On August 25, 2021 a
APPL AND AFF OF INDIGENCY - FOUND INDIGENT F/B PLT
was filed
involving a dispute between
Suzette Grace Rodriguez,
and
David Aaronberg,
Krista Marx,
Micheal Vann Goodwin,
Thomas Ceccarelli,
for OTHER PROFESSIONAL MALPRACTICE
in the District Court of Palm Beach County.
Preview
wes CASE NUMBER: 502021CA010044XXXXMB Div: Al ****
Filing # 133364627 E-Filed 08/25/2021 10:18:52 AM
IN THE CIRCUIT/COUNTY COURT OF THE 15TH JUDICIAL CIRCUIT
IN AND FOR PALM BEACH COUNTY, FLORIDA
SUZETTE GRACE RODRIGUEZ CASENO.
Fiamnumreuuoner oF in the interest oF
vs.
Micheal V. Goodwin tet at
Defendani/Respondent
APPLICATION FOR DETERMINATION OF CIVIL INDIGENT STATUS
Notice to Applicant: If you qualify for civil indigence, the filing and summons fees are waived; other costs and fees are not waived.
1. Ihave 4 dependents. (Include only those persons you list on your U.S. Income tax return.)
Are you Married? No Does your Spouse Work?. Annual Spouse Income? $NA
2. Ihave a net income of §, paid (+ weekly ( ) every two weeks ( ) semi-monthly () monthly ()yearly()other__
(Net income is your total income including salary, wages, bonuses, commissions, allowances, overtime, tips and similar payments,
minus deductions required by law and other court-ordered payments such as child support.)
3.1 have other income paid ( ) weekly ( ) every two weeks () semi-monthly ( ) monthly ( ) yearly (other NA
(Circle “Yes” and fill in the amount if you have this kind of income, otherwise circle “No")
Second Job.. -Yes $ 2 No Veterans’ benefits. No
Social Security benefits Workers compensatior No.
o No Income from absent family members. No.
0 No — Stocks/bonds.. No
Unemnloy 2 No Rental i No
Union payments. 0 No Dividends or interest. No
Retirement/pensi 0 No Other kinds of incom No
Trusts... o No Gifts No.
| understand that | will be required to make payments for costs to the clerk in accordance with §57.082(5), Florida Statutes, as
provided by law, although | may agree to pay more if | choose to do so.
4. [have other assets: (Circle ‘yes” and fill in the value of the property, otherwise circle “No")
Cash. -Yes$® No Savings account
Bank account(s) -Yes $9 No Stocks/bonds
Cortificates of denosit or Homestead Real Pronartv™ |
Money market accoun .Yes $9 No Motor Vehicle"
Boats* .Yes $9 No Non-homestead real property/real estate’ ...... Yes $9
Other assets* Yes $9
ence one: IWfDO ( ) DO NOT expect to receive more assets in the near future. The asset
is! .
5.1 have total liabilities and debts of $.90000 as follows: Motor Vehicle $0 , Home $9. Boat
$2______, Non-homestead Real Property$°___, Child Support paid direct $9 __, Credit Cards
$2_______, Medical Bills $0000____, Cost of medicines (monthly)$9____, Other $0 :
oo
o
6. | have a private lawyer in this case.........L_lYes LZINo
Aperson who knowingly provides false information to the clerk or the court in seeking a determination of indigent status under s. 57.082,
F.S. commits a misdemeanor of the first degree, punishable as provided in s.775.082, F.S or s. 775.083/5S. | attest that the information I
have provided on this application is true and accurate to the best of my knowledge. +
Signed on August 23, 2021_.
1974 629.0 Signature of Applicafsefor Indigent Status
Year of Birth Last 4 digits of Driver License or ID Number —_Print Full Legal Name SUZETTE GRAGE RODRIGUEZ
SUZYGRACERODRIGUEZ@GMAILCOM Phone Number/s: 5616180735
Email addre:
ai
Address: Street, City, State, Zip Code
This form was completed with the assistance of: NOT ANYONE
Clerk/Deputy Clerk/Other authorized person,
"CLERK'S DETERMINATION
Based on the information In this Application, | have determined the applicant to be[Xncigent [pet Indigent, according to s. 57.082,
FS.
vated on__AUQ 25 202 20. PRS _Joseph Abruzzo
& (( }) Clerk of the Circuit Court cl
ee ~gpania._Spskacc- 96% Sustache
APPLICANTS FOUND NOT TO BE INDIGENT MAY SEEK REVIEW BY A JUDGE BY ASKING FOR A HEARING TIME. THERE IS NO FEE FOR THIS REVIEW.
