On September 17, 2021 a
Party Statement
was filed
involving a dispute between
and
for Misdemeanor
in the District Court of Lake County.
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IN THE CIRCUIT/COUNTY COURT OF THE FIFTH JUDICIAL CIRCUIT IN AND FOR LAKE COUNTY, FLORIDA
STATE OF FLORIDA
case no. LO21MIM
S518 F
ARANGO, CHRISTOPHER.
Defends \/Minor Child
APPLICATION FOR CRIMINAL INDIGENT STATUS
1AM SEEKING THE APPOINTMENT OF THE PUBLIC DEFENDER; OR
1 JHAVE A PRIVATE ATTORNEY OR AM SELF-REPRESENTED AND SEEK DETERMINATION OF INDIGENCE STATUS FOR COSTS
Notice to Applicant: The provision of a public defender/court appointed lawyer and costs/due process services are not free. A judgment and lien may be imposed against all real or personal
property you own to pay for legal and other services provided on your behalf or on behalf of the person for whom you are making this application. There is a $50.00 fee for each application filed.
tf the application fee is not paid to the Clerk of the Court within 7 days, itwill be added to any costs that may be assessed against you at the conclusion of this case. If you are a parentguarcian
making this affidavit on behalf of a minor or tax-dependent adult, the information contained in this application must include your income and assets.
1. Ihave Rea lependents. (Do not include children not living at home and do not include a working spouse or yourself.)
2 Ihave a take home income of $ CO weekly C1 bi-weekly [1] semi-monthly (J monthly [1 yearly
(Take home income equals salary, wages, bonuses, commissions, allowances, overtime, fips and similar payments, minus ‘required by law and other court ordered support payments)
Ihave other income paid: [1] weekly qsbin weekly semi-monthly (] montht wo yearly: (Select “Yes” and fill in the amount
if you have fis Kd of income, otherwise select °No.")
Social Security benefits Veterans’ benefit...
Unemployment compensation. Hies Child support or other regular support from
Union Funds O Yes§ O Yes$.
s
family members/spouse.
Workers compensation. CDYes$ Rental income. D Yes$.
Retirement/pensions 1 Yes$, Dividends or interest O Yes§
Trusts or gifts. C1 Yes$, Other kinds of income not on the list. O Yes§
Ihave other assets; (Select “Yes” and fillin te value of the property, otherwise select “No")
Cash No Savings. D Yes$. ET fio
Bank account(s) Aves [No Stocks/bonds. O Yes$.
Certificates of deposit or money * Equity in Real estate
market accounts. 0 Yes$. [No (excluding homestead) O Yes $NA
* Equity in Motor vehicles/Boats!
Other tangible property. C1 Yes$. No nm rm
A, 2
FP
include expectancy of an interest in such property we
mom
Ihave a total amount of liabilities and debts in the amount of §,
o
Ireceive: (Select “Yes” or “No’ o< ¢
Temporary Assistance for Needy Families-Cash Assistance 1 YesCJ No Supplemental Security Income (SSI) (1 Yes
O) No
Poverty-related veterans’ benefits. O Yes a
=
7. Ihave been released on bail in the amount of $, i Cash C Surety Posted by: [] Self [] Family [1] Other
A person who knowingly provides false information to the clerk or the court in seeking a determination of indigent status under Section 27.52, Florida Statutes, commits a misdemeanor of
the first degree, punishable as provided in Section 775.082, Florida Statutes, or Section 775.083, Florida Statutes. | attest that the information | have provided on this application is
WeLe
true and accurate.
Signed this day of _16_, SEPT 20.21
Date of Birth 9/26/1985,
Seffe ot Applicant for
(4 Status
Last4 Digits of Driver's License or ID Number 73684 Or.
full legal name ARANGO, CHRISTOPHER.
Address
City, State, Zip
Phone number
CLERK’S DETERMINATION
ZO Based on the information in this Application, | have determined the applicant to be (indigent Not Indigent
choy
°_ The Public Defender is hereby appointed to the case listed above until relieved by the Court.
bated this 17] _ day of Sup wel. Q Com
This form was completed with the assistance of ea haut
Clerk/Deputy Clerl/Other authorized pers)
APPLICANTS FOUND NOT INDIGENT MAY SEEK REVIEW BY ASKING FOR A HEARING TIME.
