A. BIOGRAPHICAL INFORMATION: Fill in your. There isn't always a form to fill out.You can contact their office and make sure they know your wishes. My name is ALLEGED VICTIM. I am over the age of fourteen (14) years, and I am competent to make this affidavit. I have no other savings, property or assets. 8. I am unable to pay the costs, fees and expenses necessary to assert my rights in this case. Written Instructions for Poverty Affidavit, Video Instructions for Poverty Affidavit, Poverty Affidavit Form Order for Poverty Affidavit. Prosecutors may decide to dismiss charges based on this affidavit, which can lead to the immediate release of an accused individual. "The landlord did not fix the leak in my apartment.