On December 23, 2019 a
Statement of Inability to Afford Pmt of Court Costs - Party: Williams, Taylor Dane
was filed
involving a dispute between
Williams, Taylor Dane ,
and
for Divorce with Children
in the District Court of Denton County.
Preview
NOTICE: THIS DOCUMENT CONTAINS SENSITIVE DATA
Cause Number: f6&2” //gj%”§é fl
Plaintiff:
T J
WV E7 Wsfii A- Disfrict Court
D County Court /
w:
Co‘unty Qqufft at
D Ju ticeCourt
‘“
Wmfiém D W g; Y) Texa
.‘Z
Statement of Inability to Afford Payment of
Court Costs or an Appeal Bond
1. Your Informatiq‘gy.
My legal
full name is. é
&M
Q? mm W” liflmgMy @3/_
date of birth'Is: [a IEQQ
My addressis: §§6® 6 maiC’Hq SimvmED? ®€nmm law ”7b”?
“MW w am; Pt Pagw waéhmai-on @430;
My phone number: @340" gfl 5497M email. ‘E’flfl/fl§OVbM0 fiqmfij! fiflm
About my dependents: “The people who depend on me financially are listed below.
”m“!
-.
MMaw
-
,
€Ai駧iW%
‘
Om-POONA
2.
'
Are you represented by Legal Aid?
|am being represented in thiscase for free by an attorney who works for a legal aid provider or who
received my case through a legal aid provider.l have attached the certificate thelegal aid provider
gave me as ‘Exhibit:Legal Aid Certificate.
-0"-
lasked a legaI—aid provider to represent me, and the provider determined that I am financially eligible
for representation, but the provider could not take my case. I have attached documentation from
legal aid stating this.
or-
W 3.
am
Do you
not represented by legal aid.
receive public benefits?
Idid not apply for representation by legal aid.
”do not receive needs-based public benefits. -or -
H | receive these public benefits/government entitlements that are based on indigency:
L
L
H h
"L
Food stamps/SNAP TANF Medicaid _ CHIP SSI r
»
WIC VAABD
Public Housing or Section 8 Housing Low-Income Energy Assistance ,
Emergency Assistance
1 "
_
Telephone Lifeline , Community Care via DADS f LIS inMedicare (“Extra Help”)
Needs—based VA Pension
',
Child Care Assistance under Child Care and Development Block Grant
County Assistance, County Health Care, or General Assistance (GA)
Other:
© Form Approved by the Supreme Court of Texas by order
inMisc. Docket No. 16—9122
‘
Statement of Inability to Afford Payment 0f Court Costs Page 1 of 2
4.What isyour monthly income and income sources?
SW”
“I
et this onthl income:
$ lglgg in m:nthly wages. |work as a PMWPW‘egSIDMfor I9 D
§ in monthly unemployment. |have been unemployed since
§ inpublic benefits per month.
§ from oth people in my household each month: M,
'
etirement/Pension F 3
Tips, bonuses EMS Disability Workers Comp
,,,,,
Social Security MilitaryHousing z aDividends, interest, royalties
3Child/spousal support
i
My spouse’ s income or income from another member of my household {$2
$ from otherjobs/sources of income. {5i} v»;
3
$ laqq ismy totalmonthly income.
5.What isthe value of your property? 6.What are your monthly expenses?
“My property includes: Value* “My monthly expenses are: Amount
Cash $ Rent/house payments/maintenance $
Bank accounts, other financial assets Food and household supplies $ 2 l 5
$ and telephone
Utilities $ fig Z
$ Clothing and laundry $
$ Medical and dental expenses $ fig
Vehicles (cars, boats) (v9 Insurance health, auto, etc.)
