Application For Determination Of Civil Indigent Status Form - Florida Page 2

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CLERK’S DETERMINATION
Based on the information in this Application, I have determined the applicant to be ( ) Indigent ( ) Not Indigent, according to s.
57.082, F.S.
Dated this _________ day of ______________, 20 ____.
Clerk of the Circuit Court by
This form was completed with the assistance of: __________________________________________________
Clerk/Deputy Clerk/Other authorized person.
APPLICANTS FOUND NOT TO BE INDIGENT MAY SEEK REVIEW BY A JUDGE BY ASKING FOR A HEARING TIME.
THERE IS NO FEE FOR THIS REVIEW.
Sign here if you want the judge to review the clerk’s decision __________________________________________

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