Affidavit Of Indigency Form (Page 2 of 2) in pdf

Affidavit Of Indigency Form Page 2

Other fees or costs of $__________for (specify):

Substitution (specify):

SECTION 3:

I request that the following EXTRA FEES AND COSTS either be waived (not charged), substituted or

paid for by the state:

Cost, $_______, of expert services for testing, examination, testimony or other assistance (specify):

Cost, $_______, of taking and/or transcribing a deposition of (specify name of person):

Cassette copies of tape recording of trial or other proceeding, needed to prepare appeal for applicant not

represented by Committee for Public Counsel Services (CPCS-public defender).

Appeal bond

Cost, $_______, of preparing written transcript of trial or other proceeding

Other fees and costs, $_______, for (specify)

Substitution (specify)

Date signed

Signed under the penalties of perjury

By order of the Supreme Judicial Court, all information in this affidavit is CONFIDENTIAL. Except by special

order of a court, it shall not be disclosed to anyone other than authorized court personnel, the applicant,

applicant's counsel or anyone authorized in writing by the applicant.

This form prescribed by the Chief Justice of the SJC pursuant to G.L. c. 261, § 27B. Promulgated March , 2003

Affidavit Of Indigency Form Page 2