Ala. R. Crim. P. 10 (2026)

State of Alabama Case Number Unified Judicial System AFFIDAVIT OF SUBSTANTIAL Form C-10 Page 1 of 2 Rev.2/95 HARDSHIP AND ORDER IN THE_______________________________________COURT OF ________________________________________, ALABAMA (Circuit, District, or Municipal) (Name of County or Municipality)

STYLE OF CASE: _____________________________________________v. ___________________________________________ Plaintiff(s) Defendant(s) TYPE OF PROCEEDING:___________________________CHARGE(s) (if applicable):__________________________________

CIVIL CASE-- I, because of substantial hardship, am unable to pay the docket fee and service fees in this case. I request that payment of these fees be waived initially and taxed as costs at the conclusion of the case. CIVIL CASE-- (such as paternity, support, termination of parental rights, dependency) – I am financially unable to hire an attorney and I request that the court appoint one for me. CRIMINAL CASE-- I am financially unable to hire an attorney and request that the court appoint one for me. DELINQUENCY/NEED OF SUPERVISION-- I am financially unable to hire an attorney and request that the court appoint one for my child/me

AFFIDAVIT SECTION 1.

1. INDENTIFICATION Full name _____________________________________________________________________ Date of Birth _________________________ Spouse’s full name (if married) ________________________________________________________________________________________ Complete home address ______________________________________________________________________________________________ __________________________________________________________________________________________________________________ Number of people living in household ____________________________________________________________________________________ Home telephone number _________________________________________________ Occupation/Job_________________________________ Length of employment __________________________________________________ Driver’s license number __________________________________ *Social Security Number_________________________________________ Employer_____________________________________________ Employer’s telephone number_____________________________________ Employer’s address __________________________________________________________________________________________________ __________________________________________________________________________________________________________________ 2. ASSISTANCE BENEFITS Do you or anyone residing in your household receive benefits from any of the following sources? (if so, please check those which apply) AFDC Food Stamps SSI Medicaid Other___________________________________________ 3. INCOME/EXPENSE STATEMENT

Monthly Gross Income: Monthly Gross Income $________________ Spouse’s Monthly Gross Income (unless a martial offense) ________________ Other Earnings: Commissions, Bonuses, Interest Income, etc, ________________ Contributions from Other People Living in Household ________________ Unemployment/Workmen’s Compensation, Social Security, Retirements, etc, ________________ Other Income (be specific) _______________________ ________________

TOTAL MONTHLY GROSS INCOME $____________________

Monthly Expenses: A. Living Expenses $________________ Rent/Mortgage ________________ Total Utilities: Gas, Electricity, Water, etc ________________ Food ________________ Clothing ________________ Health Care/Medical ________________ Insurance ________________ Car Payment(s)/Transportation Expenses ________________ Loan Payment(s) ________________

*OPTIONAL

Form C-10 Page 2 of 2 Rev.2/95 AFFIDAVIT OF SUBSTANTIAL HARDSHIP AND ORDER Monthly Expenses:(cont’d page1) Credit Card Payment(s) ________________ Educational/Employment Expenses ________________ Other Expenses (be specific) _____________________ ________________ _____________________________________________ ________________ Sub-Total A $____________________

B. Child Support Payment(s)/Alimony $________________ Sub-Total B $____________________ C. Exceptional Expenses $________________

TOTAL MONTHLY EXPENSES (add subtotals from A & B monthly only) $____________________

Total Gross Monthly Income Less total monthly expenses:

DISPOSABLE MONTHLY INCOME $____________________

4. LIQUID ASSETS: Cash on Hand/Bank (or otherwise available such as stocks, bonds, certificates of deposit) $_________________ Equity in Real Estate (value of properly less what you owe) _________________ Equity in Personal Property, etc. (such as the value of motor vehicles, stereo, VCR, furnishing, jewelry, tools, _________________ guns, less what you owe) Other (be specific) Do you own anything else of value? Yes No (land, house, boat, TV, stereo, jewelry) _________________ If so, describe _____________________________________ _________________________________________________ TOTAL LIQUID ASSETS $____________________

