Wash. R. App. P. Form 13
See RAP 18.17 for document formatting requirements.
[Rule 15.2(c)]
SUPERIOR COURT OF WASHINGTON FOR ____________ COUNTY
[Name of Plaintiff] Plaintiff, | ) | |
) | No. [trial court] | |
v. | ) | |
) | Motion for Order | |
of Indigency- | ) | (Criminal), |
) | (Juvenile | |
) | Offense), | |
) | (Dependency), | |
) | (Termination), | |
[Name of Defendant] | ) | (Commitment), |
(Civil | ) | (Contempt), |
Defendant. | ) | (Habeas Corpus), |
) | (Appeal), | |
) | involving a | |
) | (Constitutional or | |
) | Statutory Right to | |
) | Counsel) Case | |
) |
______________________, (defendant) (respondent) (petitioner), files a notice of appeal in the above-referenced (criminal), (juvenile offense), (dependency), (termination), (commitment), (civil contempt), (habeas corpus), (appeal involving a constitutional or statutory right to counsel) case, and moves the court for an Order of Indigency authorizing the expenditure of public funds to prosecute this appeal (wholly at public expense) (partially at public expense).
(Defendant) (Respondent) (Petitioner) was found indigent by order of this court on . There has been no change in (defendant) (respondent) (petitioner)'s financial status since that time, and (defendant) (respondent) (petitioner) continues to lack sufficient funds to seek review in this case.
(Defendant) (Respondent) (Petitioner) asks the court to order the following to be provided at public expense: all filing fees; attorney fees; preparation, reproduction, and distribution of briefs; preparation of verbatim report of proceedings; and preparation of necessary clerk's papers.
The following certificate is made in support of this motion.
DATED: __________________
Signature
_________________________________________________
(Defendant) (Respondent) (Petitioner) (personal pronouns (optional))
Signature
_________________________________________________
Name of Attorney for (Defendant) (Respondent) (Petitioner)-
(personal pronouns (optional))
WSBA # _______________________
CERTIFICATE
I, __________________________________, certify as follows:
1. That I have previously been found indigent by this court.
2. That the highest level of education I have completed is:
( ) Grade School ( ) High School ( ) College or greater
3. That I have held the following jobs: ____________________
_____________________________________________________________
_____________________________________________________________
4. That I: ( ) have not received job training ( ) have received the following job training: ___________
_____________________________________________________________
_____________________________________________________________
5. That I: ( ) do not have a mental or physical disability that would affect my ability to work
( ) have the following mental or physical disability that would affect my ability to work: ___________
_____________________________________________________________
_____________________________________________________________
6. That I: ( ) do not have children or family members that normally depend on me for financial support ___________________
( ) have the following children or family member that normally depend on me for support
_____________________________________________________________
_____________________________________________________________
7. That I: ( ) do not anticipate my financial condition improving in the foreseeable future through inheritance, sale of land, or similar.
( ) anticipate my financial condition improving in the foreseeable future as follows: ____________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
I, ___________________________, certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct.
_________________
Date
_____________________________
Signature
Name of (Defendant) (Respondent) (Petitioner)
_____________________
Place
Wash. R. App. P. Form RAP 13