Thornton Municipal Court

Petition For Indigency Determination



You must fill out the application completely. Information that does not apply, indicate Not Applicable (or N/A). An incomplete form could result in rejection or denial of your application.

If under the age of 18, a parent or guardian must complete the form.

PLAINTIFF: People of the State of Colorado by and through the People of the City of Thornton
VS
DEFENDANT


Personal Information


Number of Dependants

Employment Information

$

Spouse Employment Information

$

Other Household Members Contributing To The Common Support Of The Household

Your application cannot be considered without the gross income from ALL MEMBERS of the household who contribute monetarily to the common support of the household.


Contributing Member #{{ index+1 }}
Gross Monthly Income
$
$

$
$

$
$

$
$

$
$


I swear under penalty of perjury that the following information is true and complete. I will notify the Court of any improvement or decline in my financial condition from the date of this Petition. I also understand that if the Court grants this request, I may later be ordered to reimburse the City of Thornton for attorney fees spent on my behalf.