Case Title: In Re: Approval of Application For Determination of Indigent Status Form For Use By Clerks And Amendment To Florida Rule of Criminal Procedure 3.984

Citation: 

Docket Number: SC08-2176

State: florida

Court: Florida Supreme Court

Date: 2009-03-19T00:00:00Z

Document:
Supreme Court of Florida 
 
 
____________ 
 
No. SC08-2176 
____________ 
 
 
IN RE: APPROVAL OF APPLICATION FOR DETERMINATION OF 
INDIGENT STATUS FORM FOR USE BY CLERKS AND AMENDMENT 
TO FLORIDA RULE OF CRIMINAL PROCEDURE 3.984. 
 
[March 19, 2009] 
 
PER CURIAM. 
 
The Florida Clerks of Court Operations Corporation has submitted for the 
Court’s approval a revised Application for Criminal Indigent Status form.  We 
have jurisdiction.  Art. V, §§ 2(a), 15, Fla. Const; R. Regulating Fla. Bar 10-2.1(a).   
 
Sections 27.52 and 57.082, Florida Statutes (2008), require a person seeking 
to be declared indigent in a criminal or civil proceeding to apply to the clerk of 
court for determination of indigent status using an application form “developed by 
the Florida Clerks of Court Operations Corporation with final approval by the 
Supreme Court.”  § 27.52(1), Fla. Stat. (2008); § 57.082(1), Fla. Stat. (2008).  In 
accordance with these statutes, the Court previously approved an Application for 
Determination of Civil Indigent Status form and an Application for Criminal 
Indigent Status form for use by the clerks of court.  See In re Approval of 
 
 
Application for Determination of Indigent Status Forms for Use by Clerks, 910 So. 
2d 194 (Fla. 2005);  see also In re Approval of Application for Determination of 
Indigent Status Forms for Use by Clerks and Amendment to Florida Rule of 
Criminal Procedure 3.984, 969 So. 2d 285 (Fla. 2007) (approving revisions to 
Application for Determination of Civil Indigent Status).  The Court also deleted the 
language of then existing Florida Rule of Criminal Procedure 3.984, Affidavit of 
Indigent Status, and replaced it with the language of the Application for Criminal 
Indigent Status.  See  In re Approval of Application for Determination of Indigent 
Status Forms, 910 So. 2d at 195.  
 
Due to a recent legislative change, the Clerks Corporation has revised the 
“Notice to Applicant” portion of the Application for Criminal Indigent Status form 
to reflect an application fee of $50.00, rather than a $40.00.  See ch. 2008-111, § 4, 
Laws of Fla. (amending § 27.52 (1)(b), Fla. Stat. (2007)).   
We approve the revised form as set forth in the appendix to this opinion.1  
To incorporate the revision to the form, we also amend Florida Rule of Criminal 
Procedure 3.984, Application for Criminal Indigent Status, by replacing the body 
                                          
 
 
1.  As we did with the original form developed by the Clerks Corporation, 
we approve the revised form pursuant to rule 10-2.1(a) of the Rules Regulating the 
Florida Bar, which allows nonlawyers to assist in the completion of legal forms 
approved by this Court.  However, only clerks of court and third parties with 
whom the clerk has contracted to perform functions assigned by the clerk are 
authorized to assist individuals in completion of the approved form.  See § 
27.52(1)(e)(1), Fla. Stat. (2008).   
- 2 - 
 
- 3 - 
 
                                          
of rule 3.984 with the revised form. 2  The amendment shall be effective 
immediately. 
It is so ordered. 
QUINCE, C.J., and PARIENTE, LEWIS, CANADY, POLSTON, and 
LABARGA, JJ., concur. 
 
NOT FINAL UNTIL TIME EXPIRES TO FILE REHEARING MOTION, AND 
IF FILED, DETERMINED. 
 
Original Proceeding – Florida Rule of Criminal Procedure 
 
Judge Thomas H. Bateman, III, Chair, Criminal Procedure Rules Committee, 
Tallahassee, Florida, and John D. Dew, Executive Director, Florida Clerks of 
Court Operations Corporation, Tallahassee, Florida, 
 
 
for Petitioner 
 
 
 
 
 
2.  We amend rule 3.984 pursuant to Florida Rule of Judicial Administration 
2.140(d).   
 
 
APPENDIX  
 
IN THE CIRCUIT/COUNTY COURT OF THE ____________________ JUDICIAL CIRCUIT 
IN AND FOR   _________________  COUNTY, FLORIDA 
 
STATE OF FLORIDA    vs.                 
 
 
 
 
 
         CASE NO.______________________________________ 
______________________________________  
 
Defendant/Minor Child    
APPLICATION FOR CRIMINAL INDIGENT STATUS  
 
____ I AM SEEKING THE APPOINTMENT OF THE PUBLIC DEFENDER           
 
 
 
OR 
____ I HAVE A PRIVATE ATTORNEY OR AM SELF-REPRESENTED AND SEEK DETERMINATION OF INDIGENCE STATUS FOR COSTS  
 
 
 
 
 
 
 
 
 
 
    
Notice to Applicant:  The provision of a public defender/court appointed lawyer and costs/due process services are not free.  A judgment and lien may be imposed against all real or 
personal property you own to pay for legal and other services provided on your behalf or on behalf of the person for whom you are making this application.  There is a $50.00 fee for each 
application filed.  
If the application fee is not paid to the Clerk of the Court within 7 days, it will be added to any costs that may be assessed against you at the conclusion of this case.  If you are a 
parent/guardian making this affidavit on behalf of a minor or tax-dependent adult, the information contained in this application must include your income and assets.  
 