5. Affidavit/Request I swear or affirm that the answers are true and reflect my current financial status. I understand that a false statement or answer to any question in the affidavit may subject me to the penalties of perjury, I authorize the court or its authorized representative to obtain records of information pertaining to my financial status from any source in order to verify information provide by me. I further understand and acknowledge that, if the court appoints an attorney to represent me, the court may require me to pay all or part of the fees and expenses of my court-appointed counsel,

Sworn to and subscribed before me this ________________________________________________ Affiant’s Signature _________ day of ___________________, __________

_____________________________________________ _________________________________________________ Judge/Clerk/Notary Print or Type Name

ORDER OF COURT SECTION II IT IS THEREFORE, ORDERED, AND ADJUDGED BY THE COURT AS FOLLOWS: Affiant is not indigent and request is DENIED. Affiant is partially indigent and able to contribute monetarily toward his/her defense; therefore defendant is ordered to pay $_____________ towards the anticipated cost of appointed counsel. Said amount is to be paid to the clerk of court or as otherwise ordered and disbursed as follows: ______________________________________________________________________________ Affiant is indigent and request is GRANTED. The prepayment of docket fees is waived.

IT IS FURTHER ORDERED AND ADJUDGED that _____________________________ is hereby appointed as counsel to represent affiant. IT IS FURTHER ORDERED AND ADJUDGED that the court reserves the right and may order reimbursement of attorney’s fees and expenses, approved by the court and paid to the appointed counsel, and costs of court. Done this________________________ day of ________________________________________

________________________________________________ Judge

State of Alabama Case Number Unified Judicial System AFFIDAVIT OF SUBSTANTIAL HARDSHIP Form C-10A Page 1 of 2 Rev.2/95

IN THE_______________________________________COURT OF ________________________________________, ALABAMA (Circuit, District, or Municipal) (Name of County or Municipality)

STYLE OF CASE: _____________________________________________v. ___________________________________________ Plaintiff(s) Defendant(s) TYPE OF PROCEEDING:___________________________CHARGE(s) (if applicable):__________________________________ CIVIL CASE-- I, because of substantial hardship, am unable to pay the docket fee and service fees in this case. I request that payment of these fees be waived initially and taxed as costs at the conclusion of the case. CIVIL CASE-- (such as paternity, support, termination of parental rights, dependency) – I am financially unable to hire an attorney and I request that the court appoint one for me. CRIMINAL CASE-- I am financially unable to hire an attorney and request that the court appoint one for me. DELINQUENCY/NEED OF SUPERVISION-- I am financially unable to hire an attorney and request that the court appoint one for my child/me

AFFIDAVIT SECTION 1.

1. IDENTIFICATION Full name _____________________________________________________________________ Date of Birth _________________________ Spouse’s full name (if married) ________________________________________________________________________________________ Complete home address ______________________________________________________________________________________________ __________________________________________________________________________________________________________________ Number of people living in household ____________________________________________________________________________________ Home telephone number _________________________________________________ Occupation/Job_________________________________ Length of employment __________________________________________________ Driver’s license number __________________________________ *Social Security Number_________________________________________ Employer_____________________________________________ Employer’s telephone number_____________________________________ Employer’s address __________________________________________________________________________________________________ __________________________________________________________________________________________________________________ 2. ASSISTANCE BENEFITS Do you or anyone residing in your household receive benefits from any of the following sources? (if so, please check those which apply) AFDC Food Stamps SSI Medicaid Other___________________________________________

3. INCOME/EXPENSE STATEMENT

Monthly Gross Income: Monthly Gross Income $________________ Spouse’s Monthly Gross Income (unless a martial offense) ________________ Other Earnings: Commissions, Bonuses, Interest Income, etc, ________________ Contributions from Other People Living in Household ________________ Unemployment/Workmen’s Compensation, Social Security, Retirements, etc, ________________ Other Income (be specific) _______________________ ________________

