Defendants Financial Affidavit

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DEFENDANT'S FINANCIAL AFFIDAVIT
Case Number_________
Offense:________________________
My name is ________________________________. I am fully competent to make this affidavit.
1. Full legal name:__________________________________________________.
2. Social Security Number:_______________________ TDL ______________________.
3. Other names I have used:_________________________________________.
4 Age:____Date of Birth:___________Place of Birth:_____________________.
5. Names and relationship of those persons who live with me or who are otherwise dependent
upon me for support:
Name
Relationship
Age
____________________________ ______________________________
_____
____________________________ ______________________________
_____
____________________________ ______________________________
_____
____________________________ ______________________________
_____
6. Number of years married to a person listed above: _____________________________
7. I live at:_______________________________________________________________
8. How long at this address:_________ How long at last address:____________________
9. House, apartment, condominium:____________Renting or Buying:________________
10. Job or occupation:____________________________ How long:__________________
11. I am employed/unemployed:_______________________________________________
12. Employer's Name:_______________________________________________________
13. Employer's Address:_____________________________________________________
14. Work Telephone Number:_________________________________________________
14a Supervisor's Name:______________________________________________________
15. If unemployed, my last job was:____________________________________________
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