WSR 17-03-035
RULES OF COURT
STATE SUPREME COURT
[January 5, 2017]
IN THE MATTER OF THE EXPEDITIOUS ADOPTION OF THE PROPOSED AMENDMENT TO RAP FORM 13
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ORDER
NO. 25700-A-1174
The Court having recommended the expeditious adoption of the proposed amendment to RAP Form 13, and having considered the amendments and comments submitted thereto, and having determined that the proposed amendments will aid in the prompt and orderly administration of justice;
Now, therefore, it is hereby
ORDERED:
(a) That the amendments as shown below are adopted.
(b) That the amendments will be published expeditiously in the Washington Reports and will become effective upon publication.
DATED at Olympia, Washington this 5th day of January, 2017.
 
 
Madsen, C.J.
Johnson, J.
 
Wiggins, J.
Fairhurst, J.
 
Gonzalez, J.
Owens, J.
 
Gordon McCloud, J.
Stephens, J.
 
Yu, J.
RULES ON APPEAL APPENDIX OF FORMS
FORM 13 - Motion for Order of Indigency
SUPERIOR COURT OF WASHINGTON
FOR _________ COUNTY
[Name of Plaintiff]
(________________)
Plaintiff,
 
v.
 
 
 
 
 
 
 
[Name of defendant]
Defendant
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No. [trial court]
 
Motion for Order of Indigency - (Criminal), (Juvenile Offense), (Dependency), (Termination), (Commitment), (Civil Contempt), Habeas Corpus), (Appeal involving a Constitutional or Statutory Right to Counsel) Case
______________,(defendant) (respondent) (petitioner), files a notice of appeal in the above-referenced (criminal), (juvenile offense), (dependency), (termination), (commitment), (civil contempt), (habeas corpus), (appeal involving a constitutional or statutory right to counsel) case, and moves the court for an Order of Indigency authorizing the expenditure of public funds to prosecute this appeal (wholly at public expense) (partially at public expense).
(Defendant) (Respondent) (Petitioner) was found indigent by order of this court on _____________. There has been no change in (Defendant) (Respondent) (Petitioner)'s financial status since that time and (Defendant) (Respondent) (Petitioner) continues to lack sufficient funds to seek review in this case.
(Defendant) (Respondent) (Petitioner) asks the court to order the following to be provided at public expense: all filing fees, attorney fees, preparation, reproduction, and distribution of briefs, preparation of verbatim report of proceedings, and preparation of necessary clerk's papers.
The following certificate is made in support of this motion.
DATED:_________
__________________________
(Defendant) (Respondent) (Petitioner)
 
_____ 
- WSBA#            
Attorney for (Defendant) (Respondent) (Petitioner)
CERTIFICATE
I, _____________________,certify as follows:
1. That I have previously been found indigent by this court.
2. That the highest level of education I have completed is:
( ) Grade School   ( ) High School   ( ) College or greater
3. That I have held the following jobs:                         
_____ 
4. That I:     ( ) have not received job training
( ) have received the following job training: .
5. That I:     ( ) do not have a mental or physical disability
that would affect my ability to work
( ) have the following mental or physical
disability that would affect my ability to
work: .
6. That I:     ( ) do not have children or family members
that normally depend on me for financial
support
( ) have the following children or family
members that normally depend on me for
support .
7. That I:     ( ) do not anticipate my financial condition
improving in the foreseeable future
through inheritance, sale of land, or
similar.
( ) anticipate my financial condition
improving in the foreseeable future as
follows: .
I am the (defendant) (respondent) (petitioner) and I wish to appeal the judgment that was entered in the above entitled cause.
2. [Check one box]
[ ] a. I have previously been found to be indigent by order of this court on _______________. There has been no change in my financial status since that time and I continue to lack sufficient funds to seek review in this ease;
or
[ ] b. I have not previously been found indigent by this court or there has been a change in my financial status since the court found me to be indigent and I am including a certificate providing information as to my current financial situation.
[Attach Appendix A]
3. I ask the court to order the following to be provided at public expense: all filing fees, attorney fees, preparation, reproduction, and distribution of briefs, preparation of verbatim report of proceedings, and preparation of necessary clerk's papers.
4. I authorize the court to obtain verification information regarding my financial status from banks, employers, or other individuals or institutions, if appropriate.
5. I will immediately report any change in my financial status to the court.
6. I seek review in geed faith. The following is a brief statement of the nature of the ease and the issues sought to be reviewed:
_____ 
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7. [For cases governed by rule 15.2(c) only] I have a constitutional or statutory right to review at public expense, and the issues I want reviewed have probable merit: [Identify statutory or constitutional right and briefly describe the merit of the appeal sought]
_____ 
_____ 
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I, ______________, certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct.
____________
Date and Place
__________________________
Signature of (Defendant) (Respondent) (Petitioner)
APPENDIX A [To Form 13]: Initial Declaration of Indigency [To be completed if party has not previously been found indigent or certifies a material change in financial status since original finding of indigency (Box 2(b) in Form 13)]
I, _______________ certify as follows:
1. I have not previously been found indigent by this court.
2. That I own:
( ) a. No real property
( ) b. Real property valued at $_________.
3. That I own:
( ) a. No personal property other than my personal effects
( ) b. Personal property (automobile, money, inmate amount, moters, tools, etc.) valued at $_________.
4. That I have the following income:
( ) a. No income from any source.
( ) b. Income from employment, disability payments, social security, welfare, insurance, annuities, stocks, bonds, interests, etc., in the amount of $______ on an average monthly basis. I received $______ after taxes over the past year.
5. That I have:
( ) a. Undischarged debts in the amount of $________.
( ) b. No debts.
6. That I am without other means to prosecute said appeal and desire that public funds be expended for that purpose.
7. That I can contribute the following amount toward the expense of review:
$_________.
I, ___________________, certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct.
____________
Date and Place
__________________________
Signature of (Defendant) (Respondent) (Petitioner)
[December 24, 2002; amended effective September 1, 2010]
Reviser's note: The typographical error in the above material occurred in the copy filed by the State Supreme Court and appears in the Register pursuant to the requirements of RCW 34.08.040.
Reviser's note: The brackets and enclosed material in the text of the above section occurred in the copy filed by the agency and appear in the Register pursuant to the requirements of RCW 34.08.040.