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Here is the text we could read:

Cape Verdean Creole -  
Supplement to Affidavit of Indigency 

 

Stadu di Massachusetts 

SUPLEMENTU À DEKLARASON 
JURAMENTADU DI POBREZA 
I PEDIDU PA ANULA, SUBSTITUISON Ô 
PAGAMENTU STATAL DI TAXAS I KUSTUS 
(Nota: Si bu marka (C) na DEKLARASON JURAMENTADU DI POBREZA, bu ten ki konpleta es formuláriu.) 

Tribunal 

Nomi i Numeru di Prosesu (si konxedu) 

Sob dispozison di Lei Jeral, Kapítulu 261, Sesons 27A-27G, n ta jura ô afirma kel ki ta sigi li di baxu: 

(Sidadi ô vila) 

(Stadu i Kódigu Postal) 

Nomi di petisiunáriu: 

Nderesu:  

(Rua i numeru) 

1.

INFORMASON PESOAL

(a) Data di nasimentu:

(b) Grau más Altu na Escola:

(c) Treinu Special:

dispesas di vida:

(e) Númeru di Dependentis:

(d) Lista kalker defisiênsia físika ô mental ki bu kre revela i ki ta afeta bu kapasidadi di ganha dinheru ô bus

2. RENDIMENTU DIPOS DI INPOSTUS (mensal)

(a) Si di trabadju, lista bu profison i nomi i nderesu di bu empregador[patron]:

(b) Fonte di rendimentu, si ka ben di trabadju:

(c) Nha rendimentu anual brutu na últimus doze mês foi: $

(d) Rendimentu Brutu (mensal):

(e)

Impostus Diskontadu (mensal):

Impostu Federal 

Impostu Statal 

Seguransa Social 

Medicare 

Otus Impostu (spesifika) 

Total di Impostus Diskontadu 

(f) Total di Renda Dipos Impostus (subtrai 2(e) di 2(d)):

$ 

$ 

$ 

$ 

$ 

(g) Si otu membru di bu lar [agregadu familiar] sa ta trabadja, lista profison i nome i deresu di se empregador i
rendimentu mensal dipos [após] impostus:

3. RENDAMENTU NA BU DISPOZISON (mensal)

(a) Redimentu dipos di impostus (di linha 2(f)):

(b) Despezas (mensal):

Renda or Ipoteka  $

Despezas ki ka kobertu pa seguru $ 

Kumida 

Eletrisidadi 

Gas 

Oliu 

Agu 

Telefoni 

$ 

$ 

$ 

$ 

$ 

$ 

Otu (spesifika): 

Total di Despezas 

Despezas di edukason pa fidju 

Penson pa sustenta menor 

Krexe 

Ropa 

Bati ropa/Limpeza 

Seguru di Karu 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

Seguru di Saúdi   $ 

Despezas di Transporti 

(c) Rendimentu Dipos di Impostus Menus Despezas (mensal) (subtrai 3(b) di 3(a)):

$  

$ 

 
$ 

$ 

$ 

$ 

4. BENS

(a) Ten Kaza? Sim 

Nau

 Valor na Markadu $

Saldu debedu $ 

(b) Ten Karu? Sim

 Nau 

   Anu & Marka 

(c) Kontas na Banku (spesifika tipu i saldu)

Valor na Markadu $ 

Saldu Debedu $ 

(d) Otus Bens inkluidu Imóvel (spesifika tipu y valor)

5. DÍVIDAS

(a) Spesifika:

6. DIVERSUS

(a) Otus fatus ki pode ser ligadu ku bu kapasidadi di paga taxas e kustus?

Asinadu sob pena di tistimunh falsu: 

Asinatura: 

x 

Digite/Skrebe Nomi: 

Nderesu: 

Sidadi: 

Data di asinatura: 

Stadu: 

Kódigu Postal: 

Di akordu ku ordi di di Supremu Tribunal Judisial, tudu informason ki sta na kel deklarason juramentada é 
KONFIDENSIAL. Sem ordi spesial di tribunal, ka divulgadu pa ningén ki ka é funsiunáriu autorizadu di 
 
 
tribunal, petisiunáriu, di advogadu di petisiunáriu ô di kalker algén autorizadu pa petisiunáriu pa skritu . 

