<p>A plea must be on file with this court. This Court does not accept requests for changes or modifications to payment plans by phone. Please put your request in writing, be specific about what you are seeking and submit your request to the Court along with a statement of inability to pay costs.</p><p>The address of the Court is: Judge Katy Hubener 841 W. Irving Blvd. Irving TX 75060</p><p>The fax number is: 214-589-7048</p><p>Once received, the Judge will review the application and request and send an order either denying or granting the request to you at the address on file.</p><p>Judge Katy Hubener Justice of the Peace 4-2 Dallas County, Texas 841 West Irving Boulevard Irving, TX 75060 P. (214) 589-7000 F. (214) 589-7048 CAUSE NUMBER: ______L THE STATE OF TEXAS § IN THE JUSTICE COURT § § VS. § PRECINCT 4, PLACE 2 § § ______§ DEFENDANT § DALLAS COUNTY, TEXAS</p><p>DECLARATION OF FINANCIAL INABILITY TO POST BOND OR PAY FINE IN CLASS C MISDEMEANOR CASE</p><p>I am the Defendant in the above–styled cause. I am not represented by counsel in this proceeding. I verify that the statements made in this affidavit are true and correct, and contain complete information as to the my identity, the nature and amount of governmental entitlement income, the nature and amount of employment income, other income, (interest, dividends, etc.), spouse's income if available to me, property owned (other than homestead), cash or checking account, dependents, debts, and monthly expenses. I have no assets except the following.</p><p>DEFENDANT’S IDENTITY</p><p>Defendant’s Full Name</p><p>Defendant’s Street Address, City, State, Zip Code</p><p>Tenant’s Primary Phone Defendant’s Secondary Phone</p><p>Defendant’s Date of Birth</p><p>SPOUSE’S IDENTITY</p><p>Spouse’s Full Name</p><p>Spouse’s Street Address, City, State, Zip Code</p><p>Spouse’s Primary Phone Spouse’s Secondary Phone</p><p>Spouse’s Date of Birth</p><p>DEPENDANTS</p><p>Number of Dependants Ages of Dependants</p><p>Residence of Dependants Address, City, State, Zip Code</p><p>Judge Katy Hubener Justice of the Peace 4-2 Dallas County, Texas 841 West Irving Boulevard Irving, TX 75060 P. (214) 589-7000 F. (214) 589-7048 INCOME OF TENANT & SPOUSE</p><p>Tenant’s Employer Tenant’s Job Title and/or Duties</p><p>Tenant’s Employer Address, City, State, Zip Code</p><p>Tenant’s Supervisor’s Name Tenant’s Supervisor’s Phone</p><p>Tenant’s Monthly Salary/Income Tenant’s Other Income</p><p>Spouse’s Employer Spouse’s Job Title and/or Duties</p><p>Spouse’s Employer Address, City, State, Zip Code</p><p>Spouse’s Supervisor’s Name Spouse’s Supervisor’s Phone</p><p>Spouse’s Monthly Salary/Income Spouse’s Other Income</p><p>GOVERNMENT ENTITLEMENT INCOME</p><p>Unemployment Benefits AFDC/TANF</p><p>Social Security Disability</p><p>Veteran’s Benefits Child Support</p><p>Other Amounts - Describe</p><p>ALL OTHER INCOME</p><p>List all other sources of income and amounts. Cash on hand</p><p>Financial Institution of Checking Account Balance Amount</p><p>Financial Institution of Savings Account Balance Amount</p><p>REAL PROPERTY (residential, commercial, or land owned)</p><p>Address of Real Property Owned Value of Property</p><p>Address of Real Property Owned Value of Property</p><p>Judge Katy Hubener Justice of the Peace 4-2 Dallas County, Texas 841 West Irving Boulevard Irving, TX 75060 P. (214) 589-7000 F. (214) 589-7048 PERSONAL PROPERTY (other than household furnishings, clothes, tools of a trade, or personal effects. This includes vehicles and other sources of transportation)</p><p>Description of Property Owned Value of Property</p><p>Description of Property Owned Value of Property</p><p>MONTHLY EXPENSES</p><p>Rent and/or MortgageAmount Vehicle/Car Payment Amount</p><p>Insurance Amount Utility Amount</p><p>Child Care Amount Child Support Amount</p><p>Food and/or Incidental Amount Medical and/or Dental Amount</p><p>Other Amount Describe Other Amount</p><p>Other Amount Describe Other Amount</p><p>Signed this the ______day of ______, 20______.</p><p>Signature of Affiant Printed Name of Affiant</p><p>THE STATE OF TEXAS § COUNTY OF DALLAS §</p><p>BEFORE ME, the undersigned authority, on this day personally appeared the above named affiant who upon oath, stated that he/she is the Tenant making this Pauper’s Affidavit and that the information provided is true and correct.</p><p>Subscribed and sworn to before me on this the ______day of ______, 20______</p><p>______Notary Public or Clerk of Court</p><p>CERTIFICATE OF DELIVERY: I the Defendant in the above and entitled forcible detainer / forcible entry and detainer certify that I have sent the forgoing document to the opposing party on this the ______day of ______, 20______.</p><p>Signature of Defendant Printed Name of Affiant</p><p>Judge Katy Hubener Justice of the Peace 4-2 Dallas County, Texas 841 West Irving Boulevard Irving, TX 75060 P. (214) 589-7000 F. (214) 589-7048 Form 6a Affidavit of Indigency (Financial Inability to Post Bond or Pay Fine) – Class C. Misdemeanor Case Page 1 of 3 No. THE STATE OF § IN THE JUSTICE TEXAS COURT VS. § PCT. ____ PLACE ______(DEFENDANT § ______COUNTY, TEXAS ) I, ______, am the Defendant in the above–styled cause. I am not represented by counsel in this proceeding. I have no assets except the following. Employed By:______Address of Employer: ______My Earnings Are: $ ______Per Week $ ______Per Month I have other income as follows: (State Source and Amount): I am ______Married ______Single ______Divorced Number of Children: ______and other dependents: ______Amount of monthly Court Ordered support Paid/Received: $______I own the following property: Home (Address): ______Other: ______Monthly Payments: $ ______Balance Owed: $ ______I do not own real estate, but am renting premises located at: ______Monthly Rental: $ ______List Car/Truck Owned: ______Monthly Payment: $______Balance $ ______Notes, Mortgages, Trust Deeds Owned:______</p><p>Judge Katy Hubener Justice of the Peace 4-2 Dallas County, Texas 841 West Irving Boulevard Irving, TX 75060 P. (214) 589-7000 F. (214) 589-7048</p>