What information and documents does the form require?

It asks about your personal and financial situation, including income, expenses, property, dependents, and public benefits. Attach supporting financial documentation to prove your current situation.

Do I need a notary for the Statement of Inability to Afford Payment of Fine/Court Costs?

No. The document has no notary block; you sign and date its declaration under penalty of perjury and attach supporting financial documentation.

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

Submit the completed form to the Court with supporting financial documentation. The form does not list an address, email, or online submission portal.

Westlake, TX · Tarrant County

No notary required

Statement of Inability to Afford Payment of Fine/Court Costs

This form lets a person with a Westlake Municipal Court matter request indigency consideration for fines, court costs, and fees.

What this form is

The Westlake Municipal Court uses this form for a person who believes they are indigent and cannot afford payment of fines, court costs, or fees. The applicant provides personal, employment, dependent, property, expense, and public-benefit information, and must attach supporting financial documentation. The form also asks the applicant to sign a declaration and indicate whether they want the judge to review the request or hold an indigency hearing.

Who needs it

A person who believes they are indigent and owes fines, court costs, or fees to the Westlake Municipal Court should complete this form.

How to submit it

Submit the completed form to the Court with supporting financial documentation proving your current situation; the form does not provide an address, email, or portal.

About notarization

This document is signed and dated without a notary; the signer makes a declaration under penalty of perjury and attaches supporting financial documentation.

How to submit this form

1
Download the Form
Download the fillable Statement of Inability to Afford Payment of Fine/Court Costs.
2
Complete Every Field
Answer all questions, write “NA” where a question does not apply, and do not leave blanks.
3
Gather Supporting Documents
Attach financial documentation to prove your current situation.
4
Sign and Submit
Sign and date the declaration, then submit the form and supporting documents to the Court.

Frequently asked questions

What is the Statement of Inability to Afford Payment of Fine/Court Costs?: It is a Westlake Municipal Court form for a person who believes they are indigent to request consideration for fines, court costs, and fees.
What information and documents does the form require?: It asks about your personal and financial situation, including income, expenses, property, dependents, and public benefits. Attach supporting financial documentation to prove your current situation.
Do I need a notary for the Statement of Inability to Afford Payment of Fine/Court Costs?: No. The document has no notary block; you sign and date its declaration under penalty of perjury and attach supporting financial documentation.
How do I submit the Statement of Inability to Afford Payment of Fine/Court Costs?: Submit the completed form to the Court with supporting financial documentation. The form does not list an address, email, or online submission portal.

Need something notarized?

This Statement of Inability to Afford Payment of Fine/Court Costs doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.