City of Trenton
Municpal Court
Are you only charged with traffic or parking offenses? *
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?
Application Made By *
Financial Questionnaire to Establish Indigency
If you answered "Yes" to all of the above 3 questions, go to the Certification tab below and sign the Certification
Last Name *
Are you receiving welfare or participating in another government based income maintenance program? *
Application For *
Are you only completing this form for installment payments of your fine? *
Applicant First Name *
Email Address *
225 N. Clinton Avenue
Trenton, NJ 08607
609-989-3302
www.trentonnj.org
  • Certification
  • Defendant
  • Case Information
  • Income
  • Assets
  • Expenses
  • Attorney
  • Attachments
Type Full Name :
Sign With Hand
Type Full Name :
Sign With Hand
Type Full Name :
Sign With Hand
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 *
Social Security Number
Issuing State
First Name *
State *
Are you currently employed? *
Months
Current Employer if employed; if unemployed, Most Recent Employer
State
Years
Eye Color
Driver's License No.
City
Federal
Email Address *
If "Yes", Length of Employment
Last Name *
Which Income Tax Returns were filed last year? (Select all that apply, or "None")
ZIP
Children or other family members
Sex *
Marital Status *
City
Employment History
State
ZIP *
Home Phone Number *
Number of those you support
Position Held
If Unemployed, Date Last Employed
None
Phone Number
MI
Home Address *
Years
How long at this home address?
Defendant Information
Date of Birth *
Address
City *
Months
Name of Bail Bond Agency or Person(s) who posted bail
Complaint Number(s)
Number of Co-Defendants
State
Address
City
Phone Number
ZIP
Charges
Have you posted bail for this charge? *
Amount Posted
Case Information
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? *
Amount
Checking Account: Bank Name
Add a record for any real estate that you own partially or in full
Other Personal Property
Other Cash Available - Description
Total Assets
Balance
Total Value of Personal Property
Account Number
Add a record for any vehicle that you own partially or in full
Balance
Total Value of Vehicles
Assets - Include all assets you own by yourself or with someone else
Account Number
Total Value of Real Estate
Vehicles
Add a record for any personal property items that you own partially or in full
Savings Account: Bank Name
Real Estate Owned
Do you owe credit card balances?
Total Liabilities
Total Balance Owed
Do you have outstanding loans (Car, home, personal, etc.) ?
Do you owe medical expenses - Doctor / Hospital / Other?
Total Assets
Total Mortgage/Rent Payment
Total Net Worth
Do you owe money for attorney fees?
Monthly Payment
Total Liabilities
Total Monthly Payments
Do you pay for living expenses (food, clothing, utilities, transportation, etc.)?
Credit Limit
Are you required to pay Child Support or Alimony?
Do you pay rent?
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Do you have a mortgage?
Expenses and Liabilities
Do you owe court fines, penalties, or costs?
Do you live in a halfway house?
Do you owe insurance premiums and/or surcharges?
Can you afford to pay for an attorney? *
Phone Number
Extension
Address
Who paid for the attorney?
Attorney Last Name
ZIP
Can parents, guardians, relatives or friends help you pay for an attorney?
State
City
Amount Paid
Firm Name
If "Yes", how much?
Did a private attorney ever represent you? *
Attorney First Name
Attorney Information
You may attach documents relevant to this request, such as proof of residency, income and job status, or other court-related matters
Attachments