Heather J. Barbieri, P.C., lawyers in McKinney, TX, Texas

Wel

NO. [*____*]

STATE OF TEXAS	§	IN THE DISTRICT COURT
	§
vs.	§	*[____] JUDICIAL DISTRICT*
	§
DEFENDANT	§	COLLIN COUNTY, TEXAS

SWORN STATEMENT OF INDIGENCY

STATE OF TEXAS	§
	§
COUNTY OF COLLIN	§

On May 21, 2001, DEFENDANT appeared BEFORE ME, and after being placed under oath made the following statements and affirmed their truth:

1. "My name is DEFENDANT and I am the Defendant in this cause. I am not able to afford counsel in this cause because of my financial circumstances.

2. "I receive income or financial payments by reason of government entitlement in the amount of $[*____*] from the Social Security Administration, the Veterans Administration and the [*____*].

3. "The amount of income that I receive from all other sources is as shown on Exhibit A.

4. "My property and my assets include the following:

[____]	$5
5	$5
5	$55
5	$5
5	$5

"The value of my property and assets is $75.

5. "My monthly expenses are as shown on the attached Exhibit A, as well as calculations showing the deficiency between my monthly income and my expenses.

6. "I do not have knowledge of any other source from which I can obtain funds to obtain the services of counsel.

7. "I reaffirm that I am unable to afford counsel and I verify that the statements are true and correct.

8. "On May 21, 2001, I have been advised by the Court of my right to representation by counsel in the trial of the charges pending against me. I certify that I am without means to employ counsel of my own choosing and I hereby request the court to appoint counsel for me."

DEFENDANT

Sworn to and subscribed before me on .

NOTARY PUBLIC

Welcome to our Web site. We hope that you will find our site informative and useful. Our goal is to provide the highest quality legal services to you and your business in a timely fashion. We welcome the opportunity to talk with you and to discuss how we may be of service.

The Law Offices of Heather J. Barbieri pracitces criminal defense law in the following areas:

Virtually all Misdemeanor and Felony Criminal Defense charges

Drunk Driving and DUI Defense

Appeals

Writs of Habeas Corpus

Expunctions Proceedings

Federal Crimes

Domestic Violence

Drug Possession

Possession for Sales of Narcotics

Juvenile Crimes

Assault and Battery

Domestic Violence

Fraud

Robbery

Burglary

Grand Theft and Petty Theft

Embezzlement

Probation or Parole Matters

Sex Offenses

Lewd Conduct

Solicitation

Prostitution

Unlawful Conduct With a Minor

Molestation

Terrorist Threats

Reckless Driving

Driving on a Suspended License

DMV suspensions and hearings from Drunk Driving

All other Texas DUI and Criminal Defense matters everywhere in Texas.

The Law Offices of Heather J. Barbieri practices law in the areas throughout the Dallas/Ft. Worth Metroplex:

throughout the Dallas/Fort Worth Metroplex:

Collin County , including providing outstanding criminal defense law practice in the cities of:

Allen, Anna, Blue Ridge, Carrollton, Celina, Dallas, Fariview, Farmersville, Frisco, Garland, Josephine, Lavon, Lowry Crossing, Lewis, McKinney, Melissa, Murphy, Nevada, New Hope, Parker, Plano, Princeton, Prosper, Richardson, Royse City, Sachse, Saint Paul, Van Alstyne, Weston, Wylie

Dallas County , including providing outstanding criminal defense law practice in the cities of:

Addison, Balch Springs, Buckingham, Carrollton, Cedar Hill, Cockrell Hill, Coppell, Dallas, DeSoto, Duncanville, Farmers Branch, Flower Mound, Garland, Glenn Heights, Grand Prairie, Highland Park, Hutchins, Irving, Lancaster, Lewsville, Mesquite, Ovilla, Richardson, Rowlett, Sachse, Seagoville, Sunnyvale, University Park, Wilmer, Wylie

Denton County , including providing outstanding criminal defense law practice in the cities of:

Argyle, Aubrey, Bartonville, Carrollton, Coppell, Copper Canyon, Corinth, Corral City, Cross Raods, Dallas, Denton, Double Oak, Flower Mount, Forth Worth, Frisco, Grapevine, Hackberry, Hasley, Hebron, Hickory Creek, Highland Village, Jusin, Krugerville, Krum, Lake Dallas, Lakewook Village, Lewisville, Lincoln Park, Little Elm, Marshall Creek, Northlake, Oak Point, Pilot Point, Plano, Ponder, Roanoke, Sanger, Shady Shores, Southlake, The Colony, Trophy Club, Westlake

