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Get Affidavit Of Indigency Florida

Mailing Address City Case No. Name 1) State Phone ( ) II. OTHER PERSONS LIVING IN HOUSEHOLD Relationship Name 3) D.O.B. D.O.B. Zip Code Cell Phone ( ) D.O.B. Relationship 2) 4) III. PRESUMPTIVE ELIGIBILITY The appointment of counsel is presumed if the person represented meets any of the qualifications below. Please place an X Ohio Works First / TANF: SSI: SSD: Medicaid: Poverty Related Veterans Benefits: Food Stamps: Refugee Settlement Benefits.

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