On April 20, 2018 a
DETERMINATION OF INDIGENT STATUS
was filed
involving a dispute between
Hubbard, Leah M,
Independent Services Of Vero Beach Llc,
and
E Clayton Yates Pa,
Yates, E Clayton Pa,
Yates Law Firm,
for MALPRACTICE - OTHER PROFESSIONAL
in the District Court of Indian River County.
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7
yy
zZ v
Yo “ietil Ws oe
IN THE CIRCUITICOUNTY COURT OF THE — JUDICIAL CIRCUIT 273 w
IN AND FOR SEaNCA- GOUNTY, FLORIDA g-
TSE Wry
K2a\hn Me. WA bhevel CASE NO. ————
PiaintiffiPetitioner or Ih the Interest Of 4 2 3.0
vs. x
Senn v v ”
APPLICATION FOR DI TION OF CIVIL INDIGEN is
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 fee shall not be charged for Dependency or Chapter 39 Termination of
Parental Rights actions.
4. Ihave__\___ dependents. (inci; ude only those persons you list en your U.S. Income tax return.)
Are you Married?. Yes (No\poes your Spouse Work?...Yes No Annual Spouse Income? §.
2. Ihave a net income of $. h paid weekly everytwoweeks semi-monthly monthly yearly. other
(Net income is your total income including salary, wages, bonuses, commissions, allowances, overtime, tips and similar payments,
minus deductions required by law and other court-ordered payments such as child support.)
3. | have other income paid weekly every two weeks _—semi-monthly yearly other.
(Circle “Yes” and fill in the amount if you have this kind of income, otherwise circle “No
y
For you...
For child(ren) .. Stocks/bonds.
Unemployment compensation Rental income.
Union payments .. Dividends or interest. lo}
Retirement/pensions Other kinds of income not on the list
Trusts... Gifts ..
4. | have other assets: (Circle “yes” and fill in the value of | erty, otherwise circle “No”)
Cash... $ ‘Savings account.
Bank account(s) Stocks/bonds...
Certificates of deposit or
money market accounts..
Boats*
Homestead Real Property".
Motor Vehicle”......
Non-homestead real property/real estate”
“show loans on these assets in paragraph 5
Checkone:! DO, NOT expect to receive more assets in the near future. The asset is,
5. thave total liabilities and debts of $2.99) as follows: Motor Vehicle $, Home §. Other Real
Property $. Child Support paid direct $, Credit Cards $_ Medical Bills § Cost of
medicines (monthly) §,
Other $2) Day -& Loses cae ASTS | ce SOVLVITOA Seva e CRPGA FS Gnel Wns.
~- YesQo)
6. | have a private lawyer in this case...
‘A person who knowingly provides false 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, FS. or s. 775.083, F.S. I attest that the information I have
provided on this seat is true and accurate to the best of my knowledge.
Ege. an* day of eS 20. Q te
Date of Birth river's License or ID Number,
ia nie ly R
Rey, os Cape NLD 79 3
Address, P O Address, Street, City, State, Zip Code »
60 Bap “So
tury
AeCLERK’S DETERMINATION
Based on the information in this Application, I have determined the applicant to be indigent ( ) Not Indigent, according to s.
57.082, FS. ; .
Dated this. LO. aay of Ope wtX
Clerk of the Circuit Court m2
This form was completed with the assistance of:
Clerk/Deputy Clerk/Other authorized person.
APPLICANTS FOUND NOT TO BE INDIGENT MAY SEEK REVIEW BY A JUDGE BY ASKING FOR A HEARING
THERE IS NO FEE FOR THIS REVIEW.
Sign here if you want the judge to review the clerk’s decision
Document Filed Date
April 20, 2018
Case Filing Date
April 20, 2018
Category
MALPRACTICE - OTHER PROFESSIONAL
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3] Q0\8SCOO07EB fox C)7S = 7 yy zZ v Yo “ietil Ws oe IN THE CIRCUITICOUNTY COURT OF THE — JUDICIAL CIRCUIT 273 w IN AND FOR SEaNCA- GOUNTY, FLORIDA g- TSE Wry K2a\hn Me. WA bhevel CASE NO. ———— PiaintiffiPetitioner or Ih the Interest Of 4 2 3.0 vs. x Senn v v ” APPLICATION FOR DI TION OF CIVIL INDIGEN is 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 fee shall not be charged for Dependency or Chapter 39 Termination of Parental Rights actions. 4. Ihave__\___ dependents. (inci; ude only those persons you list en your U.S. Income tax return.) Are you Married?. Yes (No\poes your Spouse Work?...Yes No Annual Spouse Income? §. 2. Ihave a net income of $. h paid weekly everytwoweeks semi-monthly monthly yearly. other (Net income is your total income including salary, wages, bonuses, commissions, allowances, overtime, tips and similar payments, minus deductions required by law and other court-ordered payments such as child support.) 3. | have other income paid weekly every two weeks _—semi-monthly yearly other. (Circle “Yes” and fill in the amount if you have this kind of income, otherwise circle “No y For you... For child(ren) .. Stocks/bonds. Unemployment compensation Rental income. Union payments .. Dividends or interest. lo} Retirement/pensions Other kinds of income not on the list Trusts... Gifts .. 4. | have other assets: (Circle “yes” and fill in the value of | erty, otherwise circle “No”) Cash... $ ‘Savings account. Bank account(s) Stocks/bonds... Certificates of deposit or money market accounts.. Boats* Homestead Real Property". Motor Vehicle”...... Non-homestead real property/real estate” “show loans on these assets in paragraph 5 Checkone:! DO, NOT expect to receive more assets in the near future. The asset is, 5. thave total liabilities and debts of $2.99) as follows: Motor Vehicle $, Home §. Other Real Property $. Child Support paid direct $, Credit Cards $_ Medical Bills § Cost of medicines (monthly) §, Other $2) Day -& Loses cae ASTS | ce SOVLVITOA Seva e CRPGA FS Gnel Wns. ~- YesQo) 6. | have a private lawyer in this case... ‘A person who knowingly provides false 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, FS. or s. 775.083, F.S. I attest that the information I have provided on this seat is true and accurate to the best of my knowledge. Ege. an* day of eS 20. Q te Date of Birth river's License or ID Number, ia nie ly R Rey, os Cape NLD 79 3 Address, P O Address, Street, City, State, Zip Code » 60 Bap “So tury AeCLERK’S DETERMINATION Based on the information in this Application, I have determined the applicant to be indigent ( ) Not Indigent, according to s. 57.082, FS. ; . Dated this. LO. aay of Ope wtX Clerk of the Circuit Court m2 This form was completed with the assistance of: Clerk/Deputy Clerk/Other authorized person. APPLICANTS FOUND NOT TO BE INDIGENT MAY SEEK REVIEW BY A JUDGE BY ASKING FOR A HEARING THERE IS NO FEE FOR THIS REVIEW. Sign here if you want the judge to review the clerk’s decision