The Law Offices of Heather J. Barbieri pracitces criminal defense law in the following areas:

Virtually all Misdemeanor and Felony Criminal Defense charges

Drunk Driving and DUI Defense

Appeals

Writs of Habeas Corpus

Expunctions Proceedings

Federal Crimes

Domestic Violence

Drug Possession

Possession for Sales of Narcotics

Juvenile Crimes

Assault and Battery

Domestic Violence

Fraud

Robbery

Burglary

Grand Theft and Petty Theft

Embezzlement

Probation or Parole Matters

Sex Offenses

Lewd Conduct

Solicitation

Prostitution

Unlawful Conduct With a Minor

Molestation

Terrorist Threats

Reckless Driving

Driving on a Suspended License

DMV suspensions and hearings from Drunk Driving

All other Texas DUI and Criminal Defense matters everywhere in Texas.

The Law Offices of Heather J. Barbieri practices law in the areas throughout the Dallas/Ft. Worth Metroplex:

throughout the Dallas/Fort Worth Metroplex:

Collin County , including providing outstanding criminal defense law practice in the cities of:

Dallas County , including providing outstanding criminal defense law practice in the cities of:

Denton County , including providing outstanding criminal defense law practice in the cities of:

EXHIBIT A TO AFFIDAVIT OF INDIGENCY

Defendant: DEFENDANT

(A) GROSS MONEY RECEIVED PER MONTH:

1	Gross Wage and Salary Income	$5
2	Commissions, Tips and Bonuses	[____]
3	Self-employment Income (net of expenses other than depreciation and tax credits)	[____]
4	Rental Income (net of expenses)	[____]
5	All Other Income Actually Received	[____]
	GROSS MONEY EARNED PER MONTH	$5.00

(B) ACTUAL DEDUCTIONS PER MONTH (Attach most recent pay stub from each employer):

1	Income Tax Liability	$[____]
2	FICA (Social Security)	[____]
3	Health Insurance	[____]
4	Union Dues	[____]
5	Other (Specify): [____]	[____]
	ACTUAL DEDUCTIONS PER MONTH	$0.00

(C) NET MONEY ACTUALLY RECEIVED PER MONTH:

(A) $5.00, LESS (B) $0.00 = $5.00

(D) TOTAL MONEY NEEDED PER MONTH BY ME AND MINOR CHILD(REN) LIVING WITH ME. (For items which are not paid monthly, express the amount as a monthly average.)

Rent or House Payment	$[____]
Real Property Taxes	[____]
Residence Maintenance	[____]
Insurance/Home-Renters	[____]
Utilities - Gas	[____]
Utilities - Electricity & Water	[____]
Utilities - Telephone	[____]
Utilities - Garbage	[____]
Groceries	[____]
Meals Away from Home	[____]
School Lunches	[____]
Dental/Ortho	[____]
Medical	[____]
Laundry	[____]
Car Payment	[____]
Gasoline/ Vehicle	[____]
Clothing & Shoes	[____]
Insurance - Car	[____]
Insurance - Life	[____]
Insurance - Health (OMIT if deducted)	[____]
Child Care	[____]
Children's Activities	[____]
Entertainment	[____]
Hair Care	[____]
Cable TV and Newspaper	[____]
Support or Alimony Payments to Other Persons	[____]
Other: [____]	[____]
TOTAL OF GENERAL EXPENSES	$0.00

(E) MONTHLY DEBT PAYMENTS:

Description of Monthly Debt

Amount of Monthly Debt

[*____*] 5

5 5

Total of Monthly Debt Payments:

$25.00

(F) TOTAL MONTHLY EXPENSES:

TOTAL GENERAL EXPENSES	$0.00
TOTAL MONTHLY DEBT PAYMENTS	25.00
TOTAL MONEY NEEDED PER MONTH	$25.00

(G) SUMMARY:

Income (C)	$5.00
LESS Monthly Expenses and Debt (F)	- 25.00
DIFFERENCE Between MONEY RECEIVED and MONEY NEEDED	$-20.00

come to our Web site. We hope that you will find our site informative and useful. Our goal is to provide the highest quality legal services to you and your business in a timely fashion. We welcome the opportunity to talk with you and to discuss how we may be of service.