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E-FILED 2013 NOV 10 7:20 AM SAC - CLERK OF DISTRICT COURT

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E-FILED 2013 NOV 10 7:20 AM SAC - CLERK OF DISTRICT COURT

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7. The Defendant is informed of his/her rights to a preliminary hearing and preliminary hearing is:^ . Set for the day of j Q C M t t r f e s , 2 _ , at {f l' -J t A . M .in the

Magistrate Courtroom, Courthouse, Sac City,Sac County. Iowa.Ifa preliminary hearing datehas beenset, you should contact the county attorney at (712)662-4791before attendingthis hearing todeterminewhetheror not itw i l lbe held.8. IFY O UH A V E N O T B E E N F I N G E R P R IN T E D A N D P H O T O G R A P H E DFOR THISO F F E N S E , Y O U M U S T R E P O R TTO THES A C C O U N T Y S H E R I F F ' S D E P A R T M E N T W I T H IN 10D A Y SF R O M THIS D A T E TO DO SO. IF D E F E N D A N THAS NOT P R E S E N T E D T H E M S E L V E S W I T H I N 10D A Y S F R O M THIS D A T E , THE SAC C O U N T Y S H E R I F F 'S D E P A R T M E N T IS O R D E R E D AT HISC O N V E N I E N C ETOP I C KUPD E F E N D A N TTO BE P H O T O G R A P H E D A N D F I N G E R P R IN T E D .

If you require the assistance of auxiliary aids or services to participate in court because of a disability,immediately callyour district A D Acoordinator at (641) 421-0990. (Ify ouare hearipgjimpaired, callRelay IowaT T Yat1-800-735-2942.)

Warren L. Bush/Joseph J . Heidenreich, Judicial Magistrate

Copies to:Sac County AttorneyDefendantSac CountySheriff

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IN TH E IOWA DISTRICT C OUR T FOR Sac

D'STRicrcouR-roF/nwS C COUNTYFILENOV 2 AH9: ?n

C O U N T Y n ^ C U

S T A T E OF IOWA orPlaintiff/Petitioner,vs.

Defendant/Respondent.

Criminal CivilO ^Ct fo lZ MSqFI N A N C I A L A FFI D A V I T /A PPL I C A T I ON

FOR A PPOIN T M E N T OF C OU N SE L

In support of my application for appointm ent of counsel, and under penalty of perjury, the undersigned states:B ir th Date : / / - J7 ^ ~ 9 ^a me : Y aJ nS .S 7^/-/^)E-mail: YY\9v\l\J/l f y j l (nA-rrwr I.C0StreetAddress: ^ l l V P.U S > g l I S f o g \ T \ L O t t ? I ft g O S S * *

Street/P.O.Box Apt City State ZipPendingcharges:Do youhaveajob? N o Job Yes, Full Time \pLYes,PartTime (ListHours/week: Q )Who do youworkfor? C - ^ K l f l g / J l ( l / S r . Q ^ x f v n g < ;H owmuchmoneydo youcurrentlymake beforetaxesordeductions? per hour month yearH owmuchmoney haveyo umadein the last 12monthsfrom any source, beforetaxesordeductions?H owmanyfamilymembersare supportedby or live withyou? ^Ifaspouselives with you, howmuchmoneydoesyourspousemake? per hour month yearList allother moneyyou, oranyone elseliving inyour household,hascomingin: Q

Listwhatyou ow n includingmoneyinbanks, cars,trucks,othervehicles,land,houses,buildings, cash,oranythingelseworthmore than 100: ^

Listamountsyou pay monthlyfo rmortgages,rent,carloans, creditcards,childsupport,or anyotherdebts: C }

Iunderstand I may be required to repay the State for all or part of my attorneyf sand costs, I may berequired to sign awageassignment, and I mustreport any changes in the information submitted on thisfinancialaffidavit..Ipromiseunderpenaltyofperjurythatthe statementsImakeinthisapplication are trueand thatI amunableto pay for anattorneytorepresent me.

Date 11-/0-/1 Signature / x ^ ? ^ , 4 ^ , J ~ ^ V y / ^ a ^ / ^Rev 1/6/12

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