Sign here if you want the judge to review the clerk’s decision of not indigent:
Florida Rules of Criminal Procedure 3.984 April 6, 2020 The Florida Bar
Document Filed Date
September 17, 2021
Case Filing Date
September 17, 2021
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IN THE CIRCUIT/COUNTY COURT OF THE FIFTH JUDICIAL CIRCUIT IN AND FOR LAKE COUNTY, FLORIDA STATE OF FLORIDA case no. LO21MIM S518 F ARANGO, CHRISTOPHER. Defends \/Minor Child APPLICATION FOR CRIMINAL INDIGENT STATUS 1AM SEEKING THE APPOINTMENT OF THE PUBLIC DEFENDER; OR 1 JHAVE A PRIVATE ATTORNEY OR AM SELF-REPRESENTED AND SEEK DETERMINATION OF INDIGENCE STATUS FOR COSTS Notice to Applicant: The provision of a public defender/court appointed lawyer and costs/due process services are not free. A judgment and lien may be imposed against all real or personal property you own to pay for legal and other services provided on your behalf or on behalf of the person for whom you are making this application. There is a $50.00 fee for each application filed. tf the application fee is not paid to the Clerk of the Court within 7 days, itwill be added to any costs that may be assessed against you at the conclusion of this case. If you are a parentguarcian making this affidavit on behalf of a minor or tax-dependent adult, the information contained in this application must include your income and assets. 1. Ihave Rea lependents. (Do not include children not living at home and do not include a working spouse or yourself.) 2 Ihave a take home income of $ CO weekly C1 bi-weekly [1] semi-monthly (J monthly [1 yearly (Take home income equals salary, wages, bonuses, commissions, allowances, overtime, fips and similar payments, minus ‘required by law and other court ordered support payments) Ihave other income paid: [1] weekly qsbin weekly semi-monthly (] montht wo yearly: (Select “Yes” and fill in the amount if you have fis Kd of income, otherwise select °No.") Social Security benefits Veterans’ benefit... Unemployment compensation. Hies Child support or other regular support from Union Funds O Yes§ O Yes$. s family members/spouse. Workers compensation. CDYes$ Rental income. D Yes$. Retirement/pensions 1 Yes$, Dividends or interest O Yes§ Trusts or gifts. C1 Yes$, Other kinds of income not on the list. O Yes§ Ihave other assets; (Select “Yes” and fillin te value of the property, otherwise select “No") Cash No Savings. D Yes$. ET fio Bank account(s) Aves [No Stocks/bonds. O Yes$. Certificates of deposit or money * Equity in Real estate market accounts. 0 Yes$. [No (excluding homestead) O Yes $NA * Equity in Motor vehicles/Boats! Other tangible property. C1 Yes$. No nm rm A, 2 FP include expectancy of an interest in such property we mom Ihave a total amount of liabilities and debts in the amount of §, o Ireceive: (Select “Yes” or “No’ o< ¢ Temporary Assistance for Needy Families-Cash Assistance 1 YesCJ No Supplemental Security Income (SSI) (1 Yes O) No Poverty-related veterans’ benefits. O Yes a = 7. Ihave been released on bail in the amount of $, i Cash C Surety Posted by: [] Self [] Family [1] Other A person who knowingly provides false information to the clerk or the court in seeking a determination of indigent status under Section 27.52, Florida Statutes, commits a misdemeanor of the first degree, punishable as provided in Section 775.082, Florida Statutes, or Section 775.083, Florida Statutes. | attest that the information | have provided on this application is WeLe true and accurate. Signed this day of _16_, SEPT 20.21 Date of Birth 9/26/1985, Seffe ot Applicant for (4 Status Last4 Digits of Driver's License or ID Number 73684 Or. full legal name ARANGO, CHRISTOPHER. Address City, State, Zip Phone number CLERK’S DETERMINATION ZO Based on the information in this Application, | have determined the applicant to be (indigent Not Indigent choy °_ The Public Defender is hereby appointed to the case listed above until relieved by the Court. bated this 17] _ day of Sup wel. Q Com This form was completed with the assistance of ea haut Clerk/Deputy Clerl/Other authorized pers) APPLICANTS FOUND NOT INDIGENT MAY SEEK REVIEW BY ASKING FOR A HEARING TIME. Sign here if you want the judge to review the clerk’s decision of not indigent: Florida Rules of Criminal Procedure 3.984 April 6, 2020 The Florida Bar