OCCA

ORDER ADOPTING NEW FORMS

¶1 Pursuant to revisions made to Section 983 of Title 22 of the Oklahoma Statutes, we find that new forms should be adopted. Revision of the Rules of the Oklahoma Court of Criminal Appeals by the creation of new Forms 13.17a, 13.17b, 13.17c, 13.17d, 13.17e, 13.17f, and 13.17g is necessary. Therefore, pursuant to the provisions of Section 1051(B) of Title 22 of the Oklahoma Statutes, we promulgate the following new Forms as portions of the Rules of the Oklahoma Court of Criminal Appeals, Title 22, Ch.18, App. (2023), as follows:

Form 13.17a Affidavit Regarding Ability to Pay

IN THE DISTRICT COURT OF ___________ COUNTY

STATE OF OKLAHOMA

STATE OF OKLAHOMA,
Plaintiff,

___________________________,
Defendant.

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Case Nos.:

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AFFIDAVIT REGARDING ABILITY TO PAY

[This affidavit and any supporting documents shall not be visible on a court-controlled website. 22 O.S. § 983(I).
If you need additional space on any questions, please use page 5 or attach additional pages.]

GOVERNMENT BENEFITS

Do you receive (circle all that apply):

SNAP (food stamps)

WIC

TANF

SSI

SSDI

Tribal Disability

Veterans Disability

Section 8 (Housing Choice Voucher)

Other housing assistance (be specific): ______________________________________________________________________

Other federal need-based support (be specific): _______________________________________________________________

Proof is attached for the following programs: __________________________________________________________________

INCOME

Do not list any disability or other government benefits listed above.

Number of adults in household: ____ Number of children that you support: ___

	Defendant	Adult 2	Adult 3	Adult 4
Relationship to you: (spouse, parent, etc.)	Yourself	_______________	_______________	_______________
Income Amount:	_______________	_______________	_______________	_______________
Income source: (employment, gift, etc.)	_______________	_______________	_______________	_______________
How often? (week/month)	_______________	_______________	_______________	_______________
Do you support this person?	Yes	_______________	_______________	_______________

If you support adults in your household, explain why you must support them:

______________________________________________________________________________

Are you currently employed? Yes / No How long employed/unemployed? _____________

Highest Grade/Degree completed: _____________

In the past ten (10) years, what was your longest term of employment? (employer/job title/how long)

______________________________________________________________________________

Are you currently still doing that type of work? Yes / No

If no, describe any barriers preventing you from going back to that type of work:

______________________________________________________________________________

Do you have any physical or mental health conditions that make it difficult for you to work or manage your money? If yes, describe:

______________________________________________________________________________

List any other reasons you would like the judge to know about why it is difficult for you to earn enough income to pay your fines/fees off:

______________________________________________________________________________

EXPENSES

List your expenses. The Court may ask you to provide proof of these expenses, so bring proof with you to your cost hearing.

Expense:	Amount:	Last time late (or amount behind):	Expense:	Amount:	Last time late (or amount behind):
Rent/Mortgage	__________	_______________	_______________	__________	_______________
Utilities (Water/Phone/Power)	__________	_______________	_______________	__________	_______________
Car payment	__________	_______________	_______________	__________	_______________
Insurance	__________	_______________	_______________	__________	_______________
Child care/expenses	__________	_______________	_______________	__________	_______________
Medical Bills Insurance/Prescriptions	__________	_______________	_______________	__________	_______________

List any additional expenses:

_____________________________________________________________________________

Do you pay child support? Yes / No If so, how much per month? ________

Are you behind on child support? Yes / No If so, how much? ______

Do you have to pay any other expenses on these cases (restitution, DA fees, probation fees, drug test fees)? If yes, please describe.

_____________________________________________________________________________

When was the last time you had difficulty paying for food? What did you do?

_____________________________________________________________________________

When was the last time you had difficulty paying for housing? What did you do?

_____________________________________________________________________________

ASSETS

Do you own the following:

Your Home: Yes / No

Investments (stocks/bonds): Yes / No

Other land/homes: Yes / No

More than one vehicle: Yes / No

(Car, truck, motorcycle,

Boat, ATV, etc.)

