Supreme Court of Missouri
en banc
September 19, 2016
(Note: By order dated December 14, 2016, this order was corrected.)
In re: MODEL LOCAL RULE 69.01 - DETERMINING INDIGENT STATUS IN MUNICIPAL DIVISION CASES
ORDER
1. The Court hereby approves for distribution the following model local rule:-
69.01 DETERMINATION OF INDIGENT STATUS
(a) A person seeking permission to proceed as an indigent in a municipal division case shall submit to the court the following “Statement of Financial Condition.”
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STATEMENT OF FINANCIAL CONDITION
Name: __________________________ Case Number: ____________________
Address: __________________________________________________________
Your Age and Date of Birth: __________________________________________
Phone Number: _______________ (Is it OK to text you at this number? Yes/No)
1) If you plead guilty or are found guilty, can you pay your fines and costs
today? Yes/No
If you answered “No,” why not? _______________________________________
__________________________________________________________________
__________________________________________________________________
If you answered “No” to Question #1, or if you want the court to consider your
financial situation, please answer the following questions and provide the
following information:
2) Are you currently in the custody of the Children’s Division or DYS? Yes/No
3) Have you spent a night in jail during the past year because you were unable to
post a bond?
Yes/No If “Yes,” how much was your bond? $________________
4) Are you receiving public assistance? Yes/No If “Yes,” please tell us what
type of public assistance you are receiving (for example, food stamps, TANF,
Medicaid, housing assistance, other types of public assistance): ______________
__________________________________________________________________
__________________________________________________________________
5) Please list the following income from the previous month for your entire
household:
Take home pay for the month including overtime and bonuses: __________
Social security income (including social security disability): __________
Workers’ compensation income: __________
Unemployment income: __________
Retirement income: __________
All other income: __________
Total: __________
6) How many people live in your household? __________
7) Do you have cash, bank accounts, or any other assets, including vehicles or real
estate free of debt, that totals more than $5,000? Yes/No If “Yes,” what type?
__________________________________________________________________
__________________________________________________________________
If you are facing the possibility of jail time and cannot afford to hire a lawyer,
you are entitled to have a lawyer appointed by the court to represent you.
Do you want a lawyer to represent you in this case? Yes/No
Can you afford to hire a lawyer to represent you in this case? Yes/No
Are you asking the court to give you some more time to hire a lawyer? Yes/No
Are you asking the court to appoint a lawyer for you today? Yes/No
The above information is true and correct to the best of my knowledge under
penalty of law.
_____________________________
Applicant
[The above form is for the Judge’s use and does not replace the Legal Aid Application.]
(b) A person is presumed indigent if the person:
(1) Is in the custody of the Children’s Division or the Division of
(2)(A) Has unencumbered assets totaling under $5,000, and
(B) Has total household monthly income below 125% of Federal Poverty Guidelines, which currently are:
1 household person: $1,237
2 household persons: $1,668
3 household persons: $2,100
4 household persons: $2,531
5 household persons: $2,962
6 household persons: $2,715
7 household persons: $3,393
8 household persons: $4,258
[Add $433 for each additional person]
3. It is ordered that notice of this order be published in the Journal of the Missouri Bar.
4. It is ordered that this order be published in the South Western Reporter.
Day – to – Day
________________________________
PATRICIA BRECKENRIDGE
Chief Justice