On March 28, 2024 a
Party Statement
was filed
involving a dispute between
and
Rodriguez-Campos, Sergio Jomal,
in the District Court of Clay County.
Preview
Case# 2024CF000398 File Date 04/05/2024 10:03 AM Tara S. Green Clay County Clerk of Court
ie
, wl
IN THE.CIRCUIT/COUNTY COURT OF THE FOURTH
JUDICIAL CIRCUIT IN-AND FOR: CLAY COUNTY;,FLORIDA.
Si
‘STATE OF FLORIDA
caseno, 2024-00729! iIe
Rodriguez-Cam| Sergi
DefendantMinor
Child: I
APPLICATION:FOR CRIMINAL INDIGENT STATUS.
ll AM.SEEKING THE APPOINTMENT OF THE PUBLIC DEFENDER
i
| HAVE A PRIVATE ATTORNEY OR’AM SELF-REPRESENTED AND SEEK DETERMINATION OF INDIGENCE STATUS FOR COSTS:
Noticeta Applicant: The provision ofa public defender/court appointed lawyer and costs/due process éetvites aré nat freé, A udgiient arid len thay be imposed againstll real or personal
roperty you own to pay for legal and other services pravided on your behalf or on behalfof the person for whom you-are making this application, Théte'is.2 $50.00 fee for each application.
ifthe application fe isnot paid tothe Clerkof the Court within 7 days; twill be added to any costs that riay be-asseSsel! agaist you: atthe conclision of this case, Ifyou are'a parentigual
making this affidavit on behalf ofa minor or tax-dependent
adult, the ifvfarmation contained in, ication must include yourincome and assets,
4 Thave 4 deperidents: (Do nat include children not living at ime and do not include a working spouse or yoursall,)
2. Lhave atake ome income of S600 paid Quweekly @biweeky C) séini-monthly
Chmonthi yearly,
(Take home income squats salary, wages, Banuses, commissions, allowances, overtime, lips and similar payments, minus dedlictons required by law and other court ordered’
‘support payments)
3, Thave‘othér income péid () weekly () biweekly ( sonidon (monthly () va (inthe amcut ou have ind fea, tars check No')
Social Security benefits: Veterans’ benefit. Nowy
Unemployment compens te" § om Child support or other regutar support
Union Funds. Nes§: No from family members/spouse «Yes$. Nol
Workers compensatio Yes §. No i Rental incomé., Yes$. Noft
Retiremantipension: Yes. §: No Dividends or interes! Yes §. Nott
Trusts
or gifts. Yes§: Noi Other kinds of income not‘on list. jes §. NoBt
4, Thave other assets: (Circle “yes” and fillin the value of the property, otherwise circle-“No.")
Cash..is Yes $: No BE Savings. Yes $. No Bl
Bank accour Yes $. No i ‘Stocks/bon: Yes $, Nok
Catifcatesof depos! “Equity in Real ) Yes §, NoGl
money market accounts. Yes§, No i “include expectancy of an interest in'such property
Equity in Motor vehiclesBoal Yes $ No i
ther tangible property
§..J have.a total amount of llabilitiés and debts in'tha amount of §.
6. I receives: (Circle “Yes” or “No.
‘Temporary Assistance for Needy Families-Cash Assistance, Yes EI No
Poverty- related veterans’ benefls. Oves EI No
Supplemental Security Income (SSI). see Dyes Fi No
7. J have been released on bail In the atiount of $. Cash __ Surety. Postedhy: Self Farnity Other J 1
‘A persén who knowingly provides false information to the clerk or the court in seeking a determination of indigent status unders, 27.52, F.S. commits a misdemeanor of the first degree,
punishable as provided in s. 775,082, F.S. or s, 775.083, F.S. | attest that the information | have provided on this: Application is true and accurate to the best, oF my i
knowledge. -
!
Signed this D day of April 2024
Pie
Date.of sith 09/08/2000: Signature of applicant forindigent status,
Driver's license or [O number 362790003280 Print full egal name Sergio
1646 W Jomal:
44th St‘Rodriguez-Campos
ress Jacksonville, FL. 32209
City,
Phone number (904) 686-0523
CLERK'S DETERMINATION I
—Hhoesee ‘on the information in this Application, 'havé determined
the applicant to bel indigent )Not Indigent
The Public Defender is hereby appointed to'thé casé listed above until rélieved:by the Court.
