Ohio Probate Form - Affidavit Of Indigency
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1PROBATE COURT OF ________________ COUNTY, OHIO
_____________, JUDGE
IN THE INTEREST OF: ______________________________________________________
CASE NO. __________
AFFIDAVIT OF INDIGENCY
________________________________________, respondent, being first duly cautioned and
sworn, states the following facts are true:
1.
My current address is: ____________________________________________.
2.
I have lived at this address for:______________________________________.
3.
My current monthly income is:_______________________________________.
4.
My monthly source of income is:_____________________________________.
5.
My monthly expenses are:__________________________________________.
6.
I am responsible for the care of _________________persons
7.
I own the following:
Real Estate
$________________________.
Bank Accounts
$________________________.
Automobile(s)
$________________________.
Other (stocks, bonds, IRA, etc.)
$________________________.
TOTAL OF ASSETS
$________________________.
____________________________________.
Affiant, Respondent
Sworn to before me and subscribed in my presence this_______day of_____________,
20_____.
____________________________________.
Notary Public
ENTRY
Upon consideration of the Affidavit of Indigency, the Court finds the respondent is indigent and
orders the appointment of Court-Appointed Counsel.
___________________________________.
Judge
Print Form
FORM 26.8 – AFFIDAVIT OF INDIGENCY
Effective Date: July 1, 2016
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