Fill and Sign the Form 133 Paupers Affidavit

OCCAOnline Rules of the Court of Criminal Appeals 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. P ER SO NS I N H O USEH O LDIs P ers o n a D ependentSpouse:Children:Others:________________ ________________ _________________________ ________________ _________________________ ________________ _________________________ ________________ _________Yes( ) No( )Yes( ) No( )Yes( ) No( )Yes( ) No( )Are you claimed as a dependent by parent or guardian?Yes( ) No( )If so, explain: __________________________________________________________________________________________________________________II. F IN AN CIA L S TA TU S--A SSETS ( D efe ndant o r p ers o n(s ) r e sp onsib le f o r d efe ndant's s u pport) : A.1. C ash o n H and: $ _ ________ ________________2 . B ank A cco unts : B an k N am e A cco unt # C heckin g/S avin gs $ A m ount /A ddre ss_ __ ___ _________________________________________ __________________ __ ___ _________________________________________ _________________3 . B onds & S ecu rit ie sD escrip tio n V alu e_ __ ___ _________________________________________ ________ __ ___ _________________________________________ _______4 . A ll O th er P osse ssio ns o f V alu e: ( in clu din g t a x r e fu nds, n ote s, a ccts . R ece iv a ble , e tc .)D escrip tio n V alu e_ __ ___ _________________________________________ ________ __ ___ _________________________________________ _______ B .1. C urre nt E m plo ym ent: _ ___ __ _________________________________________ _ ___ ______ ___________________________________________________________2 . E arn in gs: _ _ ________________________________________________________ _ ___ ______ ___________________________________________________________3 . I f n ot c u rre ntly e m plo ye d, la st e m plo ym ent: ( P la ce & D ate )_ _________________________________ _____________________ _ ___ ______ ___________________________________________________________4 . S upple m enta l I n co m e: ( V .A ., S oc. S ecu rit y , D is a bilit y , C hild S upport, e tc .) _ _____ __________________________________________________________C .Hom e a nd O th er R eal E sta te :R ea l P ro perty V alu e B ala nce O wed_ __ ___ _________________________________________ ________________________D .Veh ic le (s ):D escrip tio n V alu e B ala nce O wed_ __ ___ _________________________________________ _________________________ __ ___ _________________________________________ ________________________E .Pers o na l P ro perty : ( fu rn it u re , a pplia nce s, t o ols , e quip m ent, e tc .)I te m s M ark e t V alu e B ala nce O wed_ __ ___ _________________________________________ _________________________ __ ___ _________________________________________ _________________________ __ ___ _________________________________________ ________________________F .Lit ig a tio n y o u o r y o ur s p ouse h a ve p endin g f o r r e co ve ry o f m oney:C ase N o. C ounty_ __ ___ _________________________________________ ________________________III.F IN AN C IA L S TA TU S--L IA BIL IT IE SA .C ha rg e o r O pe n A cco unts :D escrip tio n B ala nce_ __ ___ _________________________________________ _________________________ __ ___ _________________________________________ _________________________ __ ___ _________________________________________ ________________________B .H ou se p aym ent o r R ent:M ortg ag ee/L and lo rd M onth ly P aym ent_ __ ___ _________________________________________ ________________________If o w n, b ala nce :_ __________________________________ _____________________C .Child S up port O blig atio nsM onth ly P aym en t:_ ____________________________________________________ D.O th er D ebts :C re dit o r B ala nce_ __ ___ _________________________________________ _________________________ __ ___ _________________________________________ _________________________ __ ___ _________________________________________ ________________________ IV . O TH ERA.H ave y o u t r a nsfe rre d o r s o ld a ny a sse ts s in ce c h arg es w ere f ile d in t h is c a se ? Y es( ) N o( ) If so, describe the buyer and the amount received:______________________________________________________________________________________________________________________________________________B.H ave y o u r e ta in ed c o unse l in t h is c a se o r in a ny o th er p end in g c rim in al c a se ? Y es( ) N o( ) 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 SignatureSubscribed and sworn to before me this __________ day of __________ 20__________.State of OklahomaCounty of _________________ OR_________________________________ Notary PublicMy C om mis sio n E xp ir e s_ ________C O URT C LE R KBy: _ __ ___________________ ___ D ep uty