On April 24, 2023 a
Request,Application
was filed
involving a dispute between
Mayes, Jason,
and
for Circuit Civil 3-C
in the District Court of Jackson County.
Preview
IN THE CIRCUITICOUNTY COURT OF THE
14TH JUDICIAL CIRCUIT
IN AND For Jackson. COUNTY, FLORIDA
caseno,_ 10 RE ASDencp
vs,
a Ye Ww
Defendant/Respondent
PPLICATION Ft DETERMI OF Cl IGENT STATUS
Notica to Appileant: If you qualify for civil indigence you must enroll in the clerk's office payment plan and pay a
one-time administrative fee of $25.00. This fee shall not be charged for Dependency or Chapter 39 Termination of
Parental Rights actions,
4.Uhave _ FH dependents. (Include only those persons you list on your U.S. Income
tax retum.)
Are you Married?, Yes No Does your Spouse Work?...Yes No Annual Spouse hcome? $e
Bit have g netincome of § Gg pald weekly - averytwoweeks seml-monthly monthly- yearly other ~~
(Net income Is your total income including salary, wages, bonuses, allowances, overtime, Ups and similar payments,
minus deductions required by law and other court-ordered payments such as child support}
3. have otherincome paid weekly everytwoweeks semlmonthly monthly yearly other, SG
(Circle “Yes” and fill in the amount if you have this kind of Income, otherwise circle “No’)
Second Job. wee VOS $ @_ wo Veterans’ benefits... Yes $ E__Wo
Social Security benefits Workers compensation. 0 Yes $
For you. Yes $ No Incame from absent family members Yes $
For chlid(ren) Yes $ No ‘Stocks/bonds. Yes $
Unemployment compensation Yes $___ No Rental income. Yes $
Union payments Yes $ No Dividends or intorest..... Yes
Retlrementpensions... Yes § No Other kinds of income not on the list. Yes $
TUSES wee. Yes $ G__No riasensseatoeenenesbonten Yes$__ @F No
{ understand that | will be required to make payments for fees and coststo the clerk In accordance with §57,082(6), Florida Statutes,
a8 provided by law, although | may agree to pay more if | choose to do $0,
4. Uhave other assets: (Circle ‘yes” and fill in the value ofthe property, otherwise clrole “No’}
Cash, es ‘Savings account Yes$_@ No
Bank account(s Yes § GN Stocks/bonde.... Yes$ __ No
Certificates of depositor Homestead Real Property’. Yes $ No
money market accounts. Yes $ No Motor Vehicle’. Yes $ No
Boats’ se Yes $ No Non-homestaad rea! property/real estate’ Yes $ 2. No
“show loans on these assets In paragraph 5
Check one:! DO DO NOT expectto recelve more assets in the near future, The esset Is, 2
roperty eo
§. Thave total llabjlitles and debts of $,
medicines (monthly) $.
D
jpport pald direct $
88 follows:
a
Motor Vehicle $
Credit Cards $. + Medical Bills $__
Other Real
ge Cost of
6. | have a private Iawyer in this case. ‘es No
7. iChave [have not (mark one) been adjudicated Indigent under s. 57.085, Florida Statutes, certified
Indigent unders. 57,081, Florida Statutes, or authorized to proceed as an Indigent under 28 U.S.C. s, 1915 by
a federal court more than twice in the 3 years preceding the filing of this action. (If the affiant has been so
adjudicated, affiant must seek leave of court to pursue a new suit)
A person who knowingly provides thlse information to the clerk or the court in 4 determination of indigent status under s, 57.082, F.S.
coramits a misdemeanor of the first degree, punishable
as provided in 9.775.082, FS. or s. 775.083, F.S, I attest that the information I have
provided on this applicationis true and accurate to the best of my knowledge,
signedthis ' dayof May » 2023 C2:
Date of Birth Driver's License orID Number erat of Applicant for Indigent Status
‘Legal Name.
flak ctl 52 da et bring Sots, Fran
JACKSON COUNTY CLERK OF COURT 05/25/2023 12:51
q SUD IC
¥
ca CEs
pe 7B SON oS oe,
CLERK’S DETERMINATION ©
Based on the information in this Application, have determined the applicantto be| ligent () Not
57.082, F. a URN >t
rh zi\
Dated this as* day of, tc 200%. LZ
Clerk of the Circuit! ourt by 42 att I
This form was completed with the assistance of: Ss fe
Clerk/Deputy Clerk/Other authorized person.
Nd; 5
APPLICANTS FOUND NOT TO BE INDIGENT MAY SEEK REVIEW BY A JUDGE BY ASKING FOR A 2
‘THERE IS NO FEB FOR THIS REVIEW.
