Lynnwood, WA · Snohomish County
Confidential Indigency Screening Form
This confidential form is for people asking the Lynnwood Municipal Court to determine whether they qualify for public defense services based on their financial circumstances.
What this form is
The form collects information for the Lynnwood Municipal Court to determine indigency and eligibility for public defense services. Applicants report household income, benefits, dependents, assets, and routine expenses, then sign a declaration that the information is true and agree to notify the court of financial changes. The court section records the eligibility determination.
Who needs it
People asking the Lynnwood Municipal Court to determine their eligibility for public defense services should complete this form.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; the signer dates a declaration under penalty of perjury, but the form does not request notarization.
How to submit this form
- 1
Download The Form
Download the Confidential Indigency Screening Form.
- 2
Complete The Questions
Provide information about your household, income, benefits, assets, and expenses.
- 3
Sign And Date
Sign and date the declaration confirming the information is true and agreeing to notify the court of financial changes.
- 4
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- Do I need a notary for the Confidential Indigency Screening Form?
- No. The form does not request notarization; the signer signs and dates a declaration under penalty of perjury.
- How do I submit the Confidential Indigency Screening Form?
- Submit it to the city department named on the form; check the city website for current contact details.
- What information does the form ask for?
- It asks about benefits, employment, household income and dependents, assets, routine expenses, and whether you have funds to hire a private attorney.
Need something notarized?
This Confidential Indigency Screening Form doesn’t need a notary — but if you have another Lynnwood form that does, a commissioned online notary can help.