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ve K Att ‘STATE OF ALABAMA AFFIDAVIT OF INDIGENCY | ve ee a ane *AND ORDER Sut oasis ve SF Ch eteng Tash Yo6? the f ‘e In the mater 4tol Huser ‘Adres Ser Tyee AsAHemeles Murde Pom [ [errors eerrirecmnan 55 / Sull via Alan Lora |A. Do you have ajob or work for yourself? Employer Name and Address ‘How mach do you ear each week? 'B. Does your husband or wife work? Employer Name and Address How money does he/she earn each week? [c. Do you or your wife receive benefits fom any other source? row much do you receive each month? "A, Do-you have any money in any bank savings and loan eedit union, or any other place including cash on hand? —_Ye oir Se Hewes B, Doyou own anything else of value? (Land. House, Car, Etc) __ Yes r What? X Areyou RT Waried Widowed —___ Biverced/ Separated Single » comimmipminee Xe | sen Saw lrkrS IE Walaastenyocoiad not 80 Creditor ‘Total Debt Monthly Payment “Total Debt Monthly Payment 2 Loans s s. s, 5. 3 lcharge Accounts. 5 s. s. 3 | House or Rent Payment §. $ s 8 /Alimany s. $ 5 s Support s 5, s 8. Tes my desir at is tine o have counsel appointed by de cour to represent me on the above charge) In suppott ofthis request. have arawered the preceding questions relating to ability to pay. I swear or alfirm Yat he arswers are ru and reflect my present franca staus. 1 ttdersind tha als statement or answer lary questions in tis afdavit may subject eto penals for pur. Fauthorie i necessary, hecourt tor its muhorized representative to obtain records o information pertaining to my fancal status from any source. I futher understand and cknowledge tal ifthe cour appoint an attorney to represent me, the court may require me to pay the fees and expenses of my court appointed counsel i a pais seers 10 ic iitent sorote bo Aue tenant Hoy HALA ss Fodge/ Notary ¥ e ez ‘ORDER tis ordered that the foregoing request be: ‘Granted O Deniea APPOINTMENT OF tis therefore ordered and adjudged by the Court that. ishereby appointed as counsel lorepresnt, assist and defend in this (these) cases) Its farther ordered thatthe Court reserves reimburement of Atfomeys fees an expenses, approved by the Cour and pid othe appointed counsel. boca Tepe Ae te wi Wie He Tinea Coat Rin TBatead