Sign here if you want the judge to review the clerk's decision.
ae
JACKSON COUNTY CLERK OF COURT 05/25/2023 12:51
Document Filed Date
May 25, 2023
Case Filing Date
April 24, 2023
Category
Circuit Civil 3-C
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IN THE CIRCUITICOUNTY COURT OF THE 14TH JUDICIAL CIRCUIT IN AND For Jackson. COUNTY, FLORIDA caseno,_ 10 RE ASDencp vs, a Ye Ww Defendant/Respondent PPLICATION Ft DETERMI OF Cl IGENT STATUS Notica to Appileant: If you qualify for civil indigence you must enroll in the clerk's office payment plan and pay a one-time administrative fee of $25.00. This fee shall not be charged for Dependency or Chapter 39 Termination of Parental Rights actions, 4.Uhave _ FH dependents. (Include only those persons you list on your U.S. Income tax retum.) Are you Married?, Yes No Does your Spouse Work?...Yes No Annual Spouse hcome? $e Bit have g netincome of § Gg pald weekly - averytwoweeks seml-monthly monthly- yearly other ~~ (Net income Is your total income including salary, wages, bonuses, allowances, overtime, Ups and similar payments, minus deductions required by law and other court-ordered payments such as child support} 3. have otherincome paid weekly everytwoweeks semlmonthly monthly yearly other, SG (Circle “Yes” and fill in the amount if you have this kind of Income, otherwise circle “No’) Second Job. wee VOS $ @_ wo Veterans’ benefits... Yes $ E__Wo Social Security benefits Workers compensation. 0 Yes $ For you. Yes $ No Incame from absent family members Yes $ For chlid(ren) Yes $ No ‘Stocks/bonds. Yes $ Unemployment compensation Yes $___ No Rental income. Yes $ Union payments Yes $ No Dividends or intorest..... Yes Retlrementpensions... Yes § No Other kinds of income not on the list. Yes $ TUSES wee. Yes $ G__No riasensseatoeenenesbonten Yes$__ @F No { understand that | will be required to make payments for fees and coststo the clerk In accordance with §57,082(6), Florida Statutes, a8 provided by law, although | may agree to pay more if | choose to do $0, 4. Uhave other assets: (Circle ‘yes” and fill in the value ofthe property, otherwise clrole “No’} Cash, es ‘Savings account Yes$_@ No Bank account(s Yes § GN Stocks/bonde.... Yes$ __ No Certificates of depositor Homestead Real Property’. Yes $ No money market accounts. Yes $ No Motor Vehicle’. Yes $ No Boats’ se Yes $ No Non-homestaad rea! property/real estate’ Yes $ 2. No “show loans on these assets In paragraph 5 Check one:! DO DO NOT expectto recelve more assets in the near future, The esset Is, 2 roperty eo §. Thave total llabjlitles and debts of $, medicines (monthly) $. D jpport pald direct $ 88 follows: a Motor Vehicle $ Credit Cards $. + Medical Bills $__ Other Real ge Cost of 6. | have a private Iawyer in this case. ‘es No 7. iChave [have not (mark one) been adjudicated Indigent under s. 57.085, Florida Statutes, certified Indigent unders. 57,081, Florida Statutes, or authorized to proceed as an Indigent under 28 U.S.C. s, 1915 by a federal court more than twice in the 3 years preceding the filing of this action. (If the affiant has been so adjudicated, affiant must seek leave of court to pursue a new suit) A person who knowingly provides thlse information to the clerk or the court in 4 determination of indigent status under s, 57.082, F.S. coramits a misdemeanor of the first degree, punishable as provided in 9.775.082, FS. or s. 775.083, F.S, I attest that the information I have provided on this applicationis true and accurate to the best of my knowledge, signedthis ' dayof May » 2023 C2: Date of Birth Driver's License orID Number erat of Applicant for Indigent Status ‘Legal Name. flak ctl 52 da et bring Sots, Fran JACKSON COUNTY CLERK OF COURT 05/25/2023 12:51 q SUD IC ¥ ca CEs pe 7B SON oS oe, CLERK’S DETERMINATION © Based on the information in this Application, have determined the applicantto be| ligent () Not 57.082, F. a URN >t rh zi\ Dated this as* day of, tc 200%. LZ Clerk of the Circuit! ourt by 42 att I This form was completed with the assistance of: Ss fe Clerk/Deputy Clerk/Other authorized person. Nd; 5 APPLICANTS FOUND NOT TO BE INDIGENT MAY SEEK REVIEW BY A JUDGE BY ASKING FOR A 2 ‘THERE IS NO FEB FOR THIS REVIEW. Sign here if you want the judge to review the clerk's decision. ae JACKSON COUNTY CLERK OF COURT 05/25/2023 12:51