In the    [  ] District    [  ] Justice    Court of Utah 

__________ Judicial District ________________ County 

Court Address ______________________________________________________ 

Order on Declaration of Financial 
Status (Criminal) 
(Utah Code 78B-22-201.5) 

_____________________________________ 
Plaintiff 

[  ] Hearing Requested 

v. 

_____________________________________ 
Defendant 

_______________________________ 
Case Number 

_______________________________ 
Judge 

The court finds: 

Based upon the facts in the Declaration of Financial Status (Criminal) and other 
testimony presented on the record, the court finds: 

[   ] The Defendant is indigent 

[   ] The Defendant is NOT indigent 

[   ] 
Other:_________________________________________________________________ 

The court orders: 

[   ] A lawyer is appointed to represent the Defendant in this case. 

[   ] The Defendant is NOT entitled to an appointed lawyer. 

This order is subject to modification in the event the financial circumstances of the 
Defendant changes during the time that this case is being actively litigated in this court.   

(Judge’s signature may instead appear at the top of the first page of this document.) 

 

Date 

 

 

Signature ► 

Judge 

 

 

 

1002CRJ Approved January 18, 2022 

Order on Declaration of Financial Status (Criminal) 

Page 1 of 1 



Order on Declaration of Financial Status (Criminal)

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