On October 29, 2019 a
was filed
involving a dispute between
and
Cleek, Jacquelyn Michelle,
for FELONY
in the District Court of Osceola County.
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IN THE CIRCUITICOUNTY. URT OF THE gn JUDICIAL CIRCUIT IN
‘COUNTY, FLORIDA
MoEBIS
‘STATE OF FLORIDA,
cues aH dy
Ceo
vs.
C id
us
APPLICATION FOR CRIMINAL INDIGEI TAT!
x AM SEEKING THE APPOINTMENT OF THE PUBLICDEFENDER
| HAVE A PRIVATE ATTORNEY OR AM SELF-REPRESENTED AND SEEK DETERMINATION OF INDIGENT 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
imposes 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
be added to any costs
making this application. There is a $50.00 fee for each application filed. lf the application fee is not paid to the Clerk within 7 days, it will
that may be assessed against you at the conclusion of this case. If you are a parent/lagal guardian making this application on behall of a minor or tax-
dependent aguf, the information containad in this application must inciude your income and assats.
7. have. ,dependents. (Do not include. not living at home and do not include a working spouse or yourself.)
2.1havea home income of $. id ( } weekly () every Iwo weeks () semi-monthly ( ) monthly ( )yearly
(Take home income equais salary, wages, ‘commissions, allowances, overtime, tips and similar payments, minus deductions
required by law and
other court-ordered support payments.
3.~ Vhave other income paid () weekly () every two weeks {) semi-monthly () monthly () yearly. (Circle “Yes” and fill in the amount if you have this kind of
income, otherwise circie “No’)
Social Security benefits . Yes $, Veterans’ benefits...
Child support or other regular support
Yes $__fe
Unemployment compensation Yes$.
Union Funds. Yes $. from family members/spouse ‘es $
Workers Compensation Yes$ Rental income... ‘es §
Retirementipensions. es §. Dividends or interest ‘es $
Trusts/gits.. Yes$. Other kinds of incom es $
q inesthe$. vaiue
of the circle “No”, use the back.
4, | have other assets: (Circie ‘yes* and. /, otherwise ic
Cash .... ings. Yes $
Bank account(s) ‘Stocks/bonds ‘es $
Certificates af deposit or “Equity in real estate (excluding homestead) ‘es $
money market accounts . . es $. List the addressof this property.
“Equity in motor vehicles/ooats/ ‘as $, * Equity means value minus loans. Also fst any
other tangible expectancy in an intarestin such property.
List the yearrmake/model & tag#.
5. U have total liabilities
and debts in the amount
of $, q .
6. receive: (Circe “Yes* or “No’)
Temporary Assistance for Needy Families Cash Assistance . Yes
Yes
Poverty-related Veterans’ Benefits _.
Supplemental Security income (SS!) ve CS
7. J have been released on bail in the amount of $. Casi Surety. Posted by: Seif Family. Other
A person who i fides: of the first Cegree, puni
!2ise information to the clerk or the court in seeking a determination of indigent status under FS 27.52 commits a misdemeanor
provided in FS 775.082 or 775.083. | attest that the information | have provided on this apptication is tue and. te to the best of e.
day of 20,
‘Applicantfor higent po
Print Full Legal Name.
‘Driver License # Phane Number:
“Wesiess, Gy, Sale, Zp Code =
CLERK
Based on the information in this Application, | have determinedthe apolean bs eat on the Public Oafender is appointedto this case unt saved iy the Coun; 9) Notinaigant :
wee found or tase found match these std inthis application,
conducted a roviewof motor vette and prope records anda veticls or propery recs
— TST cle perty records and records were found that are cot listed in this application.
