RAP FORM 12A: FINDINGS OF INDIGENCY

[Rule 15.2(c)]

SUPERIOR COURT OF WASHINGTON

FOR ____________ COUNTY

[Name of plaintiff] )

Plaintiff, ) No. [trial court]

)

v. ) FINDINGS OF INDIGENCY AND

) ORDER TO TRANSMIT FINDINGS OF

[Name of defendant] ) INDIGENCY

Defendant. )

The court finds that ____________________________, the appellant/petitioner in this action is unable by reason of poverty to pay for all or some of the expenses of appellate review. The court finds, however, that the moving party is able to contribute $ _______. The following portions of the record are reasonably necessary for review:

(1) Those portions of the verbatim report of proceedings as follows: [Designate parts of report.]

(2) A copy of the clerk’s papers as follows: [Designate papers by name and trial court clerk’s subnumber.]

(3) Preparation of original documents to be reproduced by the clerk as provided in rule 14.3(b).

(4) Reproduction of briefs and other papers on review that are reproduced by the clerk of the appellate court.

(5) The cost of transmitting cumbersome exhibits: [Designate cumbersome exhibits needed for review. See rule 9.8(b).]

(6) Other items: [Designate items]

Now, therefore, it is ordered that the clerk of the superior court shall promptly transmit to the Supreme Court the Motion for Order of Indigency, any affidavit or declaration in support of the motion, and the Findings of Indigency.

[Date]

Signature

________________________________

[Name]

Judge of the Superior Court

Presented by:

[signature]

________________________________

Print Name: ______________________

Address of Party:__________________

________________________________

[If presented by an attorney, name of Attorney, name of party, and Washington State Bar Association membership number.]

[Adopted effective September 1, 2010; amended effective January 3, 2016.]