(life, $
20' l TU 01/42 $ ”.000
I
School and child care $
play $ Transportation, auto repair, gas
$32 0
$ Child / spousal support $
Other property (like jewelry,stocks, land, Wages withheld by court order
another house, etc.) $
$ Debt payments paid to: ,9, $
$ $
$ $
Total value of property a$
‘
7. Are there debts or other facts explaining your financial situation?
“My debtsinclude: w SGhODI financial [OMS (/0, 0003 ’
hilolrm medtoaJ 005+ '.(’5oo w)
5 Check here Ifyou attach another page.
8. Declaration
Ideclare under penalty of perjury that the foregoing is true and correct.|further swear:
§
Judge
McFarling, Bruce
Track Judge’s New Case
Document Filed Date
December 23, 2019
Case Filing Date
December 23, 2019
Category
Divorce with Children
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NOTICE: THIS DOCUMENT CONTAINS SENSITIVE DATA Cause Number: f6&2” //gj%”§é fl Plaintiff: T J WV E7 Wsfii A- Disfrict Court D County Court / w: Co‘unty Qqufft at D Ju ticeCourt ‘“ Wmfiém D W g; Y) Texa .‘Z Statement of Inability to Afford Payment of Court Costs or an Appeal Bond 1. Your Informatiq‘gy. My legal full name is. é &M Q? mm W” liflmgMy @3/_ date of birth'Is: [a IEQQ My addressis: §§6® 6 maiC’Hq SimvmED? ®€nmm law ”7b”? “MW w am; Pt Pagw waéhmai-on @430; My phone number: @340" gfl 5497M email. ‘E’flfl/fl§OVbM0 fiqmfij! fiflm About my dependents: “The people who depend on me financially are listed below. ”m“! -. MMaw - , €Ai駧iW% ‘ Om-POONA 2. ' Are you represented by Legal Aid? |am being represented in thiscase for free by an attorney who works for a legal aid provider or who received my case through a legal aid provider.l have attached the certificate thelegal aid provider gave me as ‘Exhibit:Legal Aid Certificate. -0"- lasked a legaI—aid provider to represent me, and the provider determined that I am financially eligible for representation, but the provider could not take my case. I have attached documentation from legal aid stating this. or- W 3. am Do you not represented by legal aid. receive public benefits? Idid not apply for representation by legal aid. ”do not receive needs-based public benefits. -or - H | receive these public benefits/government entitlements that are based on indigency: L L H h "L Food stamps/SNAP TANF Medicaid _ CHIP SSI r » WIC VAABD Public Housing or Section 8 Housing Low-Income Energy Assistance , Emergency Assistance 1 " _ Telephone Lifeline , Community Care via DADS f LIS inMedicare (“Extra Help”) Needs—based VA Pension ', Child Care Assistance under Child Care and Development Block Grant County Assistance, County Health Care, or General Assistance (GA) Other: © Form Approved by the Supreme Court of Texas by order inMisc. Docket No. 16—9122 ‘ Statement of Inability to Afford Payment 0f Court Costs Page 1 of 2 4.What isyour monthly income and income sources? SW” “I et this onthl income: $ lglgg in m:nthly wages. |work as a PMWPW‘egSIDMfor I9 D § in monthly unemployment. |have been unemployed since § inpublic benefits per month. § from oth people in my household each month: M, ' etirement/Pension F 3 Tips, bonuses EMS Disability Workers Comp ,,,,, Social Security MilitaryHousing z aDividends, interest, royalties 3Child/spousal support i My spouse’ s income or income from another member of my household {$2 $ from otherjobs/sources of income. {5i} v»; 3 $ laqq ismy totalmonthly income. 5.What isthe value of your property? 6.What are your monthly expenses? “My property includes: Value* “My monthly expenses are: Amount Cash $ Rent/house payments/maintenance $ Bank accounts, other financial assets Food and household supplies $ 2 l 5 $ and telephone Utilities $ fig Z $ Clothing and laundry $ $ Medical and dental expenses $ fig Vehicles (cars, boats) (v9 Insurance health, auto, etc.) (life, $ 20' l TU 01/42 $ ”.000 I School and child care $ play $ Transportation, auto repair, gas $32 0 $ Child / spousal support $ Other property (like jewelry,stocks, land, Wages withheld by court order another house, etc.) $ $ Debt payments paid to: ,9, $ $ $ $ $ Total value of property a$ ‘ 7. Are there debts or other facts explaining your financial situation? “My debtsinclude: w SGhODI financial [OMS (/0, 0003 ’ hilolrm medtoaJ 005+ '.(’5oo w) 5 Check here Ifyou attach another page. 8. Declaration Ideclare under penalty of perjury that the foregoing is true and correct.|further swear: §