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Montana Administrative Register Notice 23-2-248 No. 19   10/13/2017    
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BEFORE THE DEPARTMENT OF JUSTICE

OF THE STATE OF MONTANA

 

In the matter of the amendment of ARM 23.2.301 pertaining to the affidavit of indigence and statement of inability to pay court costs and fees

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NOTICE OF PROPOSED AMENDMENT

 

NO PUBLIC HEARING CONTEMPLATED

 

TO: All Concerned Persons

 

1. The Department of Justice proposes to amend the above-stated rule.

 

2. The Department of Justice will make reasonable accommodations for persons with disabilities who wish to participate in this rulemaking process or need an alternative accessible format of this notice. If you require an accommodation, contact Department of Justice no later than 5:00 p.m. on October 27, 2017, to advise us of the nature of the accommodation that you need. Please contact J. Stuart Segrest, Department of Justice, P.O. Box 201401, Helena, Montana, 59620-1401; telephone (406) 444-2026; fax (406) 444-3549; or e-mail contactdoj@mt.gov.

 

3. The rule as proposed to be amended provides as follows: [following is the rule in its current form]

 

            23.2.301 AFFIDAVIT OF INDIGENCE

 

                                                  AFFIDAVIT OF INDIGENCE

                                                               AND ORDER

 

ANSWER ALL QUESTIONS. USE N/A IF NOT APPLICABLE

 

STATE OF MONTANA                                )

                                                                        :ss.

County of _______________________ )

 

            I, _______________________ , being first duly sworn, depose and say:  That I have a good cause of action or defense but am unable to pay the costs or get security to secure the cause of action or defense. I request the court or administrative tribunal to waive the costs and approve indigence status. I declare the following:

 

I.          PERSONAL INFORMATION

 

Name                                                                                                                                         

Address                                                                                                                                     

Telephone _______________  Birthdate ________ Age ___ SSN                          

Employed Yes ___ No ____                               Self-Employed Yes _____   No             

Employer's name & address                                                                                                  

                                                                                                                                                     

Month last employed ________________                      Job                                                    

Single _____           Married ______             Divorced ____               Separated              

Dependents?                 Spouse _________            Number of children                        

Spouse's name                                                                                                                        

Spouse's birthdate ____________ Age _______    Spouse's SSN                             

Spouse's employer & address                                                                                               

                                                                                                                                                     

Are you sharing expenses with anyone? Yes ___________      No                              

Explain                                                                                                                                      

Are you sharing income with anyone?                       Yes ________    No                    

Explain                                                                                                                                      

 

II.         INCOME

 

Income available:

My wages or salary $ ___________________              AFDC $                                      

Other wages/salary $ ___________________              Unemployment $                      

Workers' Comp         $ ___________________              SSI $                                           

Food Stamps            $ ___________________              Medicaid $                                  

Pension                     $ ___________________              Retirement $                              

Child support            $ ___________________              Other Income $                          

Total Household Income:

Last month                $ _____________          Previous 12 months $                               

 

III.        ASSETS

 

A.        Motor vehicles? Yes ___________ No _____________   How many?             

            Spouse's motor vehicles                                                                                             

            Is/are vehicle(s) paid for?                                        Yes ________   No                  

            If not, how much do you owe? $                                                                                

            Year, make and model                                                                                                 

 

B.        Do you or your spouse own any land or other real estate or are you or your spouse buying any?                                   Yes __________   No

            What is the approximate value?                                                                                 

            How much did you pay for it?   $________________     When?                         

            Is it paid for? Yes ________     No _________

            If not, how much do you or your spouse owe?                                                       

 

C.        Checking accounts? Yes _________     No ___________      $                         

            Savings accounts?    Yes _________     No ___________      $                          

            Bank                                                                                                                                

            Stocks or bonds? Yes _________     No ___________      $                                 

            Wages due but not yet received      $                                                                         

            Money owed to me or my spouse  $                                                                         

            Guns, boats, sporting equipment, trailer, camper, or tools $                                

            Stereo or TV                                        $                                                                         

            Furniture & appliances                     $                                                                         

            Other personal property                    $                                                                         

            Specify:                                                                                                                           

                                                                                                                                                     

 

IV.       OBLIGATIONS/DEBTS

 

            Do you or your spouse have any outstanding debts or obligations: (specify and list amount):                                                                                                

                                                                                                                                                     

                                                                                                                                                     

 

            I further declare that I am the person named above, that I have read the foregoing questions and information and know the same to be true of my own knowledge, AND THAT IF ANY PART OF THE ABOVE IS MADE FALSELY I AM SUBJECT TO PROSECUTION FOR PERJURY.

 

 

                                                                                                                                                     

                                                                        Signature of Requestor

 

            SUBSCRIBED AND SWORN TO before me this ______________ day of ______________________, 19___.

