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To qualify you must be a patient who is:Enrolled in the federal Social Security Disability Income or the Supplemental Security Income disability programs. Provide documentation for the following:Enrolled in a State Retirement System and receiving monthly disability benefits. Provide documentation for the following:
Use this form to ask the court not to charge you for court fees. This form is also called an Affidavit of Inability to Pay Court Costs or a Pauper's Oath. You can only use this form if: (1) you get public benefits because you are poor or (2) you can't pay court fees.
(1) An applicant whose gross income is 187.5 per cent or less of federally established poverty levels is presumed indigent and entitled to appointed counsel.
Impoverished, or unable to afford the necessities of life. A defendant who is indigent has a constitutional right to court-appointed representation, according to a 1963 Supreme Court decision, Gideon v. Wainright.
(1) An applicant whose gross income is 187.5 per cent or less of federally established poverty levels is presumed indigent and entitled to appointed counsel.