Financial Disclosure Affidavit Of Indigency {WCJC-12}

FINANCIAL DISCLOSURE FORM. The Indigency Affidavit and Financial Disclosure Form for the Warren County Common Pleas Court, Probate Juvenile Division, is used to determine whether an individual qualifies for court-appointed legal counsel based on financial need. This form must be completed by individuals seeking legal representation who cannot afford to hire an attorney. It requires applicants to provide personal and financial information, including income, assets, expenses, and household details. If the applicant is a juvenile, the parent or custodian must also disclose their income for potential recoupment purposes. Supporting documents, such as paycheck stubs or tax returns, must be submitted as proof of financial status. The court evaluates the information to determine eligibility based on the Federal Poverty Guidelines. If the applicant’s income exceeds 187.5% of the Federal Poverty Guidelines, they may be required to pay a portion or the full cost of legal representation. A $25.00 non-refundable application fee may be assessed unless waived by the court. The affidavit includes a certification section where applicants affirm the accuracy of their financial disclosures under penalty of law. www.FormsWorkflow.com