Es formuláriu previstu pa Juiz Prezidenti di TSJ di akordu ku Lei Jeral c. 261, § 27B. Promulgadu Marsu, 2003. 
PDF ki pode preentxedu kriadu Agostu 2013.  Traduzidu pa Kabuverdianu na 2021.

Kriolu di Cabo Verde

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Massachusetts state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from www.mass.gov (2023-03)
Page(s): 3
Fields(s): 62
Average fields per page: 20
Reading Level: Grade 9
LIST Grouping(s): Unknown

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

tribunal was Tribunal (0.65 conf)
nomi_numeru_di_prosesu_si_konxedu was Nomi i Numeru di Prosesu si konxedu (0.51 conf)
nomi_di_petisiun_riu was Nomi di petisiunáriu (0.53 conf)
rua_numeru was Rua i numeru (0.37 conf)
sidadi_vila was Sidadi ô vila (0.52 conf)
stadu_k_digu_postal was Stadu i Kódigu Postal (0.36 conf)
b_grau_altu_na_escola was b Grau más Altu na Escola (0.55 conf)
undefined__1 was undefined (0.38 conf)
ki_bu_ta_di_bus was d Lista kalker defisiênsia físika ô mental ki bu kre revela i ki ta afeta bu kapasidadi di ganha dinheru ô bus (0.56 conf)
e_n_meru_di_dependentis was e Númeru di Dependentis (0.38 conf)
undefined__2 was undefined_2 (0.39 conf)
b_fonte_di_si_ka_ben was b Fonte di rendimentu si ka ben di trabadju (0.46 conf)
nha_anual_na_doze_foi was c Nha rendimentu anual brutu na últimus doze mês foi (0.49 conf)
undefined__3 was undefined_3 (0.39 conf)
undefined__4 was undefined_4 (0.39 conf)
undefined__5 was undefined_5 (0.39 conf)
undefined__6 was undefined_6 (0.39 conf)
undefined__7 was undefined_7 (0.39 conf)
undefined__8 was undefined_8 (0.39 conf)
undefined__9 was undefined_9 (0.39 conf)
undefined__10 was undefined_10 (0.39 conf)
undefined__11 was undefined_11 (0.39 conf)
undefined__12 was undefined_12 (0.39 conf)
renda_ipoteka was Renda or Ipoteka (0.42 conf)
despezas_ki_ka_kobertu_pa_seguru was Despezas ki ka kobertu pa seguru (0.47 conf)
undefined__13 was undefined_13 (0.39 conf)
undefined__14 was undefined_14 (0.39 conf)
undefined__15 was undefined_15 (0.39 conf)
undefined__16 was undefined_16 (0.39 conf)
undefined__17 was undefined_17 (0.39 conf)
undefined__18 was undefined_18 (0.39 conf)
undefined__19 was undefined_19 (0.39 conf)
undefined__20 was undefined_20 (0.39 conf)
undefined__21 was undefined_21 (0.39 conf)
undefined__22 was undefined_22 (0.39 conf)
undefined__23 was undefined_23 (0.39 conf)
undefined__24 was undefined_24 (0.39 conf)
seguru_di_sa was Seguru di Saúdi (0.44 conf)
undefined__25 was undefined_25 (0.39 conf)
otu_spesifika__1 was Otu spesifika 1 (0.38 conf)
otu_spesifika__2 was Otu spesifika 2 (0.38 conf)
undefined__26 was undefined_26 (0.39 conf)
unknown__1 was 1 (0.38 conf)
unknown__2 was 2 (0.38 conf)
text__1 was Text1 (0.35 conf)
text__2 was Text2 (0.35 conf)
saldu_debedu__1 was Saldu debedu (0.35 conf)
valor_na_markadu was Valor na Markadu (0.49 conf)
saldu_debedu__2 was Saldu Debedu (0.35 conf)
x was x (0.34 conf)
digite_skrebe_nomi was DigiteSkrebe Nomi (0.49 conf)
nderesu was Nderesu (0.35 conf)
sidadi was Sidadi (0.35 conf)
stadu was Stadu (0.35 conf)
data_di_asinatura was Data di asinatura (0.38 conf)
text__3 was Text3 (0.35 conf)
text__4 was Text4 (0.35 conf)
text__5 was Text5 (0.35 conf)
text__6 was Text6 (0.35 conf)
text__7 was Text7 (0.35 conf)
text__8 was Text8 (0.35 conf)
text__9 was Text9 (0.35 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Kriolu di Cabo Verde

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02