What is the Statement of Inability to Afford Payment of Court Costs?

It is a form for a person in a court case to give financial information and declare they cannot afford court costs or an appeal bond or cash deposit.

What information does the form ask for?

It asks about your identity, case, dependents, public benefits, income, property, monthly expenses, debts, and other facts about your financial situation.

How do I submit the Statement of Inability to Afford Payment of Court Costs?

File the form with the clerk’s office. The form says the clerk’s office will fill in the cause number when you file, but it does not give an address or submission method.

Houston County, TX · Houston County

No notary required

Statement of Inability to Afford Payment of Court Costs or an Appeal Bond

This form lets a person in a court case explain their finances and declare they cannot afford court costs or an appeal bond.

At a glance

Issued by: City of Houston County · Houston County, Houston County, Texas
Notarization: Not required: file this form without a notary.
Official source: co.houston.tx.us
Blank form: Download the PDF
Catalogued: Oct 5, 2026
Machine-readable: JSON record · about the forms index

What this form is

Use this form to ask the court to consider your inability to pay court costs or furnish an appeal bond or cash deposit for an appeal from a justice court decision. It asks for personal and case information, dependents, benefits, income, property, expenses, debts, and other financial facts. Attach proof of benefits or legal-aid documentation when applicable; an additional page may be attached for supporting facts.

Who needs it

A person in a court case who cannot afford court costs or an appeal bond can complete this statement and provide financial information.

How to submit it

File it with the clerk’s office, which will fill in the cause number when you file; the form does not provide an address or submission method.

About notarization

This form is signed without a notary; the signer declares under penalty of perjury and swears they cannot afford court costs or an appeal bond.

How to submit this form

1
Download the Form
Download the Statement of Inability to Afford Payment of Court Costs or an Appeal Bond.
2
Complete the Form
Provide your case and personal information, then complete the sections about benefits, income, property, expenses, and debts.
3
Gather Supporting Documents
Attach proof of public benefits or legal-aid documentation when applicable; attach an additional page for other supporting facts if needed.
4
File With the Clerk
File the completed form with the clerk’s office; the office will fill in the cause number when you file.

Frequently asked questions

What is the Statement of Inability to Afford Payment of Court Costs?: It is a form for a person in a court case to give financial information and declare they cannot afford court costs or an appeal bond or cash deposit.
What information does the form ask for?: It asks about your identity, case, dependents, public benefits, income, property, monthly expenses, debts, and other facts about your financial situation.
Do I need a notary for the Statement of Inability to Afford Payment of Court Costs?: No. The form has no notary block; the signer declares under penalty of perjury and swears they cannot afford court costs or an appeal bond.
How do I submit the Statement of Inability to Afford Payment of Court Costs?: File the form with the clerk’s office. The form says the clerk’s office will fill in the cause number when you file, but it does not give an address or submission method.

Need something notarized?

This Statement of Inability to Afford Payment of Court Costs or an Appeal Bond doesn’t need a notary, but Texas residents can notarize other documents online with a commissioned online notary.