CR-105 - Defendant's Financial Statement on Eligibility for Appointment of Counsel and Reimbursement and Record on Appeal at Public Expense

Summary

Defendant's Financial Statement on Eligibility for Appointment of Counsel and Reimbursement and Record on Appeal at Public Expense

Text

Form ID: CR-105
Title: Defendant's Financial Statement on Eligibility for Appointment of Counsel and Reimbursement and Record on Appeal at Public Expense
Effective Date: 2023-09-01
Mandatory Form: no
Info Page: https://selfhelp.courts.ca.gov/jcc-form/CR-105
Primary Download URL: https://www.courts.ca.gov/documents/cr105.pdf
Form Detail Page:
Defendant's Financial Statement on Eligibility for Appointment of Counsel and Reimbursement and Record on Appeal at Public Expense
(CR-105)
Tells the court that you are eligible to: (1) have an attorney appointed to you because you cannot afford one; (2) be reimbursed for the cost of a court-appointed attorney; or (3) receive a copy of the court reporter's transcript at the public's expense. Use this form to list your assets, income, and expenses for the court to consider in making a decision on this request.
Get form CR-105
Effective: September 1, 2023
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How-to instructions for Criminal
PDF Text:
DEFENDANT'S FINANCIAL STATEMENT ON ELIGIBILITY FOR 
APPOINTMENT OF COUNSEL AND 
RECORD ON APPEAL AT PUBLIC EXPENSE
Pen. Code, § 987 
www.courts.ca.gov
Form Approved for Optional Use 
Judicial Council of California 
CR-105  [Rev. September 1, 2023]
CR-105
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
DEFENDANT:
PEOPLE OF THE STATE OF CALIFORNIA v.
FOR COURT USE ONLY
DEFENDANT'S FINANCIAL STATEMENT 
(check all that apply)
ELIGIBILITY FOR APPOINTMENT OF COUNSEL 
ELIGIBILITY FOR RECORD ON APPEAL AT PUBLIC EXPENSE
CASE NUMBER:
1. a. Defendant's name:
b. Other names used:
c. Address:
d. Date of birth:
e. Telephone number:
f. Driver's license number:
2. Defendant's present employment
a. Occupation:
b. Name of employer:
c. Address:
d. Gross pay per month: $ week: $ day: $ 
e. Take-home pay per month: $ week: $ day: $ 
f. Name of union:
g. Name of credit union:
3. If defendant is not now working, state the name and address of defendant's last employer and the last date defendant was 
employed.
a. Name:
b. Address:
c. Last date of employment:
4. Defendant                                            married.is is not
5. a. Spouse's name:
b. Other names used:
c. Address:
d. Date of birth:
e. Telephone number:
f. Driver's license number:
6. Spouse's present employment
a. Occupation:
b. Name of employer:
c. Address:
d. Gross pay per month: $ week: $ day: $ 
e. Take-home pay per month: $ week: $ day: $ 
f. Name of union:
g. Name of credit union:
7. If spouse is not now working, state the name and address of spouse's last employer and the last date spouse was employed.
a. Name:
b. Address:
c. Last date of employment:
8. Dependents Name Address Relationship Age
Page 1 of 2

DEFENDANT'S FINANCIAL STATEMENT ON ELIGIBILITY FOR 
APPOINTMENT OF COUNSEL AND 
RECORD ON APPEAL AT PUBLIC EXPENSE
Page 2 of 2 CR-105  [Rev. September 1, 2023]
CR-105
PEOPLE OF THE STATE OF CALIFORNIA  v.
DEFENDANT:
CASE NUMBER:
OTHER MONTHLY INCOME9. Defendant
a. Unemployment and disability   $
b. Social Security    $
c. Welfare, TANF     $
d. Veteran's benefits  $
e. Worker's compensation    $
f. Child support payments  $
g. Spousal support payments  $
h. All other income not elsewhere listed   $
Total: $
Spouse
a. Unemployment and disability   $
b. Social Security    $
c. Welfare, TANF     $
d. Veteran's benefits  $
e. Worker's compensation    $
f. Child support payments  $
g. Spousal support payments  $
h. All other income not elsewhere listed   $
Total:  $
EXPENSES
10. Monthly expenses being paid by defendant alone or by defendant and spouse
a. Rent or house payments  $
b. Car payments    $
c. Transportation payments   $
d. Medical and dental payments   $
e. Loan payments  $
f. Clothing and laundry  $
g. Food   $
h. Support payments   $
i. Insurance payments    $
j. Other payments (union, taxes, 
utilities)
 $
Total (a-j):  $
11. Installment payments other than those listed in item 10.
Name of Creditor MonthIy Payment Balance Owed
a.  $  $
b.  $  $
c.  $  $
d.  $  $
e.  $  $
Total:  $ Total:  $
ASSETS12. What do you own? (State value):
a. Cash    $
b. House equity    $
c. Cars, other vehicles and boat equity (List 
make, year, and license number of each)
 $
d. Checking, savings, and credit union accounts 
(List name and account number of each)
 $
e. Other real estate equity  $
f. Income tax refunds due   $
g. Life insurance policies (ordinary life, face value)      $ Length of ownership
h. Other personal property (jewelry, furniture, furs, stocks and bonds, etc.)   $
Total: $
Declaration of Defendant
I declare under penalty of perjury under the laws of the state of California that the foregoing is true and correct.
Date:
SIGNATURE OF DEFENDANT

Retrieval chunks

• #1

  Form ID: CR-105 Title: Defendant's Financial Statement on Eligibility for Appointment of Counsel and Reimbursement and Record on Appeal at Public Expense Effective Date: 2023-09-01 Mandatory Form: no Info Page: https://selfhelp.courts.ca.gov/jcc-form/CR-105 Primary Download URL: https://www.courts.ca.gov/document…

• #2

  g. Name of credit union: 7. If spouse is not now working, state the name and address of spouse's last employer and the last date spouse was employed. a. Name: b. Address: c. Last date of employment: 8. Dependents Name Address Relationship Age Page 1 of 2 DEFENDANT'S FINANCIAL STATEMENT ON ELIGIBILITY FOR APPOI…