Cr-105 Superior Court Of California, County Of Street Address: Mailing Address: City And Zip

Cal. Form CR-105

California Superior Local Rules

DEFENDANT'S FINANCIAL STATEMENT ON ELIGIBILITY FOR APPOINTMENT OF COUNSEL AND RECORD ON APPEAL AT PUBLIC EXPENSE Pen. Code, § 987 www.courts.ca.gov Form Approved for Optional Use Judicial Council of California CR-105 [Rev. September 1, 2023] CR-105 SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: DEFENDANT: PEOPLE OF THE STATE OF CALIFORNIA v. FOR COURT USE ONLY DEFENDANT'S FINANCIAL STATEMENT (check all that apply) ELIGIBILITY FOR APPOINTMENT OF COUNSEL ELIGIBILITY FOR RECORD ON APPEAL AT PUBLIC EXPENSE CASE NUMBER: 1. a. Defendant's name: b.

Other names used: c. Address: d. Date of birth: e. Telephone number: f. Driver's license number: 2. Defendant's present employment a. Occupation: b. Name of employer: c. Address: d. Gross pay per month: $ week: $ day: $ e. Take-home pay per month: $ week: $ day: $ f. Name of union: g. Name of credit union: 3. If defendant is not now working, state the name and address of defendant's last employer and the last date defendant was employed. a. Name: b. Address: c. Last date of employment: 4. Defendant married.is is not 5. a. Spouse's name: b. Other names used: c. Address: d. Date of birth: e. Telephone number: f.

Driver's license number: 6. Spouse's present employment a. Occupation: b. Name of employer: c. Address: d. Gross pay per month: $ week: $ day: $ e. Take-home pay per month: $ week: $ day: $ f. Name of union: g. Name of credit union: 7. If spouse is not now working, state the name and address of spouse's last employer and the last date spouse was employed. a. Name: b. Address: c. Last date of employment: 8. Dependents Name Address Relationship Age DEFENDANT'S FINANCIAL STATEMENT ON ELIGIBILITY FOR APPOINTMENT OF COUNSEL AND RECORD ON APPEAL AT PUBLIC EXPENSE CR-105 [Rev.

September 1, 2023] CR-105 PEOPLE OF THE STATE OF CALIFORNIA v. DEFENDANT: CASE NUMBER: OTHER MONTHLY INCOME9. Defendant a. Unemployment and disability $ b. Social Security $ c. Welfare, TANF $ d. Veteran's benefits $ e. Worker's compensation $ f. Child support payments $ g. Spousal support payments $ h. All other income not elsewhere listed $ Total: $ Spouse a. Unemployment and disability $ b. Social Security $ c. Welfare, TANF $ d. Veteran's benefits $ e. Worker's compensation $ f. Child support payments $ g. Spousal support payments $ h. All other income not elsewhere listed $ Total: $ EXPENSES 10.

Monthly expenses being paid by defendant alone or by defendant and spouse a. Rent or house payments $ b. Car payments $ c. Transportation payments $ d. Medical and dental payments $ e. Loan payments $ f. Clothing and laundry $ g. Food $ h. Support payments $ i. Insurance payments $ j. Other payments (union, taxes, utilities) $ Total (a-j): $ 11. Installment payments other than those listed in item 10. Name of Creditor MonthIy Payment Balance Owed a. $ $ b. $ $ c. $ $ d. $ $ e. $ $ Total: $ Total: $ ASSETS12. What do you own? (State value): a. Cash $ b. House equity $ c.

Cars, other vehicles and boat equity (List make, year, and license number of each) $ d. Checking, savings, and credit union accounts (List name and account number of each) $ e. Other real estate equity $ f. Income tax refunds due $ g. Life insurance policies (ordinary life, face value) $ Length of ownership h. Other personal property (jewelry, furniture, furs, stocks and bonds, etc.) $ Total: $ Declaration of Defendant I declare under penalty of perjury under the laws of the state of California that the foregoing is true and correct. Date: SIGNATURE OF DEFENDANT

Document details

Collection	California Superior Local Rules
Citation	Cal. Form CR-105
Type	court_rule
Language	en
Format	pdf
Source	CA_LOCAL
Identifier	e2aa0a8f02711f46b72684386f29fdf5cc4ff821

Source file is stored in the law ingest library (pdf).