On May 03, 2024 a
Party Statement
was filed
involving a dispute between
State Of Florida,
and
Collins Tennille M,
for DRUGS
in the District Court of Brevard County.
Preview
IN THE CIRCUIT/COUNTY COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT
IN AND FOR BREVARD COUNTY, FLORIDA
STATE OF FLORIDA vs. CASE NO, 05-2024-CF-027016-AXXX-BC
TENNILLE M COLLINS:
Defendant/Minor Child
y APPLICATION FOR CRIMINAL INDIGENT STATUS
| AM SEEKING THE APPOINTMENT OF THE PUBLIC DEFENDER OR
| HAVE A PRIVATE ATTORNEY OR AM SELF-REPRESENTED AND SEEK DETERMINATION OF INDIGENCE STATUS
FOR COSTS
Ne i A nt 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 behalfof the person for whom you are making this application. There is a $50.00 fee for each application filed. If
the application fee is not paid to the Clerk of the Court within 7 days, it will be added to any costs that may be assessed against you
at the conclusion of this case. If you are a parent/guardian making this affidavit on behalf of a minor child or tax-dependent adult,
the informatis ontained in this application must include your income and assets.
fe children not living at home and do not include a working spouse or yourself.)
2.
I have dependents. (Do n ot
Ihave take home income of $.
Ee paid () weekly () biweekly ()semi-monthly ( )monthly ( ) yearly
(Take home income equals salary, wages, bonuses, commissions, allowances, overtime, tips and similar payments minus
deductions required by law and other court ordered support payments.)
Ihave other income paid () weekly () bi-weekly () semi-monthly (.) monthly () yearly
(Circle "Yes" and fill in the amount if you have this id of itcome, otherwise circle "No.")
Social Security benefits Yes $ Veterans’ benefit... Yes $ No
Unemployment compensation Yes $ No Child support or other regular support
Union funds. Yes $ —_f— No from family members/spouse. Yes $ No
Worker's compensation Yes $ —_}|— No Rental Income. Yes $ No
Retirement/pensions Yes $ No Dividends or interest. Yes $ No
Trusts or gifts. Yes $ No Other kinds of incom Yes $ No
| have other assets: (Circle “Yes” and fill in the woperty, otherwise circle "No.")
Cash... Yes $. Savings. Yes $ No
Bank account(s) Yes $ ) Stocks/bonds.. Yes $ No
Certificates of deposit or * Equity in homestead real estate Yes $ No
money market accounts. Yes $. No Equity in non-homestead real esta! Yes $ No
* Equity in motor vehicle: Yes $__{ No
* Equity in boats/other tangible property... Yes $__| No Include expectancy of an interest in such property
have a total amount of liabilities and debts in th
Ireceive: (Circle "Yes" or "No.")
amount oj go FILED IN OPEN COURT
This 3rd day of May,
Temporary Assistance for Needy Families-Cash Assistance. Yes No
Poverty-related veterans’ benefits... . Yes No 20 24, at M.
‘Supplemental Security Income (SSI)... Yes No oy be. OF eek.
| have been released on bail in the amount of $ “ ) Cash () rety
Posted by: () Self () Family ( ) Other IN
A person who knowingly provides false information to the Clerk or the Court in seeking a defermination
of indigent status under
§. 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.
Signed this 3rd day of May, 20 24
<< Print full legal name: TENNILLE M COLLINS
Signature of a fcant for indigent status Address:
Year of Birth: 1977 City, State, ip:
8660 Phone number:
Tast four digits of Driver's License or 1D Number E-mail Address:
— EE SS SS EE oO LO I" 0 0a
CLERK'S DETERMINATION
HE.
jased on the information in this Application, | have determined the applicant to be (“TTndigent (_) Not Indigent
aa he Public Defender is hereby appointed to the case listed above until relieved by the Court.
Dated this 3rd day of May, 20 24 Deputy Clerk for Rachel M. Sadoff, Clerk of Courts
This form was compieted with the assistance of Clerk/Deputy Clerk/Other authorized person.
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.