 

 

                                                                                                                                                     

                                                                        Notary Public for the State of Montana

                                                                        Residing at ________________, Montana

                                                                        My Commission expires                                  

 

 

                                                                    ORDER

 

            Indigence status is hereby denied/granted.

 

            DATED:   _____________________________

 

 

 

                                                                                                                                                     

                                                                        Judge/Administrative Officer

 

 


[following is the rule in its proposed form] 

 

23.2.301 STATEMENT OF INABILITY TO PAY COURT COSTS AND FEES

 

____________________________________

Name

_____________________________________

Mailing Address

_____________________________________

City               State               Zip Code

_____________________________________

Phone Number

_____________________________________

E-mail Address (optional)

Appearing without a lawyer

 

 

MONTANA ___________ JUDICIAL DISTRICT COURT, ___________ COUNTY

IN THE JUSTICE COURT OF _____________ COUNTY, STATE OF MONTANA

IN THE MUNICIPAL OR CITY COURT OF ______________, MONTANA

 

 

 

________________________________,

Petitioner / Plaintiff,

and

________________________________,

Respondent / Defendant.

 

 Case No: ____________________

    (leave blank, the clerk will write in)

 

Statement of Inability to Pay Court Costs and Fees

 

I have a good cause of action or defense but am unable to pay filing or other court fees. I request the court waive the costs and fees. I provide the following information about my income and expenses.

 

My full legal name is: ___________________________.  I was born in this month _____________ and this year ___________.

 

   I am represented by an entity that provides free legal services to low-income persons.

 

Or

 

   I am represented by a volunteer/pro bono attorney, and am financially eligible for free legal services. (Attach a certificate of eligibility from legal aid organization.)

[If you checked either box above, skip to the bottom of this form, and sign it. You don’t need to fill out pages 2, 3, and 4. If you did not check either box above, you may still qualify for a fee waiver—please continue to fill out pages 2, 3, and 4 of this form so the Court has the information it needs to decide if you qualify for the fee

 

What do you do for work?_______________________________

 

Who is your employer?_________________________________

 

Are you married? Yes  No   NOTE: You do not need to provide your spouse′s income below if you are not married, if you and your spouse are separated, or if one of you is filing for dissolution of marriage.

waiver.]

I.          INCOME

 

 

Do you receive any of these benefits [check the box for each benefit you receive]

SNAP       TANF       SSI       Medicaid      WIC         LIEAP

  

·         If you checked a box, skip to the bottom of this form, and sign it. You don’t need to fill out the rest of this form.

·         If no, then fill in the chart below with the income you receive.

·         If you or your spouse don′t receive income from a listed source, put a "0" in the blank for that amount per month.

 

 

Income Sources

Gross amount YOU receive per month

Gross amount YOUR SPOUSE receives per month

Employment

$

$

Investments

$

$

Rental Income

$

$

Retirement

$

$

Workers′ Compensation

$

$

Social Security

$

$

Unemployment

$

$

Survivor′s Benefits

$

$

Veterans Benefits

$

$

Child Support

$

$

Pension

$

$

A person or agency pays my rent or other monthly expenses

 

$

 

$

Other Income--describe: __________

$

$

     Total here:

$

$

 

If you are unemployed, when were you last employed? _______________________ Your job?___________________________________________________________

How many persons, if any, depend on you financially? If none, then write ′N/A′ below. [Attach another page if needed.]

 

Initials only, of the person

 

Age

 

Relationship to You

 

 

 

 

 

 

 

II.         ASSETS

 

What property do you own, along with your spouse, if married and not separated and not filing for dissolution?  Fill in the chart below, for each item that you could sell for $600 or more.  If you don′t own an item listed, write "N/A" in the "Value" column for that item. 

 

Asset

Value*

Cash, savings and checking

$

Vehicle 1, provide year, make and model: _________________________________________________

 

$

Vehicle 2, provide year, make and model: _________________________________________________

 

$

Home where you live now

$

Real estate other than home you're living in

$

Motorcycle/Four wheeler

$

Snowmobile

$

Camper/RV

$

Mobile home (if not the home where you live now)

$

Guns, collections

$

Boat/Watercraft

$

Other Item worth more than $600

$

 

* Value is the amount the item would sell for less the amount you still owe on it, if anything

 

III.        MONTHLY EXPENSES

 

What bills do you (and your spouse, if married) actually pay each month? Fill in the chart below. If you don’t have a monthly expense that′s listed in the chart, write "0" in the amount column for that expense.

