How to fill out an Affidavit of Indigency

Check only 1 box in Section 1 of the Affidavit of Indigency that explains why your income is too low to pay your court costs:

Category (A)

You get benefits from:  

• Massachusetts Transitional Aid to Families with Dependent Children (TAFDC)
• Massachusetts Emergency Aid to Elderly, Disabled & Children (EAEDC)
• Federal Supplemental Security Income (SSI)
• Massachusetts Veterans Benefits  
• MassHealth (formerly Medicaid) - If you check MassHealth and get other benefits, check off the other benefits, too.  

Category (B)

Your household income, after taxes, is less than 125% of the current Federal Poverty Guidelines. The federal government updates these guidelines every year. ​​​​​​​​​​​​​​​​​​​​​​

Category (C)

Your income is more than 125% of poverty (Category B). But if you paid court costs, you would not be able to pay for food, shelter and clothing. 

What happens if I Check A or B? 

If you pick Category A or B and you only ask for a waiver of normal costs, the clerk should approve your Affidavit of Indigency automatically. But the form must be complete.

If you ask for a waiver of extra costs, the clerk may send you to talk to a judge to explain why you need the things you are asking for. 

What happens if I check C? 

If you pick Category C, you must fill out another form, the Supplement to the Affidavit of Indigency. Clerks can approve your Affidavit of Indigency if you check Category C. The clerk only needs to send the forms to a judge if they believe you may be able to pay the costs in your case and still pay for your basic ​​​​​​​​​​​​​​​​​​​​​​​​​​needs. 

In Section 2 and Section 3 of the Affidavit of Indigency, check the boxes next to the costs you need the court to waive or pay. And list costs that are not already on the form. For example:

• If you are filing a case, check the box for court “Filing fee and any surcharge.” You can find filing fees on mass.gov.
• If you need to have a sheriff or other officer serve court documents, check the box next to Fees or costs for serving court summons, witness subpoenas or other court papers.
• If you need publication of notice in a newspaper, check the box next to “Other fees or costs” and enter estimates of the cost.  

If you do not know the cost of something you need for your case, list the service you need and your best estimate of the cost. You can also ask the clerk at the court about the costs.  

Important

The court cannot pay for your lawyer.  

Later in your case, if you need other court costs like subpoenas for witnesses or costs of taking depositions of witnesses, file another Affidavit of Indigency for these costs.

If you do not fill in the amounts of all the costs, the court should still accept your application.  

What is a Substitution of a Service? 

In Sections 2 and 3, the last box is for Substitution. A court can order an easier or less costly way to provide the services you need. For example, a court can order that you can post notices in certain places instead of publishing the notice in a newspaper.  

You can ask for a substitute method on this line in your application. 

If you checked C on the Affidavit of Indigency, you also need to fill out the Supplement to the Affidavit of Indigency. This form asks for information like your:

• monthly income after taxes,
• monthly expenses, and
• assets.

In box 6, Miscellaneous, you can also include information about other facts that might affect your ability to pay court costs and fees.

Also sign the Supplement, if you filled one out. When you sign, you swear that everything you put on the form is true, as far as you know.  

After you complete the Application of Indigency, you must file it with the court.

If you check Category (A) or (B), you only need to take the Affidavit to court. You do not have to bring anything else. You can bring documents that show you get benefits or your income. But you do not have to bring any proof.  

If you check Category (C), take the Affidavit and the Supplement to court. Bring proof of your income, like pay stubs, and ​​expenses, like childcare costs, utility bills, car payments, and medical bills in case you need to have a hearing before a judge.