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Defendant//Respondent CASE NO. APPLICATION FOR DETERMINATION OF CIVIL INDIGENT STATUS Notice to Applicant: If you qualify for civil indigence you must enroll in the clerk s office payment plan and pay a one-time administrative fee of $25.00. This fee shall not be charged for Dependency or Chapter 39 Termination of Parental Rights actions. 1. I have dependents. (Include only those persons you list on your U.S. Income tax return.) Are you Marrie.

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