Form CR-206 "Financial Statement" - Alaska

What Is Form CR-206?

This is a legal form that was released by the Alaska Court System - a government authority operating within Alaska. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2020;
  • The latest edition provided by the Alaska Court System;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CR-206 by clicking the link below or browse more documents and templates provided by the Alaska Court System.

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Download Form CR-206 "Financial Statement" - Alaska

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CR206
IN THE DISTRICT/SUPERIOR COURT FOR THE STATE OF ALASKA
AT
State of Alaska
)
In the Matter of
)
)
vs.
)
CASE NO.
)
)
FINANCIAL STATEMENT
Defendant or Minor.
)
For Appointment of Counsel
)
For Restitution
Full Name
Date of Birth
Residence Address
Mailing Address
1
Email Address
Soc. Sec. No.
Cell Phone
Work Phone
Home Phone
Are you under the age of 18?
No
Yes. If yes, one of your parents must appear and provide
financial information regarding the income of both parents.
Have you filled out a financial statement to apply for a court-appointed attorney within the past 12
months?
Yes
No
Was an attorney appointed for you?
Yes
No
Are you receiving public assistance?
No
Yes. If yes, check those you receive:
SSI
Food Stamps
Adult Public Assistance
ATAP
General Relief
Medicaid
Are you working now?
Yes
No
If no, date last worked
Present employer
(If not now employed, state last employer and length of job.)
Employer’s address
Other employers in past year
Are you a seasonal worker?
Yes
No If yes, describe:
Are you self-employed?
Yes
No If yes, describe:
1.
DEFENDANT’S INCOME INFORMATION (after taxes, but before other deductions)
Do not include income of spouse. If under age 18, list income of defendant and parents.
a. Current Monthly Income
Wages
$
Social Security
$
Public Assistance
$
Unemployment
$
2
Self-Employment Income (attach proof
)
$
Other (specify)
$
Total Monthly Income
$
b. Permanent Fund Dividends received in last 12 months
$
c. ANCSA or other corporate dividends received in last 12 months
$
d. Value of gifts received in last 12 months
$
e. Total Income during last 12 months
$
1
Social Security number is not mandatory. It may be used to identify your assets.
2
Examples include sales tax reports, bank statements, tax returns, cannery settlement statements.
Page 1 of 4
CR-206 (1/20)(cs)
AS 18.85
FINANCIAL STATEMENT
Crim. R. 32.1, 32.6 39, and 39.1
CR206
IN THE DISTRICT/SUPERIOR COURT FOR THE STATE OF ALASKA
AT
State of Alaska
)
In the Matter of
)
)
vs.
)
CASE NO.
)
)
FINANCIAL STATEMENT
Defendant or Minor.
)
For Appointment of Counsel
)
For Restitution
Full Name
Date of Birth
Residence Address
Mailing Address
1
Email Address
Soc. Sec. No.
Cell Phone
Work Phone
Home Phone
Are you under the age of 18?
No
Yes. If yes, one of your parents must appear and provide
financial information regarding the income of both parents.
Have you filled out a financial statement to apply for a court-appointed attorney within the past 12
months?
Yes
No
Was an attorney appointed for you?
Yes
No
Are you receiving public assistance?
No
Yes. If yes, check those you receive:
SSI
Food Stamps
Adult Public Assistance
ATAP
General Relief
Medicaid
Are you working now?
Yes
No
If no, date last worked
Present employer
(If not now employed, state last employer and length of job.)
Employer’s address
Other employers in past year
Are you a seasonal worker?
Yes
No If yes, describe:
Are you self-employed?
Yes
No If yes, describe:
1.
DEFENDANT’S INCOME INFORMATION (after taxes, but before other deductions)
Do not include income of spouse. If under age 18, list income of defendant and parents.
a. Current Monthly Income
Wages
$
Social Security
$
Public Assistance
$
Unemployment
$
2
Self-Employment Income (attach proof
)
$
Other (specify)
$
Total Monthly Income
