On December 21, 2018 a Party Statement was filed involving a dispute between Valdes, Rosa H, and Anderson, Greg, Becton, Danny, Bowman, Aaron, Boyer, Lori N, City Of Tampa Bob Buckhorn, Crescumbeni, John R, Duval County City Council, Ferraro, Al, Freeman, Terrance, Gaffney, Reggie, Garrett, Dennis L, Gulliford, Bill, Hagan, Ken, Hazouri, Tommy, Hillsborough County Commissioners, Kemp, Pat, Lopez Brosche, Anna, Miller, Lesley, Morgan, Joyce, Murman, Sandra, Newby, Samuel, Overman, Kimberly, Pittman, Ju'Coby, Smith, Mariella, State Of Florida, White, Randy, White, Stacy, Wilson, Scott, for Civil in the District Court of Hillsborough County.
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IN THE CIRCUIT/COUNTY COURT OF THE THIRTEENTH JUDICIAL CIRCUIT IN AND FOR HILLSBOROUGH COUNTY FLORIDA 994 5IaintiE // V/4zQ><6< 'ctitioner chin ' nteresl.O£ cAsiNo. MIX _ ' vs. i/71 ?£}»"i/2//9° f="4 DIVISION: xx ._ée/26614 7 APPLICATION FOR DETERMINATION OF CWIL INDIGENT STATUS Notice to Applicant: If you qualify for civil indigence you must enroll in the clerk's office payment plan and pay a one-time administrative fee of $25.00. This fees hall not be charged for Dependency or Chapter 39 Termination of Parental Rights actions. 1. I have P5 dependents. (Include only those persons you list on your_U.§Income tax return.) la. Are you Married?... Yes.@- b. Does your Spouse work'?...Yes.8 EZ. Annual Spouse Income? S FV/'7 2. I have a net income of S paid (_,.)»weekly (_-)-every two weeks (~)-semi-monthly (»)»m'onthly (»-)-yearly ( )other ¢?f . (Net income is your total income including salary, wages, bonuses, commissions, allowances, overtime, tips,gqd similar payments, minus deductions required by law and other court-ordered payments such as child support.) cm li d c => I'*'l <1 3. I have other income paid ( )weekly( )every two weeks( )semi-monthly( )monthly( )yearly ( ) otherC3®/ 1\1 (Circle "Yes" and fill in the amount if you have this kind of income, otherwise circle "No") 3 --4 'U Second Job............... ....Yes$ @ Veterans' benefit ....Yesq) ¢UIo1 on Yes$_ 8 Social Security benefits Workers compensation co i n !! For You ...Yes S Income from absent family members.. 8l i 8 ...Yes$ 4539 For Child(ren). .Yes $ 9, Stocks/bonds ...Yes$ 1\¢\1l¢\nIO\¢9 IQ Unemployment compensation . .Yes $ Rental income luuocuneonauusooaona as ~Yes$ 1 1 1 1 ...Yes$ Union payments ...Yes $ Dividends or interest Retirement/pension. .Yes S Other kinds of income not on the list. .Ycs$ ...Yes$ 1\11\ \\11 ~Yes$ ou r "> I understand that I will be required to make payments for fees and costs to the clerk in accordance with §57.082(5), Florida Statutes, as provided by law, although I mad me to pad more if I choose to do so. 4. I have other assets: (Circle "yes" and fill in the vamgofthe property, otherwise circle "No") Yes S ..Yes$ 8 1 Savings account.............................. ...Yes $ a1l1uslslta Bank account(s).......... ...Yes$ _, Stocks/bonds....................... Certificates of deposit or Ycs$ Homestead Real Propend*............ \ta \\u o a money market accounts . .Yes S Motor Vehicle*............................... ...Yes S Boats* . ...Yes $ 8 Non-homestead real property/real estate*. ..Yes $ *show loans on these assets in paragraph 5 Check one: I ( ) DO ( ) DO NOT expect to receive more assets in the near future. The asset is S. I ha total liabilities and debts of $ as follows: Motor Vehicle$ Q ' jg; , Home S Other Real Property , Cost of medicine s ¢ , lSuppon paid direct s 8 ` ,Credit Cards s gg , Medici Bills s (m08Iy) s_ _, Other s 52" 6. I have a private lawyer in this case . ..Ye~ea APPLICATION FOR DETERMINATION OF CIVIL INDIGENT STATUS (Updated 07-0 l-2009) A person who knowingly provides fads information to the clerk or the court in seeking a determination of indigent status under s. 57.082, F.S. commits a misdemeanor of the first degree, punishable as provided in s. 775.082, F.S. or s. 775.083, F.S. I attest that the Information I have provided on this application is true 1; accurate to the best of y knowledge. signed this 9 I day of! '20/Y . I' S14/ , Signature of Applicant f 144 lsdigmt Status V /Z'Z ' 9 &0 V483-;z~-79844944 - 0 Print Fu1l Legal Name JSA 14é§Z6N ' 97*2>z'§T Date of Birth Driver's License or ID Number Phone Number: 8 / 3 F2 ,33¢>/ Sk Ad so ,' * " 4 " 8/ ?'é<'4. Z¥ de 993 CLERK'S DETERMINATION 3°/m fpw /1% we 335) J Based on the information in this Application, I have determined the applicant to M ! yr Qrding to s. 57.082, F.S. Dated this M* day of DM. ,20 li . Clerk of the Circuit Cool This form was completed with the assistance of: "9n0H0 Q~ ` |\\'511 D 91 | | ll Clerk/Deputygl M M Q.. 4'&=fS°»- APPLICANTS FOUND NOT TO BE INDIGENT MAY S91"41E\f 'E E GE BY ASKING FOR A HEARING TIME. / ac: : ru / THERE is No FEE Fon THIS REVIEW. .»_ o f Sign here if you want the judge to review the clerk's decision IF Q"-...,.-- * : or, J/Ii:)\A\ : '\\\\\\\" APPLICATION FOR DETERMINATION OF CIVIL INDIGENT STATUS (Updated 07-0l~2009) o o o o o o o o o o o oO o Q O I Q Q Q Q Q Q of of O eel o ee o ee 6 eel 6 ea o ee o oO ea ea ee o ee Q o w I I V' as v- O 33 D |._ I |- N N L6 N {-- ~/3 e- o E < g O q. I ml »~. Z z LIJ m W- \- 52 N >< u. ,'il low m .Q o <- 2 E V51 9 <2 ai *..| l~ Q cu E N \-1 O P- C q |- O "Kl E D Q 8 GJ o Q (D o ..- __ a> N 2 I E GJ > D N m E v- 41 I *a L; of (D *~: w U.) 3 I LU O ni c\ Z Z* a> .Q E o E o .Q E 'D C E o O m (\ 5 z <2 z of co 5- l~ ,lgLIJ u.l r- .x (D u c G)o o 'o 8C 5 LU I- Z* z o O >- O O El z E *ii < m E u. 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