Sign here if you want the Judge to review the clerk’s decision
Updated 5/1/2019
CHEN. DAIAARCACUAAIINTY Cl INCEDU ARDIIV7ZN FLED NaINEINNN 40.49.69 ANA
Pm. PAL DLA VUUINE TT, FL, JUOL I mDNueey, ULLIAN, vureuieue! tu. 1u.ue mii
Document Filed Date
August 25, 2021
Case Filing Date
August 25, 2021
Category
OTHER PROFESSIONAL MALPRACTICE
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wes CASE NUMBER: 502021CA010044XXXXMB Div: Al **** Filing # 133364627 E-Filed 08/25/2021 10:18:52 AM IN THE CIRCUIT/COUNTY COURT OF THE 15TH JUDICIAL CIRCUIT IN AND FOR PALM BEACH COUNTY, FLORIDA SUZETTE GRACE RODRIGUEZ CASENO. Fiamnumreuuoner oF in the interest oF vs. Micheal V. Goodwin tet at Defendani/Respondent APPLICATION FOR DETERMINATION OF CIVIL INDIGENT STATUS Notice to Applicant: If you qualify for civil indigence, the filing and summons fees are waived; other costs and fees are not waived. 1. Ihave 4 dependents. (Include only those persons you list on your U.S. Income tax return.) Are you Married? No Does your Spouse Work?. Annual Spouse Income? $NA 2. Ihave a net income of §, paid (+ weekly ( ) every two weeks ( ) semi-monthly () monthly ()yearly()other__ (Net income is your total income including salary, wages, bonuses, commissions, allowances, overtime, tips and similar payments, minus deductions required by law and other court-ordered payments such as child support.) 3.1 have other income paid ( ) weekly ( ) every two weeks () semi-monthly ( ) monthly ( ) yearly (other NA (Circle “Yes” and fill in the amount if you have this kind of income, otherwise circle “No") Second Job.. -Yes $ 2 No Veterans’ benefits. No Social Security benefits Workers compensatior No. o No Income from absent family members. No. 0 No — Stocks/bonds.. No Unemnloy 2 No Rental i No Union payments. 0 No Dividends or interest. No Retirement/pensi 0 No Other kinds of incom No Trusts... o No Gifts No. | understand that | will be required to make payments for costs to the clerk in accordance with §57.082(5), Florida Statutes, as provided by law, although | may agree to pay more if | choose to do so. 4. [have other assets: (Circle ‘yes” and fill in the value of the property, otherwise circle “No") Cash. -Yes$® No Savings account Bank account(s) -Yes $9 No Stocks/bonds Cortificates of denosit or Homestead Real Pronartv™ | Money market accoun .Yes $9 No Motor Vehicle" Boats* .Yes $9 No Non-homestead real property/real estate’ ...... Yes $9 Other assets* Yes $9 ence one: IWfDO ( ) DO NOT expect to receive more assets in the near future. The asset is! . 5.1 have total liabilities and debts of $.90000 as follows: Motor Vehicle $0 , Home $9. Boat $2______, Non-homestead Real Property$°___, Child Support paid direct $9 __, Credit Cards $2_______, Medical Bills $0000____, Cost of medicines (monthly)$9____, Other $0 : oo o 6. | have a private lawyer in this case.........L_lYes LZINo Aperson who knowingly provides false information to the clerk or the court in seeking a determination of indigent status under s. 57.082, F.S. commits a misdemeanor of the first degree, punishable as provided in s.775.082, F.S or s. 775.083/5S. | attest that the information I have provided on this application is true and accurate to the best of my knowledge. + Signed on August 23, 2021_. 1974 629.0 Signature of Applicafsefor Indigent Status Year of Birth Last 4 digits of Driver License or ID Number —_Print Full Legal Name SUZETTE GRAGE RODRIGUEZ SUZYGRACERODRIGUEZ@GMAILCOM Phone Number/s: 5616180735 Email addre: ai Address: Street, City, State, Zip Code This form was completed with the assistance of: NOT ANYONE Clerk/Deputy Clerk/Other authorized person, "CLERK'S DETERMINATION Based on the information In this Application, | have determined the applicant to be[Xncigent [pet Indigent, according to s. 57.082, FS. vated on__AUQ 25 202 20. PRS _Joseph Abruzzo & (( }) Clerk of the Circuit Court cl ee ~gpania._Spskacc- 96% Sustache APPLICANTS FOUND NOT TO BE INDIGENT MAY SEEK REVIEW BY A JUDGE BY ASKING FOR A HEARING TIME. THERE IS NO FEE FOR THIS REVIEW. Sign here if you want the Judge to review the clerk’s decision Updated 5/1/2019 CHEN. DAIAARCACUAAIINTY Cl INCEDU ARDIIV7ZN FLED NaINEINNN 40.49.69 ANA Pm. PAL DLA VUUINE TT, FL, JUOL I mDNueey, ULLIAN, vureuieue! tu. 1u.ue mii