Affidavit Of Indigency And Application For Counsel Form (Page 3 of 3) in pdf

Affidavit Of Indigency And Application For Counsel Form Page 3

I do solemnly swear that the account by me delivered into this court with my application for counsel

does contain a true and full account of all my real and personal estate, debts, credits and effects

whatsoever without exception, which I or any person in trust for me have or at the time of my possession

had, or am, or was, in any respect, entitled to, in possession, remainder or reversion and that I have not

at any time since charges were made against me or before, directly or indirectly sold, leased, assigned or

otherwise disposed of or made over, in trust for myself or otherwise, other than is mentioned herein.

I understand the appointment of counsel creates a claim against the assets and estate of the person

who is provided counsel or the parents or legal guardians of a juvenile in an amount equal to the

cost of representation less the amount paid to appointed counsel, the public defender office and/or

the Commission on Indigent Defense. I understand that such claim shall be filed in the office of

the Clerk of Court in the county where I, my child, or ward are assigned counsel, but that the

filing of a claim shall not constitute a lien against my real or personal property unless, in the

discretion of the court, part of all of such claim is reduced to judgment by appropriate order of

the court after serving me with at least thirty (30) days notice that judgment will be entered.

I understand that, pursuant to §17-3-30(b), I am required to pay a non-refundable $40.00

application fee to the Clerk of Court for public defender services or other appointed counsel.

I am financially unable to employ counsel and request that counsel be assigned to represent me.

I understand that I am entitled to at least thirty days’ notice before a claim against me may be reduced to

judgment, and I do hereby waive the right to such notice.

This _____day of ____________________, _____

___________________________________

Juvenile

This _____day of ____________________, _____

___________________________________

Parent/Guardian (if applicable)

Subscribed and sworn to before me this

day of

(L.S.)

Notary Public for South Carolina

My Commission Expires:

The applicant’s request for court-appointed counsel is hereby

granted /

denied.

Dated: _____________________

Judge/Clerk or Deputy Clerk

______________, South Carolina

SCACRVIFORM02JU (12/2009)

Affidavit Of Indigency And Application For Counsel Form Page 3