NOTE: If you are applying for Indigent Defense Services, you may be charged with an application fee.
The courthouse is accessible to those with disabilities - will you require assistance?
Are you receiving welfare or participating in another government based income maintenance program? *
225 N. Clinton Avenue
Trenton, NJ 08607
609-989-3302
www.trentonnj.org
- Certification
- Defendant
- Case Information
- Income
- Assets
- Expenses
- Attorney
- Attachments
Certification
Signature of Witness *
Authorization
I authorize the court or the administrative office of the courts to conduct such investigation as may be necessary to verify my financial status,
which may include but may not be limited to a review of my credit history, state and/or federal income tax returns, wage records, bank accounts and other financial institution records.
I also understand that I may be charged an application fee when applying for Indigent Defense Services.
I certify that the foregoing statements made by me are true. I am aware and understand that if any of the foregoing statements made by me are wilfully false, i am subject to punishment.
Certification Signature *
Witness's Title or Position *
Authorization Signature *
Total Monthly Amount Contributed
Income
Pay Period
Does anyone contribute to the payment of your expenses?
By Court Order?
Total Monthly Amount Received
Monthly Gross Income
Do not account for any deduction of taxes, insurance, etc., or pre-tax deductions, such as pension or 401k contributions
Other Income Received Monthly (for example: welfare , social security, unemployment compensation, worker's camp, disability pension)
Total Monthly Income - All Sources
Gross Wages - Before All Deductions
If "Yes", who?
Do you receive alimony or child support? *
You may attach documents relevant to this request, such as proof of residency, income and job status, or other court-related matters
Attachments