Fillable Affidavit Of Indigency (Page 3 of 3) in pdf

Affidavit Of Indigency Page 3

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If you were not considered indigent in the lower court, explain why such status should be

granted in this Court.

______________________________________________________________________________

I understand that a false statement or answer to any question in this affidavit will subject me to

penalties for perjury and that state law provides as follows:

(a) A person to whom a lawful oath or affirmation has been administered commits the offense of

perjury when, in a judicial proceeding, he knowingly and willfully makes a false statement

material to the issue on point in question.

(b) A person convicted of the offense of perjury shall be punished by a fine of not more than

$1,000 or by imprisonment for not less than one nor more than ten years, or both. OCGA §16-

10-70.

I, ______________________________, do swear and affirm under penalty of law that the

statements contained in this affidavit are true. I further attest that this affidavit is not submitted

to harass or to cause unnecessary delay or needlessly increase in the costs of litigation.

This the ________day of _______________, ______.

__________________________________________

(Your name printed or typed)

___________________________________________

(Sign your name.)

___________________________________________

(Your complete address and telephone number)

Sworn to and subscribed before me

SEAL

This the ______ day of _______________, ______.

_________________________________Notary Public

Affidavit Of Indigency Page 3

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