting indigency and free process pursuant to Rule 23114(B)(2) NMRA, and the court being otherwise advised in the premises, FINDS that: [] [] [] [] the applicant is entitled to free process in accordance with Rule 23-114(B)(2) NMRA. the applicant receives public assistance and is, therefore, entitled to free process. the applicant's annual income does not exceed of the federal poverty guidelines, and the applicant is, therefore, entitled to free process. the applicant's annual gross income exceeds of the federal poverty guidelines, but the applicant is not reasonably able to pay fees or costs and is, therefore, entitled to free process. on the basis of the applicant's available funds or annual income, the applicant is not entitled to free process. [] THE COURT ORDERS that: [] [] [] the filing fee is waived. the filing fee is waived except for the $ alternative dispute resolution (ADR) fee. The applicant is granted free service of process by the Sheriff in County, New Mexico for 1 2 3 4 5 or summons(es), provided that the applicant first attempts service by certified mail pursuant to Rule 1-004 NMRA. [] the applicant is granted free service by the Sheriff in Mexico, of a temporary restraining order or the applicant is to pay the filing fee on interpretation services shall be provided to the applicant. , 20 County, New . . [] [] American LegalNet, Inc. www.FormsWorkFlow.com [] [] free process is denied. Other: . Unless specifically gran