Motion For Free Or Reduced-Cost Settlement Facilitation Services

FIRST JUDICIAL DISTRICT COURT STATE OF NEW MEXICO COUNTY OF CASE NO. , Plaintiff (Petitioner) vs. , Defendant (Respondent). MOTION FOR FREE OR REDUCED-COST SETTLEMENT FACILITATION SERVICES COMES NOW _____________________________________, and moves this Court for an order allowing free or reduced-cost settlement facilitation services in this case. As grounds for this motion, movant states that because of indigency, I cannot afford to pay court fees and costs in this case. I have attached the affidavits required by the Administrative Order No. 20081. ______________________________________ Signature of Applicant American LegalNet, Inc. www.FormsWorkFlow.com FIRST JUDICIAL DISTRICT COURT STATE OF NEW MEXICO COUNTY OF ____________________ No.__________________________ _______________________________, Petitioner, v. _______________________________ Respondent. AFFIDAVIT OF INDIGENCY STATE OF NEW MEXICO ) ) ss. COUNTY OF __________________) I, ______________________________, make under oath the following statements regarding my financial, marital and employment status, and since I am unable to prepay fees and costs for settlement facilitation services in the above-captioned case, make application to proceed in accordance with Administrative Order No. 2008-1. My marital status is: Single Separated I request interpretation services: need): . Married Widowed yes no (If yes, please describe what you Divorced American LegalNet, Inc. www.FormsWorkFlow.com INFORMATION ABOUT MY FINANCES (check all that apply to you and fill in the blanks): A. PUBLIC ASSISTANCE I do not receive public assistance (if you check this blank, go directly to Section B, EMPLOYMENT/UNEMPLOYMENT). I currently receive the following public assistance in (Please check all applicable public assistance programs): Temporary Assistance for Needy Families (TANF) Food Stamps Medicaid General Assistance (GA) Supplemental Security Income (SSI) Social Security Disability Income (SSDI) Public Housing Disability Security Income (DAI) Department of Health Case Management Services (DHMS) Other (please describe): B. EMPLOYMENT/UNEMPLOYMENT I am currently unemployed and have been unemployed for: months in the past year. I am unemployed because I receive unemployment benefits in the amount of $ per month. I have no income because I am unemployed. I am employed. My employer=s name, address and phone number is: County every other week twice a month I am paid weekly once month . When I am paid my net take-home pay minus deductions required by law like state and federal tax withholding and FICA is $ . I am married, and my spouse is unemployed and has been unemployed for months in the past year because . My spouse receives unemployment benefits in the amount of $ per month. American LegalNet, Inc. www.FormsWorkFlow.com I am married, and my spouse is employed. My spouse=s employer=s name, address and phone number is: My spouse is paid weekly every other week twice a month once a month . When my spouse is paid his or her net take home pay minus deductions required by law like state and federal tax withholding and FICA is $ . C. OTHER SOURCES OF INCOME I have income from another source not mentioned above. Child Support $ Alimony $ Investments $ Community property from my spouse $ Other $ I do not have any other sources of income. I am married, and my spouse has income from another source not mentioned above. Child Support $ Alimony $ Investments $ Other $ Other $ I am married, and my spouse does not have any other sources of income. D. OTHER ASSETS (Please list other assets owned by you or your spouse that can be turned into cash. Do not include money you have in retirement accounts.) Cash on hand Bank accounts Income tax refund Other assets (describe below): $ $ $ $ $ American LegalNet, Inc. www.FormsWorkFlow.com IF YOU DO NOT HAVE ACCESS TO YOUR OWN OR YOUR SPOUSES INCOME OR ASSETS, EXPLAIN WHY. E. MONTHLY EXPENSES House Payment/Rent Utilities Telephone Groceries (after food stamps) Car Payment(s) Gasoline Insurance Child Care Student and Consumer Loans Court-ordered family support obligations Other court-ordered payments Medical expenses Other $ $ $ $ $ $ $ $ $ $ $ $ $ F. I live at is HOUSEHOLD and the head of the household . Other than myself, the other members of the household are: Name Age Employment I Support () () () () () () This statement is made under oath. I hereby state that the above information regarding my financial condition is correct to the best of my knowledge. I hereby authorize the Court to obtain information from financial institutions, employers, relatives, the federal internal revenue service and other state agencies. If at any time the Court discovers that information in this application for free process was false, misleading, inaccurate, or incomplete at the time the application was submitted, the Court may require me to pay for any costs or fees that 5 American LegalNet, Inc. www.FormsWorkFlow.com were waived under an order of free process that was granted based on the information of this application. REPRESENTATION [] I AM REPRESENTED BY A LAWYER (Attorney's Affidavit Supporting Indigency must be attached) I AM REPRESENTING MYSELF [] (Signature) (Print Name) Petitioner (Street Address) (City, State, Zip Code) (Telephone) Respondent (Pro Se) SUBSCRIBED AND SWORN TO before me by _______________________________ this_______________ day of _________________________, ________________. Commission Expires: ___________________________________ NOTARY PUBLIC ______________________________ 6 American LegalNet, Inc. www.FormsWorkFlow.com FIRST JUDICIAL DISTRICT COURT STATE OF NEW MEXICO COUNTY OF ____________________ _______________________________ Petitioner, v. _______________________________ Respondent. No.__________________________ ATTORNEY=S AFFIDAVIT SUPPORTING INDIGENCY I _____________________, Attorney at Law, hereby certify that to the best of my knowledge and belief, the statements and information contained in_______________________________=s affidavit of indigency are true and correct. I further certify that I have not received any attorney fee from or on behalf of __________________________________________, and that if any attorney fee is paid to me, court fees and costs shall be paid to the clerk of the court from such fee. _________________________________________ Signature of Attorney at Law _________________________________________ Address _________________________________________ ___________________________