(A) In determining whether a defendant is unable to pay a fine or costs forthwith, the Court may require such defendant to file a petition, under oath, with the Court, upon a form provided by the Court, setting forth the financial condition of the defendant.
(B) Such form shall be a questionnaire and shall include, but shall not be limited to:
(1) The name and residence of the defendant and his or her occupation, if any;
(2) His or her family status and the number of persons dependent upon him or her;
(3) His or her monthly income;
(4) Whether his or her dependents are employed and, if so, their approximate monthly income;
(5) His or her banking accounts, if any;
(6) Real estate owned by the defendant or any interest he or she may have in real estate;
(7) Income produced therefrom;
(8) Any independent income accruing to the defendant; tangible and intangible personal property owned by the defendant or in which he or she may have an interest;
(9) A statement listing the approximate indebtedness of the defendant to other persons; and
(10) (a) 1. The payment plan of the defendant, should the Court exercise its discretion in permitting the payment of such fine or costs in installments or other conditions to be fixed by the Court; and
2. At the end of such form, there shall be printed in bold face type, in a distinctive color, the following:
THIS STATEMENT IS MADE UNDER OATH. ANY FALSE STATEMENT OF A MATERIAL FACT TO ANY QUESTION CONTAINED HEREIN SHALL CONSTITUTE FALSE SWEARING AND SHALL BE AN OFFENSE AGAINST THIS SECTION. THE MAXIMUM PENALTY IS $100 FINE OR THIRTY DAYS IN JAIL, OR BOTH. |
(b) A copy of the petition shall be retained by the defendant.
(C) (1) If the defendant is unable to read or write, the Court, or the Clerk, may assist the defendant in completing the petition and require him or her to affix his or her mark thereto.
(2) The consequences of the making of a false statement shall be explained to such defendant.
(1991 Code, § 11-11) Penalty, see § 37.99