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  • STATE OF FLORIDA vs. LITTLE, RICHARD BRIAN document preview
  • STATE OF FLORIDA vs. LITTLE, RICHARD BRIAN document preview
						
                                

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20~ 1465) Il IN THE CIRCUIT / COURT OF THE 20th JUDICIAL CIRCUIT IN AND FOR CHARLOTTE COUNTY, FLORIDA STATE OF FLORIDA vs. BOOKING NUMBER: 202005916 LITTLE, RICHARD BRIAN Affidavit igent Stat i re Form Pursuant to Rule 10-2.1 of the Rules Regulating the Florida Bar, before a nonlawyer assists a person in the completion of the Affidavit of indigent Status, the nonlawyer shall provide the person with a copy of this disclosure. A copy of the disclosure, signed by both the nonlawyer and the person, shall be given to the person to retain and the nonlawyer shall keep a copy in the person’s file. The disclosure does not act as or constitute a waiver, disclaimer, or limitation of liability. The Deputy Clerk/Pretrial Officer, whose signature appears below, will conduct a Pretrial interview and assist me with the Affidavit of Indigent Status. The Deputy Clerk/Pretrial Officer has told me and I understand that the Deputy Clerk/Pretrial Officer: e — Isnota lawyer; ¢ May not give legal advice or represent me in court; ¢ Cannot tell me what my rights or remedies are or how to testify in court; ¢ May only help me by asking me factual questions to fill in the blanks on the form; ° May also tell me how to file the form; e May only help fill out a form that has been approved by the Supreme Court of Florida. [X]_ I can read English © I cannot read English but this disclosure form was read to me by in (language), which I understand. You have been found to be _X__ INDIGENT “_NOT INDIGENT. The $50.00 application fee is to be paid to the Clerk of Court within 7 days or it will be added to any cost that may be assessed against you at the conclusion of your case. If you have been found indigent, the Public Defender will represent you. You must contact them at 350 E. Marion Avenue, Room 1099, Punta Gorda, FL (941.637.2181) if released. If you are not released, they will contact you at the jail. If found not indigent you may seek judicial review by asking for a hearing time. (Aatbi )2-|7-2030 DATE 20: : os 12/17/2020 i Signature of Applicant Date | 1 / Benjamin Westrum / 12/17/2020 : Signature of Deputy Clerk/Pretrial Services Officer Date | . | . FILED IN OPEN COURTIN THE CIRCUIT / COURT OF THE 20th JUDICIAL CIRCUIT IN AND FOR CHARLOTTE COUNTY, FLORIDA STATE OF FLORIDA vs. BOOKING NUMBER: 202005916 LITTLE, RICHARD BRIAN APPLICATION FOR CRIMINAL INDIGENT STATUS [KJ] 1AM SEEKING THE APPOINTMENT OF THE PUBLIC DEFENDER OR (0 I HAVEA 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 judgement 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. 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 the case. If you are a parent / guardian 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. Thave 0 dependants. (Do not include children not living at home and do not include a working spouse or yourself) 2. Ihave a take home income of $0.00 paid (Take home income equals salary, wages, bonuses, commissions, allowances, overtime, tips and similiar payments, minus deductions required by law and other court ordered support payments) 3. Ihave other income paid —_: (Circle "Yes" and fill in the amount if you have this kind of income, otherwise circle "No") Social Security benefits YesX $750.00 No Veterans’ benefit Yes $0.00 NoX Unemployment compensation Yes $0.00 NoX Child support or other regular support Yes $0.00 NoX Union Funds Yes $0.00 No xX _ from family members / spouse Workers compensation Yes $0.00 NoX Rental income Yes $0.00 NoX Trusts or gifts Yes $0.00 NoX _ Dividends or interest Yes $0.00 NoX Retirement / pensions Yes $0.00 NoX Other kinds of income not on the list Yes $0.00 NoX 4. Thave other assets: (Circle "yes" and fill in the of the property, otherwise circle "No") Cash Yes $0.00 NoX — Savings Yes $0.00 NoxX Bank account(s) Yes $0.00 NoX — Stocks / bonds Yes $0.00 NoX Certificate of deposit or money Yes $0.00 NoX — *Equity in homestead real estate Yes. $0.00 NoX market account(s) *Equity in non-homestead real estate *Equity in Motor vehicle(s) Yes $0.00 NoX include expectency of an interest in such Yes $0.00 NoX *Equity in boats/ other tangible Yes $0.00 Nox — Property Property 5. Thave a total amount of liabilities and debts in the amount of $0.00 6, I receive: (Circle "Yes" or “No") Temporary Assistance for Need;y Families-Cash Assistance Yes $0.00 NoX Poverty- related veterans’ benefits Yes $0.00 NoX Supplemental Security income (SSI) Yes $0.00 NoX t 7. Ihave been released on bail in the amount of $0.00 (1 Cash [] Surety Posted by: [] Self [] Family [] Other A person who knowingly provides false information to the clerk of the court in seeking a determination of indigent status under s. 27.52, F.S. commits a misdemeanor of the first degree, punishable as-provided in s, 775.082, F.S, I attest that the information provided on this Application is true and accurate, ot ied, BY. Defendant! 4 reat 2 4 Signature of Applicant for Indigent Status Print full name: Cn] Address: 27518 TIERRA DEL FUEGO CIRCLE Punta Gorda, FL, 33983 Phone: (941) 625-2459 Cell Phone: Last four digits of Driver's License or ID Number Email Address: t CLERK'S DETERMINATION ' Based on the information in the Application, I have determined the applicant to be Indigent [] Not Indigent [XJ The Public Defender is hereby appointed to the case listed above until relieved by the Court, ‘Clerk of the Cireuit Court This form was completed with the assistance of : / Benjamin Westrum/ Benjamin Westrum 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. (Audibly’Attested by Defendant! [Oigitaly signed by Aucibly Atested by Defendant Date 12/17/2020 2.2 1,27AM Dated this: December 17, 2020 | 1 1 | |