San Luis Obispo — Financial Declaration

Source: https://www.slo.courts.ca.gov/system/files/financial-declaration.pdf

Sparse pages use OCR; original PDF remains authoritative.

Superior Court of California, County of San Luis Obispo FOR COURT USE ONLY San Luis Obispo Branch, County Government Center, 1050 Monterey Street, Room 220, San Luis Obispo, CA 93408 Grover Beach Branch, 214 South 16th Street, Grover Beach, CA 93433 OOO Paso Robles Branch, 549 10th Street, Paso Robles, CA 93446 THE PEOPLE OF THE STATE OF CALIFORNIA Plaintiff, vs. Defendant. CASE NUMBER FINANCIAL DECLARATION NAME (PLEASE PRINT) ___ AGE: SOCIAL SECURITY NO. ADDRESS: STREET CITY, STATE ZIP TELEPHONE NUMBER: (work) DATE OF BIRTH: 1AM CHARGED WITH 1AM SINGLE ____ MARRIED SEPARATED ___ DIVORCED COMMON LAW (HAVE DEPENDENTS WHOM | SUPPORT. 1AM NOT EMPLOYED 1AM EMPLOYED BY SINCE OCCUPATION MY TAKE HOME PAY IS $ PER MONTH-WEEK. MY SPOUSE IS NOT EMPLOYED . MY SPOUSE IS EMPLOYED BY SINCE OCCUPATION AND TAKES HOME $ PER MONTH-WEEK. 1AM A FULL TIME PART TIME STUDENT AT 1AM NOT A STUDENT

| RECEIVE: WELFARE UNEMPLOYMENT IN THE AMOUNT OF $ PER MONTH.

IN ADDITION TO THE ABOVE | RECEIVE OTHER FINANCIAL AID IN THE AMOUNT OF $ PER MONTH FROM

| HAVE $ CASH ON HAND OR IN THE BANK. | OWN REAL ESTATE LOCATED AT

WHICH IS VALUED AT $ AND | OWE $ TO

| OWN THE FOLLOWING PERSONAL PROPERTY (LIST ALL MOTOR VEHICLES, TOOLS, FURNITURE, SPORTING EQUIPMENT, JEWELRY, STOCKS

AND BONDS, ETC., STATING THE VALUE AND AMOUNT OWED): 1 WAS RELEASED ON MY OWN RECOGNIZANCE (0.R.) ON

| WAS RELEASED ON CASH BAIL BAIL BOND IN THE AMOUNT OF $

WHICH WAS PAID BY

| HAVE THE FOLLOWING MONTHLY EXPENSES:

RENT HOUSE PAYMENT UTILITIES FOOD CHILD SUPPORT OTHER

| DECLARE UNDER PENALTY OF PERJURY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT AND THAT | AM UNABLE TO EMPLOY

COUNSEL AND DESIRE THAT THE COURT APPOINT AN ATTORNEY TO REPRESENT ME. | REALIZE THAT | MAY BE REQUIRED TO REIMBURSE THE COUNTY FOR ALL OR PART OF THE COST OF SUCH LEGAL SERVICES IF 1 AM ABLE TO DO SO. DATED: SIGNATURE 2510-225 (0010)