LAW 921 / 20190212 Original - File [ ] Defendant / Parent [ ] Regional Counsel or Public Defender
pase # 05- Cone oS 027016-AXXX-BC
cument Pa
i lh vi
Document Filed Date
May 03, 2024
Case Filing Date
May 03, 2024
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IN THE CIRCUIT/COUNTY COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT IN AND FOR BREVARD COUNTY, FLORIDA STATE OF FLORIDA vs. CASE NO, 05-2024-CF-027016-AXXX-BC TENNILLE M COLLINS: Defendant/Minor Child y APPLICATION FOR CRIMINAL INDIGENT STATUS | AM SEEKING THE APPOINTMENT OF THE PUBLIC DEFENDER OR | HAVE A PRIVATE ATTORNEY OR AM SELF-REPRESENTED AND SEEK DETERMINATION OF INDIGENCE STATUS FOR COSTS Ne i A nt 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 behalfof the person for whom you are making this application. There is a $50.00 fee for each application filed. If the application fee is not paid to the Clerk of the Court within 7 days, it will be added to any costs that may be assessed against you at the conclusion of this case. If you are a parent/guardian making this affidavit on behalf of a minor child or tax-dependent adult, the informatis ontained in this application must include your income and assets. fe children not living at home and do not include a working spouse or yourself.) 2. I have dependents. (Do n ot Ihave take home income of $. Ee paid () weekly () biweekly ()semi-monthly ( )monthly ( ) yearly (Take home income equals salary, wages, bonuses, commissions, allowances, overtime, tips and similar payments minus deductions required by law and other court ordered support payments.) Ihave other income paid () weekly () bi-weekly () semi-monthly (.) monthly () yearly (Circle "Yes" and fill in the amount if you have this id of itcome, otherwise circle "No.") Social Security benefits Yes $ Veterans’ benefit... Yes $ No Unemployment compensation Yes $ No Child support or other regular support Union funds. Yes $ —_f— No from family members/spouse. Yes $ No Worker's compensation Yes $ —_}|— No Rental Income. Yes $ No Retirement/pensions Yes $ No Dividends or interest. Yes $ No Trusts or gifts. Yes $ No Other kinds of incom Yes $ No | have other assets: (Circle “Yes” and fill in the woperty, otherwise circle "No.") Cash... Yes $. Savings. Yes $ No Bank account(s) Yes $ ) Stocks/bonds.. Yes $ No Certificates of deposit or * Equity in homestead real estate Yes $ No money market accounts. Yes $. No Equity in non-homestead real esta! Yes $ No * Equity in motor vehicle: Yes $__{ No * Equity in boats/other tangible property... Yes $__| No Include expectancy of an interest in such property have a total amount of liabilities and debts in th Ireceive: (Circle "Yes" or "No.") amount oj go FILED IN OPEN COURT This 3rd day of May, Temporary Assistance for Needy Families-Cash Assistance. Yes No Poverty-related veterans’ benefits... . Yes No 20 24, at M. ‘Supplemental Security Income (SSI)... Yes No oy be. OF eek. | have been released on bail in the amount of $ “ ) Cash () rety Posted by: () Self () Family ( ) Other IN A person who knowingly provides false information to the Clerk or the Court in seeking a defermination of indigent status under §. 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. Signed this 3rd day of May, 20 24 << Print full legal name: TENNILLE M COLLINS Signature of a fcant for indigent status Address: Year of Birth: 1977 City, State, ip: 8660 Phone number: Tast four digits of Driver's License or 1D Number E-mail Address: — EE SS SS EE oO LO I" 0 0a CLERK'S DETERMINATION HE. jased on the information in this Application, | have determined the applicant to be (“TTndigent (_) Not Indigent aa he Public Defender is hereby appointed to the case listed above until relieved by the Court. Dated this 3rd day of May, 20 24 Deputy Clerk for Rachel M. Sadoff, Clerk of Courts This form was compieted with the assistance of Clerk/Deputy Clerk/Other authorized person. 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. LAW 921 / 20190212 Original - File [ ] Defendant / Parent [ ] Regional Counsel or Public Defender pase # 05- Cone oS 027016-AXXX-BC cument Pa i lh vi