 

Monthly expense:

Amount per Month

Rent/Mortgage

$

Utilities (all combined)

$

Phone (cell/landline)

$

Vehicle Payments (all combined)

$

Vehicle Insurance (all combined)

$

Health insurance

$

Other health costs, such as prescriptions

$

Other Insurance

$

Groceries

$

Credit card payments actually paid

$

Child support payments actually paid

$

Spousal support payments actually paid

$

School-related expenses

$

Child care

$

Wages withheld by court order

$

Internet/Cablevision/Satellite TV (combined)

$

Gas for vehicle (or other transportation costs, such as bus fare)

$

Other monthly bills, describe: _____________________

$

                                                                 Total here:

$

 

IV.       OTHER INFORMATION -- optional

 

If you have additional information that you want the court to consider about your inability to pay court costs, attach another page called "Additional Information." Check here if you attach another page:

 

I declare under penalty of perjury and under the laws of the State of Montana that the information in this document is true and correct.  I understand that it is a crime to give false information in this document. 

 

Date: _______________ City __________________________ State ___________

 

                                                            Signature: _______________________________

 

MONTANA ___________ JUDICIAL DISTRICT COURT, ___________ COUNTY

IN THE JUSTICE COURT OF _____________ COUNTY, STATE OF MONTANA

IN THE MUNICIPAL OR CITY COURT OF ______________, MONTANA

 

 

 

________________________________,

Petitioner / Plaintiff,

and

________________________________,

Respondent / Defendant.

 

 

 Case No: ____________________

    (leave blank, the clerk will write in)

 

Order Regarding Statement of Inability to Pay Court Costs

 

 

Warning! Read carefully the section checked below.

It is a court order.

 

Waiver of court costs is Granted. Declarant shall proceed without payment of court fees or costs.

Temporary Waiver of court costs is Granted. Declarant may file without payment of court fees or costs, but the Court may determine at a later time that the declarant has the ability to pay all fees or costs and will require declarant to do so.

Temporary Waiver of fees is Granted.  Declarant may file without payment of court fees or costs, but must appear before the Court at ________ a.m/p.m. on the _____ day of ________________ and show cause why the declarant lacks the ability to pay all fees or costs.

Warning!  If this third box is checked, you must come to court on the date ordered above.  If you don′t come, the judge will deny your request to waive court costs, and you will have to pay the court costs. 

Waiver of Fees and costs is Denied. Waiver is denied based on the following:

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

Ordered this _____ day of ______________________, 20_____. 

__________________________________

Presiding Judge

 

AUTH: 25-10-404, MCA

IMP: 25-10-404, MCA

 

REASON:  This rule amendment is reasonably necessary to address deficiencies with the current financial statement form, as requested by the Access to Justice Commission. As noted by the Access to Justice Commission, the current form is not uniformly used. The current form also does not provide a section to indicate that the person is represented by a legal services organization, and thus not required to file a financial statement under 25-10-404(3), MCA. The amended form is also easier to understand than the current form, which will facilitate its use by pro se litigants. Finally, the amended form provides a separate, standalone order, which will assist the court in timely addressing fee waiver applications. 

 

4. Concerned persons may submit their data, views, or arguments concerning the proposed action in writing to: J. Stuart Segrest, Department of Justice, P.O. Box 201401, Helena, Montana, 59620-1401; telephone (406) 444-2026; fax (406) 444-3549; or e-mail contactdoj@mt.gov, and must be received no later than 5:00 p.m., November 10, 2017.

 

5. If persons who are directly affected by the proposed action wish to express their data, views, or arguments orally or in writing at a public hearing, they must make written request for a hearing and submit this request along with any written comments to J. Stuart Segrest at the above address no later than 5:00 p.m., November 10, 2017.

 

6. If the agency receives requests for a public hearing on the proposed action from either 10 percent or 25, whichever is less, of the persons directly affected by the proposed action; from the appropriate administrative rule review committee of the Legislature; from a governmental subdivision or agency; or from an association having not less than 25 members who will be directly affected, a hearing will be held at a later date. Notice of the hearing will be published in the Montana Administrative Register.  Ten percent of those directly affected has been determined to be 25.

 

7. The department maintains a list of interested persons who wish to receive notices of rulemaking actions proposed by this agency. Persons who wish to have their name added to the list shall make a written request that includes the name, e-mail, and mailing address of the person to receive notices and specifies for which program the person wishes to receive notices. Notices will be sent by e-mail unless a mailing preference is noted in the request.  Such written request may be mailed or delivered to the contact person in 4 above or may be made by completing a request form at any rules hearing held by the department.

 

8. The bill sponsor contact requirements of 2-4-302, MCA, do not apply.

 

9. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rule will not significantly and directly impact small businesses.

 

 

/s/ Matthew T. Cochenour                         /s/ Timothy C. Fox                          

Matthew T. Cochenour                              Timothy C. Fox

Rule Reviewer                                           Attorney General

                                                                   Department of Justice

           

Certified to the Secretary of State October 2, 2017.

 

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