State of Alabama
Unified Judicial System
Page 1 of 2 Rev.2/95
AFFIDAVIT OF SUBSTANTIAL
HARDSHIP AND ORDER
IN THE_______________________________________COURT OF ________________________________________, ALABAMA
(Circuit, District, or Municipal) (Name of County or Municipality)
STYLE OF CASE: _____________________________________________v. ___________________________________________
TYPE OF PROCEEDING:___________________________CHARGE(s) (if applicable):__________________________________
□ CIVIL CASE-- I, because of substantial hardship, am unable to pay the docket fee and service fees in this case. I request
that payment of these fees be waived initially and taxed as costs at the conclusion of the case.
□ CIVIL CASE-- (such as paternity, support, termination of parental rights, dependency) – I am financially unable to hire an
attorney and I request that the court appoint one for me.
□ CRIMINAL CASE-- I am financially unable to hire an attorney and request that the court appoint one for me.
□ DELINQUENCY/NEED OF SUPERVISION-- I am financially unable to hire an attorney and request that the court appoint
one for my child/me
Full name _____________________________________________________________________ Date of Birth _________________________
Spouse’s full name (if married) ________________________________________________________________________________________
Complete home address ______________________________________________________________________________________________
Number of people living in hous