$
b. Permanent Fund Dividends received in last 12 months
$
c. ANCSA or other corporate dividends received in last 12 months
$
d. Value of gifts received in last 12 months
$
e. Total Income during last 12 months
$
1
Social Security number is not mandatory. It may be used to identify your assets.
2
Examples include sales tax reports, bank statements, tax returns, cannery settlement statements.
Page 1 of 4
CR-206 (1/20)(cs)
AS 18.85
FINANCIAL STATEMENT
Crim. R. 32.1, 32.6 39, and 39.1
CR206
f.
Do you expect to receive other income in the next 6 months (for example, settlements,
dividends, gifts, inheritances)?
Yes
No
If yes, please specify
2.
HOUSEHOLD MEMBERS (People who live with you)
Name
Age
Relationship
3.
MONTHLY HOUSEHOLD EXPENSES
Expense
Amount
Balance Owed
Past Due
Housing (rent or mortgage)
$
$
$
Food
$
$
$
Utilities:
Electricity
$
$
$
Gas
$
$
$
Water and Sewer
$
$
$
Garbage
$
$
$
Telephone
$
$
$
Transportation (gas/bus)
$
$
$
Car or truck payment
$
$
$
Insurance
$
$
$
Child support and alimony
$
$
$
List Loans & Credit Card Debts:
$
$
$
$
$
$
$
$
$
$
$
$
Medical (not covered by insurance)
$
$
$
Childcare:
$
$
$
IRS Back Taxes Due
$
$
$
TOTALS
$
$
$
ADJUSTMENTS TO EXPENSES:
a. Are you married?
Yes
No
If yes, list spouse’s total income after taxes for the past 12 months
(include gifts, settlements, inheritances, wages, dividends, etc.):
$
Note: For purposes of deciding appointment of counsel, expenses will be divided
between the spouses proportionate to each spouse’s income.
b. Are any household expenses paid by someone other than you or your spouse (such as by
a roommate, parent, grandparent or child)?
No
Yes. If yes, list:
$
Name
Relationship
Amount
$
Name
Relationship
Amount
$
Name
Relationship
Amount
Page 2 of 4
CR-206 (1/20)(cs)
AS 18.85
FINANCIAL STATEMENT
Crim. R. 32.1, 32.6 39, and 39.1
CR206
4.
CASH AND ASSETS (things you own or are buying) Include all things you own by yourself and
all things you own jointly with someone else.
Value
Amount Still Owed
Cash
$
Bank Acct./Checking
$
Bank Acct./Savings
$
Stocks, Bonds, CD’s
$
Mutual Funds
$
Retirement Plans
$
Life Insurance (cash value)
$
Land, Homes, Trailers
$
$
Motor Vehicles (describe):
$
$
$
$
$
$
$
$
TV, Stereo, VCR
$
$
Computer Equipment
$
$
Snow Machines, ATVs, Sport
Boats, Airplanes, Motorcycles
$
$
Jewelry, Precious Metals or
Precious Stones
$
$
Furs ............................................ $
$
Collections (Coins, Ivory, etc.)
$
$
Tools ........................................... $
$
Guns ........................................... $
$
Sports Equipment (Kayaks,
Skis, Scuba Gear, etc.)
$
$
Fishing Gear, Nets, etc. ................ $
$
IFQ’s, Quota Shares, etc. .............. $
$
Commercial Fishing Permits .......... $
$
Commercial Fishing Boats. ............ $
$
Businesses:
$
$
$
$
Other:
$
$
$
$
TOTALS $
(-) $
= $
Do you need any of the above items to earn your living?
Yes
No
If yes, list the item and describe why you need it:
Page 3 of 4
CR-206 (1/20)(cs)
AS 18.85
FINANCIAL STATEMENT
Crim. R. 32.1, 32.6 39, and 39.1
CR206
CREDIT CARDS. List all your credit cards.
5.
Min. Monthly
Name of Card (Visa, MC, AMEX)
Credit LimitBalance Owed
Payment
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
OTHER EXPENSES
6.
Expense
Monthly Amount
Cable TV
$
Club Membership Fees
$
Internet Fees
$
Subscriptions (magazines, newspapers, etc.)
$
Entertainment (dining out, sporting events, etc.)
$
Alcohol and Tobacco
$
TOTAL
$
OATH
WARNING: Making false statements under oath is a crime.
I declare, under oath, that the above Financial Statement is true.
Date
Signature of Defendant or Parent
Subscribed and sworn to or affirmed before me in
, Alaska
on
.
(date)
(SEAL)
Clerk of Court, Notary Public or other person authorized
to administer oaths.
My commission expires:
Page 4 of 4
CR-206 (1/20)(cs)
AS 18.85
FINANCIAL STATEMENT
Crim. R. 32.1, 32.6 39, and 39.1
Page of 4