> nh 4
a
Oate: Glerkc
ol the This form
‘was completed
with the assistance of:
Cle authorized person
ING {WE. Sign here if you wart the judge to review
the clerk's
Ce)
APPLICANTS FOUND NOT TO BE | REVIEWBY 0 E BY ASBIG Fo
determination of notindigent. 5 (%2 OO. ER08 i¢
Rev. 11/2618 Developed by the Florida CCOC
Document Filed Date
November 01, 2023
Case Filing Date
October 29, 2019
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IN THE CIRCUITICOUNTY. URT OF THE gn JUDICIAL CIRCUIT IN ‘COUNTY, FLORIDA MoEBIS ‘STATE OF FLORIDA, cues aH dy Ceo vs. C id us APPLICATION FOR CRIMINAL INDIGEI TAT! x AM SEEKING THE APPOINTMENT OF THE PUBLICDEFENDER | HAVE A PRIVATE ATTORNEY OR AM SELF-REPRESENTED AND SEEK DETERMINATION OF INDIGENT 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 imposes 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 be added to any costs making this application. There is a $50.00 fee for each application filed. lf the application fee is not paid to the Clerk within 7 days, it will that may be assessed against you at the conclusion of this case. If you are a parent/lagal guardian making this application on behall of a minor or tax- dependent aguf, the information containad in this application must inciude your income and assats. 7. have. ,dependents. (Do not include. not living at home and do not include a working spouse or yourself.) 2.1havea home income of $. id ( } weekly () every Iwo weeks () semi-monthly ( ) monthly ( )yearly (Take home income equais salary, wages, ‘commissions, allowances, overtime, tips and similar payments, minus deductions required by law and other court-ordered support payments. 3.~ Vhave other income paid () weekly () every two weeks {) semi-monthly () monthly () yearly. (Circle “Yes” and fill in the amount if you have this kind of income, otherwise circie “No’) Social Security benefits . Yes $, Veterans’ benefits... Child support or other regular support Yes $__fe Unemployment compensation Yes$. Union Funds. Yes $. from family members/spouse ‘es $ Workers Compensation Yes$ Rental income... ‘es § Retirementipensions. es §. Dividends or interest ‘es $ Trusts/gits.. Yes$. Other kinds of incom es $ q inesthe$. vaiue of the circle “No”, use the back. 4, | have other assets: (Circie ‘yes* and. /, otherwise ic Cash .... ings. Yes $ Bank account(s) ‘Stocks/bonds ‘es $ Certificates af deposit or “Equity in real estate (excluding homestead) ‘es $ money market accounts . . es $. List the addressof this property. “Equity in motor vehicles/ooats/ ‘as $, * Equity means value minus loans. Also fst any other tangible expectancy in an intarestin such property. List the yearrmake/model & tag#. 5. U have total liabilities and debts in the amount of $, q . 6. receive: (Circe “Yes* or “No’) Temporary Assistance for Needy Families Cash Assistance . Yes Yes Poverty-related Veterans’ Benefits _. Supplemental Security income (SS!) ve CS 7. J have been released on bail in the amount of $. Casi Surety. Posted by: Seif Family. Other A person who i fides: of the first Cegree, puni !2ise information to the clerk or the court in seeking a determination of indigent status under FS 27.52 commits a misdemeanor provided in FS 775.082 or 775.083. | attest that the information | have provided on this apptication is tue and. te to the best of e. day of 20, ‘Applicantfor higent po Print Full Legal Name. ‘Driver License # Phane Number: “Wesiess, Gy, Sale, Zp Code = CLERK Based on the information in this Application, | have determinedthe apolean bs eat on the Public Oafender is appointedto this case unt saved iy the Coun; 9) Notinaigant : wee found or tase found match these std inthis application, conducted a roviewof motor vette and prope records anda veticls or propery recs — TST cle perty records and records were found that are cot listed in this application. > nh 4 a Oate: Glerkc ol the This form ‘was completed with the assistance of: Cle authorized person ING {WE. Sign here if you wart the judge to review the clerk's Ce) APPLICANTS FOUND NOT TO BE | REVIEWBY 0 E BY ASBIG Fo determination of notindigent. 5 (%2 OO. ER08 i¢ Rev. 11/2618 Developed by the Florida CCOC