TOTAL MONTHLY GROSS INCOME $____________________

Monthly Expenses: A. Living Expenses $________________ Rent/Mortgage ________________ Total Utilities: Gas, Electricity, Water, etc ________________ Food ________________ Clothing ________________ Health Care/Medical ________________ Insurance ________________ Car Payment(s)/Transportation Expenses ________________ Loan Payment(s) ________________ *OPTIONAL

Form C-10A Page 2 of 2 Rev.2/95 AFFIDAVIT OF SUBSTANTIAL HARDSHIP

Monthly Expenses:(cont’d page1) Credit Card Payment(s) ________________ Educational/Employment Expenses ________________ Other Expenses (be specific) _____________________ ________________ _____________________________________________ ________________ Sub-Total A $____________________

B. Child Support Payment(s)/Alimony $________________ Sub-Total B $____________________ C. Exceptional Expenses $________________

TOTAL MONTHLY EXPENSES (add subtotals from A & B monthly only) $____________________

Total Gross Monthly Income Less total monthly expenses: DISPOSABLE MONTHLY INCOME $____________________

4. LIQUID ASSETS: Cash on Hand/Bank (or otherwise available such as stocks, bonds, certificates of deposit) $_________________ Equity in Real Estate (value of properly less what you owe) _________________ Equity in Personal Property, etc. (such as the value of motor vehicles, stereo, VCR, furnishing, jewelry, tools, _________________ guns, less what you owe) Other (be specific) Do you own anything else of value? Yes No (land, house, boat, TV, stereo, jewelry) _________________ If so, describe _____________________________________ _________________________________________________ TOTAL LIQUID ASSETS $____________________

5. Affidavit/Request I swear or affirm that the answers are true and reflect my current financial status. I understand that a false statement or answer to any question in the affidavit may subject me to the penalties of perjury, I authorize the court or its authorized representative to obtain records of information pertaining to my financial status from any source in order to verify information provide by me. I further understand and acknowledge that, if the court appoints an attorney to represent me, the court may require me to pay all or part of the fees and expenses of my court-appointed counsel,

Sworn to and subscribed before me this ________________________________________________ Affiant’s Signature _________ day of ___________________, __________

_____________________________________________ _________________________________________________ Judge/Clerk/Notary Print or Type Name

State of Alabama Case Number Unified Judicial System ORDER APPOINTING Form C-10B Rev.2/95 COUNSEL (INDIGENT) IN THE___________________________________________COURT OF ______________________________________________, ALABAMA (Circuit, District, or Municipal) (Name of County or Municipality)

STYLE OF CASE: ______________________________________________v. ___________________________________________________ Plaintiff(s) Defendant STATE OF ALABAMA

Municipality of _________________________________________________ v. ________________________________________________ Defendant IN THE MATTER OF _____________________________________________________________________________, a child

IT IS, THEREFORE, ORDERED AND ADJUDGED BY THIS COURT AS FOLLOWS: Affiant is not indigent and request is DENIED. Affiant is partially indigent and able to contribute monetarily towards his defense; therefore, defendant is ordered to pay $_________________ toward the anticipated cost of appointed counsel. This amount is to be paid to the Clerk of Court or as otherwise ordered and disbursed as follows:

_____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Affiant is indigent and request is GRANTED. The prepayment of docket fees is waived.

IT IS FURTHER ORDERED AND ADJUDGED that ____________________________________________________________, is hereby appointed as counsel to represent affiant. (Name of Attorney)

IT IS FURTHER ORDERED AND ADJUDGED that the court reserves the right and may order reimbursement of attorney’s fees and expenses, approved by the court and paid to the appointed counsel, and costs of court. Done this________________________ day of ________________________________________, __________

________________________________________________ Judge