Section 7 - Contracts for Indigent Representation
In addition and as an alternative to the procedures for appointment and compensation of court-appointed counsel for services described above, the director is authorized to enter into agreements with attorneys, law firms, or associations of attorneys to provide legal services for a fee to indigent persons in emergency involuntary judicial hospitalization actions brought pursuant to Tenn. Code Ann. Title 33, Chapter 6, Part 4. Such contracts may establish a fixed fee for representation in a specified number and type of cases; provided, however, that any such fixed fee shall not exceed the rates specified in Section 2.
Attorneys providing legal services pursuant to contracts entered into pursuant to this Section shall be appointed to represent all indigent defendants in these cases unless such representation is otherwise prohibited by the Rules of Professional Conduct. See Tenn. Sup. Ct. R. 8. In any such case, the court shall appoint qualified counsel pursuant to the provisions of Section 1 of this rule.
The director shall prescribe adequate procedures to ensure compliance with the terms of such contacts and shall report to the Court annually on the effectiveness of the contract process for the provision of indigent representation.
[As adopted by order filed June 1, 2004, effective July 1, 2004; and amended by order filed September 2, 2004; by order filed September 2, 2005, effective October 1, 2005; by order filed June 12, 2006, effective June 12, 2006; by order filed February 27, 2008, effective February 27, 2008; by order filed October 9, 2008, effective July 1, 2008; by order filed July 13, 2011; effective July 13, 2011; by order filed July 27, 2012, effective July 1, 2012; by order filed February 6, 2013, effective July 1, 2013; by order filed February 20, 2013; effective April 1, 2013; by order filed March 5, 2013; by order filed September 4, 2013; effective January 1, 2014; by order filed September 19, 2013, effective January 1, 2014; by order dated November 19, 2014; effective January 1, 2015; by order filed June 29, 2018 effective July 1, 2018; and by order substituting appendix filed on June 29, 2018.]
IN THE _________ COURT FOR _________ COUNTY
STATE OF TENNESSEE Case No _________
vs.
_____________
Defendant
UNIFORM AFFIDAVIT OF INDIGENCY
Comes the defendant and, subject to the penalty of perjury, makes oath to the following facts (please list, circle, complete, etc.): PART I
1. Full Name:_____________
2. Social Security No.:____________
3. Any other names ever used:_______
4. Address:_____________
5. Telephone Nos.: (Home) ________ (Work) ________ (Other)____
6. Are you working anywhere? Yes ( ) No ( ) Where_______________
7. How much do you make?___ (weekly, monthly, etc.) 8. Birthdate:__
9. Do you receive any governmental assistance or pensions (disability, SSI, AFDC, etc.)? Yes ( ) No ( ) What is its value? _____________ (weekly, monthly, etc.)
10. Do you own any property (house, car, bank acct., etc.): Yes ( ) No ( ) What is its value? _____________________
11. Are you, or your family, going to be able to post your bond? Yes ( ) No ( )
12. Are you, or your family, going to hire a private attorney? Yes ( ) No ( )
13. Are you now in custody? Yes ( ) No ( ) If so, how long have you been in custody? _____________________
(If the defendant is in custody, unable to make bond and the answers to questions one (1) through eleven (11) make it clear that the defendant has no resources to hire a private attorney, skip Part II and complete Part III. If Part II is to be completed, do not list items already listed in Part I.)PART II
14. Names & ages of all dependents:
__________ relationship _____________________
__________ relationship _____________________
__________ relationship _____________________
15. I have met with following lawyer(s), have attempted to hire said lawyer(s) to represent me, and have been unable to do so:
Name ___________________ _____________________
Address __________________ _____________________
16. All my income from all sources (including, but not limited to wages, interest, gifts, AFDC, SSI, social security, retirement, disability, pension, unemployment, alimony, worker's compensation, etc.):
$ _________ per _____________ from _____________________
$ _________ per _____________ from _____________________
$ _________ per _____________ from _____________________
17. All money available to me from any source:
A. Cash _____________________
B. Checking, Saving, or CD Account(s)-give bank, acct. no., balance __________________________________________
C. Debts owed me _____________________
D. Credit Card(s)-give acct. no., balance, credit limit, and type (Visa, Mastercard, American Express, etc.)___________________
E. Other _____________________
18. All vehicles/vessels owned by me, solely or jointly, within the last six months (including but not limited to cars, trucks, motorcycles, farm equip., boats etc.):
_________ value $ _________ amt. owed _________________
_________ value $ _________ amt. owed _________________
_________ value $ _________ amt. owed _________________
19. All real estate owned by me, solely or jointly, within the last six months (including land, lots, houses, mobile homes, etc.):
_____________ value $ _____ amt. owed _________________
_____________ value $ _____ amt. owed _________________
20. All assets or property not already listed owned within the last six months or expected in the future:
_____________ value $ _________ amt. owed _________________
_____________ value $ _________ amt. owed _________________
21. The last income tax return I filed was for the year ___ and it reflected a net income of
$ _________.
I will file a copy of same within one week if required.
22. I am out of jail on bond of $ _________ made by _____________. The money to make bond, $ _____ was paid by _____________________.
PART III
23. Acknowledging that I am still under oath, I certify that I have listed in Parts I and II all assets in which I hold or expect to hold any legal or equitable interest.
24. I am financially unable to obtain the assistance of a lawyer and request the court to appoint a lawyer for me.
25. I understand that it is a Class A misdemeanor for which I can be sentenced to jail for up to 11 months 29 days or be fined up to $2500.00 or both if I intentionally or knowingly misrepresent, falsify, or withhold any information required in this affidavit. I also understand that I may be required by the Court to produce other information in support of my request for an attorney.
This ______ day of _________, _____. _____________________
Defendant
Sworn to and Subscribed before me this ___ day of ______, _____.
________________ _____________________
Clerk Judge