1.    I have ______dependents. (Do not include children not living at home and do not include a working spouse or yourself.) 
 
2.    I have a take home income of $_______________    paid   ( ) weekly   ( ) bi-weekly   (  ) semi-monthly   ( ) monthly ( ) yearly 
(Take home income equals salary, wages, bonuses, commissions, allowances, overtime, tips and similar payments, minus deductions required by law and other court ordered                               
support payments) 
 
3.    I have other income paid ( ) weekly ( ) bi-weekly (  ) semi-monthly ( ) monthly ( ) yearly:  (Circle “Yes” and fill in the amount if you have this kind of income, otherwise circle “No”.) 
              
Social Security benefits…………………….. Yes  $_________________ 
No                   Veterans’ benefit……………………….... Yes  $_________________ 
No 
 
Unemployment compensation…………….. Yes  $_________________ 
No                   Child support or other regular support 
Union Funds…………………………………. Yes  $_________________ 
No                    
 from family members/spouse……… Yes  $_________________ 
No 
Workers compensation…………………….. Yes  $_________________ 
No                    Rental income…………………………… Yes  $_________________ 
No
 
Retirement/pensions………………..……… Yes  $_________________ 
No                    Dividends or interest…………………….. Yes  $_________________ 
No 
 
Trusts or gifts……………………………....... Yes  $_________________ 
No                    Other kinds of income not on the list……Yes  $_________________ 
No 
 
4.    I have other assets:  (Circle “yes” and fill in the value of the property, otherwise circle “No.”)  
 
 
 
 
      
Cash…………………………………………. Yes  $_________________ 
No             Savings………………………………………… Yes  $_________________ 
No 
 
Bank account(s)…………………………….. Yes  $_________________ 
No             Stocks/bonds………………………………….. Yes  $_________________ 
No 
 
Certificates of deposit or  
            
 
 *Equity in Real estate (excluding homestead)  
Yes  $_________________ 
No 
 
 
money market accounts…………….. Yes  $_________________ 
No 
 *include expectancy of an interest in such property 
 
*Equity in Motor vehicles/Boats/…………… Yes  $_________________ 
No 
 
 
Other tangible property 
 
5.  I have a total amount of liabilities and debts in the amount of  $___________________,.  
 
6.   I receive:  (Circle “Yes” or “No.”)  
 
 
 
 
 
 
 
 
 
Temporary Assistance for Needy Families-Cash Assistance…………………………………………………………………………………..………….…. 
Yes 
No 
Poverty- related veterans’ benefits………………………………………………………………………………………………………………………..…….. 
Yes 
No 
Supplemental Security Income (SSI)………………………………………………………………………………………………………………………….…. 
Yes 
No 
 
7.   I have been released on bail in the amount of $________________.      Cash _____ Surety _____ 
      Posted by:  Self  _____    Family  _____      Other   ______   
 
A person who knowingly provides false information to the clerk or the court in seeking a determination of indigent status under s. 27.52, F.S. commits a misdemeanor of the first degree, 
punishable as provided in s. 775.082, F.S. or s. 775.083, F.S.  I attest that the information I have provided on this Application is true and accurate to the best of my 
knowledge. 
 
Signed this _______ day of _________, 20_____. 
 
 
 
 
 
 
                                  ____________________________________________________________ 
Date of Birth  ______________________  
 
                 Signature of applicant for indigent status 
 
Driver’s license or ID number______________________________ 
Print full legal name   ___________________________________________ 
 
 
 
 
 
 
 
Address 
 
___________________________________________ 
 
 
 
 
 
 
 
City, State, Zip 
___________________________________________ 
 
 
 
 
 
 
 
Phone number 
___________________________________________ 
 
 
CLERK’S DETERMINATION 
 
_______Based on the information in this Application, I have determined the applicant to be (   ) Indigent  (  ) Not Indigent 
 
_______The Public Defender is hereby appointed to the case listed above until relieved by the Court. 
 
Dated this __________________ day of ________________, 20 _____________. 
 
 
 
 
 
 
 
 
 
___________________________________________ 
 
 
 
 
 
 
 
 
 
Clerk of the Circuit Court 
 
Rev. 02/08 
 
Developed by the Clerks of Court Operations Corporation 
 
 
This form was completed with the assistance of  
 
 
___________________________________________ 
 
 
 
 
 
 
 
Clerk/Deputy Clerk/Other authorized person 
 
APPLICANTS FOUND NOT INDIGENT MAY SEEK REVIEW BY ASKING FOR A HEARING TIME.  Sign here if you want the judge to review the clerk’s 
decision of not indigent.  __________________________________________________________________________