Dated this. day of. 20
TARA S. GREEN
Cle ircuit: Court
Apa
‘This form was completed with the assistance of
Clerk/Deputy (Other aut zed person
APPLICANTS FOUND NOT INDIGENT MAY SEEK REVIEW BY ASKING FOR A HEARING TIME, Sign here if 4 want the judge to review-the clerk's decision. of
not indigent:
Developed by the. Florida Clerks of Court Operations Corporation
Document Filed Date
April 05, 2024
Case Filing Date
March 28, 2024
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Case# 2024CF000398 File Date 04/05/2024 10:03 AM Tara S. Green Clay County Clerk of Court ie , wl IN THE.CIRCUIT/COUNTY COURT OF THE FOURTH JUDICIAL CIRCUIT IN-AND FOR: CLAY COUNTY;,FLORIDA. Si ‘STATE OF FLORIDA caseno, 2024-00729! iIe Rodriguez-Cam| Sergi DefendantMinor Child: I APPLICATION:FOR CRIMINAL INDIGENT STATUS. ll AM.SEEKING THE APPOINTMENT OF THE PUBLIC DEFENDER i | HAVE A PRIVATE ATTORNEY OR’AM SELF-REPRESENTED AND SEEK DETERMINATION OF INDIGENCE STATUS FOR COSTS: Noticeta Applicant: The provision ofa public defender/court appointed lawyer and costs/due process éetvites aré nat freé, A udgiient arid len thay be imposed againstll real or personal roperty you own to pay for legal and other services pravided on your behalf or on behalfof the person for whom you-are making this application, Théte'is.2 $50.00 fee for each application. ifthe application fe isnot paid tothe Clerkof the Court within 7 days; twill be added to any costs that riay be-asseSsel! agaist you: atthe conclision of this case, Ifyou are'a parentigual making this affidavit on behalf ofa minor or tax-dependent adult, the ifvfarmation contained in, ication must include yourincome and assets, 4 Thave 4 deperidents: (Do nat include children not living at ime and do not include a working spouse or yoursall,) 2. Lhave atake ome income of S600 paid Quweekly @biweeky C) séini-monthly Chmonthi yearly, (Take home income squats salary, wages, Banuses, commissions, allowances, overtime, lips and similar payments, minus dedlictons required by law and other court ordered’ ‘support payments) 3, Thave‘othér income péid () weekly () biweekly ( sonidon (monthly () va (inthe amcut ou have ind fea, tars check No') Social Security benefits: Veterans’ benefit. Nowy Unemployment compens te" § om Child support or other regutar support Union Funds. Nes§: No from family members/spouse «Yes$. Nol Workers compensatio Yes §. No i Rental incomé., Yes$. Noft Retiremantipension: Yes. §: No Dividends or interes! Yes §. Nott Trusts or gifts. Yes§: Noi Other kinds of income not‘on list. jes §. NoBt 4, Thave other assets: (Circle “yes” and fillin the value of the property, otherwise circle-“No.") Cash..is Yes $: No BE Savings. Yes $. No Bl Bank accour Yes $. No i ‘Stocks/bon: Yes $, Nok Catifcatesof depos! “Equity in Real ) Yes §, NoGl money market accounts. Yes§, No i “include expectancy of an interest in'such property Equity in Motor vehiclesBoal Yes $ No i ther tangible property §..J have.a total amount of llabilitiés and debts in'tha amount of §. 6. I receives: (Circle “Yes” or “No. ‘Temporary Assistance for Needy Families-Cash Assistance, Yes EI No Poverty- related veterans’ benefls. Oves EI No Supplemental Security Income (SSI). see Dyes Fi No 7. J have been released on bail In the atiount of $. Cash __ Surety. Postedhy: Self Farnity Other J 1 ‘A persén who knowingly provides false information to the clerk or the court in seeking a determination of indigent status unders, 27.52, F.S. commits a misdemeanor of the first degree, punishable as provided in s. 775,082, F.S. or s, 775.083, F.S. | attest that the information | have provided on this: Application is true and accurate to the best, oF my i knowledge. - ! Signed this D day of April 2024 Pie Date.of sith 09/08/2000: Signature of applicant forindigent status, Driver's license or [O number 362790003280 Print full egal name Sergio 1646 W Jomal: 44th St‘Rodriguez-Campos ress Jacksonville, FL. 32209 City, Phone number (904) 686-0523 CLERK'S DETERMINATION I —Hhoesee ‘on the information in this Application, 'havé determined the applicant to bel indigent )Not Indigent The Public Defender is hereby appointed to'thé casé listed above until rélieved:by the Court. Dated this. day of. 20 TARA S. GREEN Cle ircuit: Court Apa ‘This form was completed with the assistance of Clerk/Deputy (Other aut zed person APPLICANTS FOUND NOT INDIGENT MAY SEEK REVIEW BY ASKING FOR A HEARING TIME, Sign here if 4 want the judge to review-the clerk's decision. of not indigent: Developed by the. Florida Clerks of Court Operations Corporation