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IN THB ~~~'~u COURT OF TNE
293264 NINETEENTH JUDICIAL CTRCUIT
IN AND FOR ~ , •
COUNTY, FLORIDA
y T~~Q~ ; CASE N0. DoC. No. Pa~¢e No.
VS ) CHARGES : C~/9~P~ ~ ~ f~
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ON
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AFFIDAVIT OF INSOI.VENCY AND LIEN
1. I have been placed under oath and make this Statament
and Affidavit under this oath.
2. I Nant and request the Public Defender ta be my La~ryer
and represent ~e in this case.
3. I have been advised and I understand that the Public
Defender cannot be.my LaWyer or represent me if I have the money or
property to hire a La~+yer.
4. I have no ptoperty such as land, houses or buildings,
autoa~obile stocks or bonds or other things of~value or money either in
my possess~on or that I can use or cause to be used to obtain~or get
the ,oney to hire a laxyer to represent ~ne in this case.
S. I an+ •aking this statament and affidavit for the purpose
of causing the Public Defender to be my La~ryer and represent me in this -
Case. .
6. I understand that the services of the Public Defeader, if ~
ha represents n~e in this case, are not free, that I Mi21 have to pay a
reasonable fee, deter~ined by the Court, for these services, or I Mill
. be obligated to pay such faes and that a Claiu or Li,en Nill be p2aced
against any property that I ~eay have neM or in the future. I Maive
any further notice of hearing xhen the Court sets this fee or of the
I~ filing of the lien. This Affidavit together with the Court Order settinR
this fee~ when filed and recorded, shall constitute a iien against all
o~ up real or personal property that I~ay have noM or in the future.
7. I have no May to Ret a lawyer unless the Public Defender
represents aie and ~ny rights vnder the I in th cas Ki~ no be
protacted,_
,
(Signed) . ~ (~~AL)
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SUBS I ED AND SMORN to be o n~e his ~ cFay,
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ORDER cc:,:, . ;:=_.f
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Based on the above Affidavit it is, ~
~ ORDERED AND ADJUDGED, that the Defendant be, and he is I
hereby declared to be insolvent Mith the meaninR of Sec. 27.52 Florida
Statutes; and it is further
~
ORDERED APID ADJUDGED~ that the office of the Public Defender
` is hereby appointed to represent the afove named Defendant thru trial
~ and any subsequent appeal.
~
DONE AND ORDE ED at
County, this day of 19~.~ "
~
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