AFFIDAVIT OF INDIGENCE Sample Clauses

AFFIDAVIT OF INDIGENCE. In the Municipal Court of the City of Biloxi, Mississippi CITY OF BILOXI
Sample 1Sample 2Sample 3See All (4)
AutoNDA by SimpleDocs
AFFIDAVIT OF INDIGENCE. The Affidavit of Indigence, which is attached as Exhibit A (Form Three) to the Agreement, is hereby replaced by the form labeled Affidavit of Indigence, which is attached hereto as Exhibit 1 (Form Four).
Sample 1Sample 2
AFFIDAVIT OF INDIGENCE. To determine eligibility for Court Appointed Attorney, YOU MUST COMPLETE THIS FORM: Size of family unit :Members of immediate family that you support financially, name & relationship Name:__________________________ Age:___________________ Relationship:____________________________ ___________________________ ___________________ ____________________________ ___________________________ ___________________ ____________________________ ___________________________ ___________________ ____________________________ Monthly Income: Your Salary:_________________ Rent/Mortgage: _____________________ Spouse Salary: ______________ Transportation/Vehice: Make and Model: ________________________ Car Payment: _____________________ Car Insurance: _____________ SSI/SSDI: ____________________ SS Check:___________________ Utilities: ___________________ Child Support: _____________________ Clothes/Food: ________________ Day Care:____________________ Health Ins.________________________ Credit Cards:__________________ Medical Expenses: ___________________ Other Income:____________________________________________________________________________________ Staff Use ONLY: Total Montly income: __________ Total Monthly Expenses: _______ Defendant Meets Eligibility Requirements: Difference:Net Income:_________ ____ YES ____NO _____UNDETERMINED I have been advised of my right to representation by counsel in the trial of the charge 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. I swear that the above information is true and correct. The information I listed is accurate and I will immediately notify the court of any changes in my financial situation. ****All information is subject to verification. Falsification of information is a criminal offense**** ___________________________________ ____________________________________
Sample 1

Related to AFFIDAVIT OF INDIGENCE

  • AFFIDAVIT The undersigned swear or affirm that the foregoing statements are correct and include all material information necessary to identify and explain the terms and operation of our joint venture and the intended participation by each joint venturer in the undertaking. Further, the undersigned covenant and agree to provide to the County current, complete and accurate information regarding actual joint venture work and the payment therefore and any proposed changes in any of the joint venture. Also, permit authorized representatives of the County to audit and examine records of the joint venture. Any material misrepresentation will be grounds for terminating any contract which may be awarded and for initiating action under Federal or State laws concerning false statements." Name of Firm: Name of Firm: Signature: Signature: Name: Name: Title: Title: Date: Date: INFORMATION FOR DETERMINING JOINT VENTURE ELIGIBILITY – PAGE 4 Date State of County of AFFIDAVIT STATE OF FLORIDA ) ) ss: COUNTY OF ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. ☐ Personally Known; OR ☐ Produced Identification. Type of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) ORANGE COUNTY, FLORIDA Procurement Division CONTRACT NO. Y22-1022 SHUTTLE BUS SERVICES FOR OCCC This contract is not valid unless bilaterally executed. Subject to mutual agreement Orange County, Florida, hereby enters into a contract subject to the following:

  • Seller’s Affidavit A customary seller's affidavit in the form ------------------ required by the Title Company;

  • FIRPTA Affidavit A non-foreign affidavit, properly executed and in recordable form, containing such information as is required by IRC Section 1445(b)(2) and its regulations.

  • Non-Foreign Affidavit The Transferor Partners shall execute and deliver to the BRI Partnership and the BRI Partnership's counsel, at Closing such evidence as may be reasonably required by the BRI Partnership to show compliance by the Transferor Partners with the Foreign Investment and Real Property Tax Act, Internal Revenue Code Section 1445(b)(2), as amended.

  • Opinion and 10b-5 Statement of Counsel for the Company Xxxxxx & Xxxxxxx LLP, counsel for the Company, shall have furnished to the Representatives, at the request of the Company, their written opinion and 10b-5 statement, dated the Closing Date or the Additional Closing Date, as the case may be, and addressed to the Underwriters, in form and substance reasonably satisfactory to the Representatives.

  • Contractor Certification regarding Boycotting Israel Pursuant to Chapter 2270, Texas Government Code, Contractor certifies Contractor (1) does not currently boycott Israel; and (2) will not boycott Israel during the Term of this Agreement. Contractor acknowledges this Agreement may be terminated and payment withheld if this certification is inaccurate.

  • Legal Opinion of Counsel The Administrative Agent shall have received an opinion or opinions (including, if requested by the Administrative Agent, local counsel opinions) of counsel for the Credit Parties, dated the Closing Date and addressed to the Administrative Agent and the Lenders, in form and substance acceptable to the Administrative Agent (which shall include, without limitation, opinions with respect to the due organization and valid existence of each Credit Party, opinions as to perfection of the Liens granted to the Administrative Agent pursuant to the Security Documents and opinions as to the non-contravention of the Credit Parties’ organizational documents and Material Contracts).

  • Opinion of Company Counsel On each Closing Date, there shall have been furnished to you, as Representatives of the several Underwriters, the opinion of Xxxxxxx Xxxxx LLP, counsel for the Company, dated such Closing Date and addressed to you in substantially the form attached hereto as Exhibit B.

  • Opinion of Borrower's Counsel The Lender shall have received the favorable opinion of counsel for the Borrowers addressed to the Lender in form satisfactory to the Lender.

  • Opinion of Counsel for Company At Closing Time, the Representative shall have received the favorable opinion, dated as of Closing Time, of Xxxxxx, Xxxxx & Xxxxxxx LLP, counsel for the Company, in form and substance satisfactory to counsel for the Underwriters, together with signed or reproduced copies of such letter for each of the other Underwriters to the effect set forth in Exhibit A hereto and to such further effect as counsel to the Underwriters may reasonably request.

Time is Money Join Law Insider Premium to draft better contracts faster.