APPLICATION FOR LEGAL ASSISTANCE
UNCOMPAHGRE VOLUNTEER LEGAL AID (UVLA)
Return completed application by mail to PO Box 488, Montrose CO 81402, or by email to firstname.lastname@example.org
Date of Birth
Spouse or Partner:
Please describe your disability:
No. of Adults in your Home
No. of Children in Home
Household Monthly Gross Income
Before Taxes & Expenses are Deducted
For office use: Household income is% of poverty level.
APPLICATION FOR LEGAL ASSISTANCE UVLA CONTINUED
Household Assets (Total amounts for applicant, spouse and all other residents)
Please write the amount in each space or write “none”
Real Estate equity (not including residence)
Cash on hand
Equity in vehicles not used for transportation
Household goods (value in excess of $3000)
Wearing apparel (value in excess of $1500)
CD’s, Money Mkt, etc.
(If yes, explain how income is likely to change):
If you listed no income above, how are you supporting yourself?
Please tell us what you pay each month for: rent/mortgage:
other (what is it?):
If your mailing address is different from your street address, please tell us your street address:
How did you hear about our program?
If you own a home, please tell us how much equity you have in your home: $
YOUR LEGAL PROBLEM:3>
Brief Description of Your Legal Problem:
Name(s) of Adverse/Opposing Party
Deadlines (Court dates, Answer dates, etc.)?
What County is your legal problem in?
Please tell us what you would like to do about your legal problem: