State form 55434: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the 'INFORMATION ABOUT APPLICANT' section. Clearly print your name, current address, date of birth, and social security number. Indicate if you are currently incarcerated and provide your phone numbers.
Next, complete the 'INFORMATION ABOUT COURT CASE' section. Enter the name of the court where your case is pending, the judge's name, and details about your charges including file and docket numbers.
Proceed to the 'FINANCIAL INFORMATION' section. Indicate your employment status, gross salary, and total monthly income. List any assets such as bank accounts or properties you own.
Ensure you attach all required financial documents and court documents as specified in the instructions. This is crucial for processing your application.
Finally, sign and date the form at the bottom to certify that all information provided is accurate.

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