The land your home is on: Yes / No

Vehicle: Yes / No (With Loan Yes / No)

Bank Accounts: Yes/No Value: ______

If you answered "Yes" to any of the answers in the box above, please describe this property:

______________________________________________________________________________

List any additional expenses:

_____________________________________________________________________________

When was the last time you had to sell or pawn something to pay for an expense? Describe what happened.

______________________________________________________________________________

OTHER INFORMATION

Is there a definite date when your financial situation will improve or worsen? (For example, you will start working on X date, your disability payments will start on X date, or you will lose your housing on X date.) If yes, please describe.

______________________________________________________________________________

If someone can verify your financial situation, please attach a letter from that person. For example, a case manager at a shelter, a clergy member who provides you with assistance, etc.

I declare under penalty of perjury under the laws of Oklahoma that the foregoing is true and correct to the best of my knowledge and belief.

Date:_____________________ Respectfully submitted,

Respectfully submitted,

____________________________________
Signature

____________________________________
Name

____________________________________

____________________________________
Address

____________________________________
Phone

Additional information:

[ ] Attached ____________________________________

[ ] Not Attached Phone

ADDITIONAL INFORMATION

Use this page if you need additional space to respond to any question. Attach additional pages if needed. Please indicate which section you are responding to (e.g. Benefits, Income, Expenses, Assets, Other).

______________________________________________________________________________

Form 13.17b Summons for Court Financial Obligations (District)

IN THE DISTRICT COURT OF ___________ COUNTY

STATE OF OKLAHOMA

STATE OF OKLAHOMA,
Plaintiff,

___________________________,
Defendant.

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Case Nos.:

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SUMMONS FOR COURT FINANCIAL OBLIGATIONS

To: _______________________ (Name)
__________________________

__________________________ (Address)

[ ] Delivered in Person

[ ] Delivered by Mail

Hearing Date and Time: ______________________

Judge: ______________________

Courtroom: ______________________

Court Address: ______________________

Court Clerk Phone: ______________________

You are ORDERED to appear for a COST HEARING at the above specified time, place, and date to determine if you are financially able to pay the fines, costs, fees, or assessments or an installment due in the above cases.

YOU MUST BE PRESENT AT THE HEARING.

At any time before the date of the cost hearing, you may contact the court clerk and pay the amount due or request in writing or in person prior to the court date, that the hearing be rescheduled for up to thirty (30) days after the scheduled time.

THIS IS NOT AN ARREST WARRANT. However, if you fail to appear for the cost hearing or fail to pay the amount due, the court will issue a WARRANT and refer the case to a court cost compliance liaison which will cause an additional administrative fee of up to thirty percent (30%) to be added to the amount owed and may include additional costs imposed by the court.

Issued this _______ day of ______________, 20___.

[Clerk Signature and Seal Block,
automated, similar to Jury Summons.]

You may consult with counsel prior to your hearing, and you may have counsel present at your hearing.

Form 13.17c Summons for Court Financial Obligations (Municipal)

IN THE MUNICIPAL COURT OF THE CITY/TOWN OF ___________

STATE OF OKLAHOMA

THE CITY/TOWN OF_________________
Plaintiff,

___________________________,
Defendant.

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Case Nos.:

__________________

SUMMONS FOR COURT FINANCIAL OBLIGATIONS

To: _______________________ (Name)
__________________________

__________________________ (Address)

[ ] Delivered in Person

[ ] Delivered by Mail

Hearing Date and Time: ______________________

Judge: ______________________

Courtroom: ______________________

Court Address: ______________________

Court Clerk Phone: ______________________

YOU MUST BE PRESENT AT THE HEARING.

THIS IS NOT AN ARREST WARRANT. However, if you fail to appear for the cost hearing or fail to pay the amount due, the court will issue a WARRANT and refer the case to a court cost compliance liaison which will cause an additional administrative fee of up to thirty-five percent (35%) to be added to the amount owed and may include additional costs imposed by the court.

Issued this _______ day of ______________, 20___.

[Clerk Signature and Seal Block,
automated, similar to Jury Summons.]

You may consult with counsel prior to your hearing, and you may have counsel present at your hearing.

Form 13.17d Cost Arrest Warrant (District)

IN THE DISTRICT COURT OF ___________ COUNTY

STATE OF OKLAHOMA

STATE OF OKLAHOMA,
Plaintiff,

___________________________,
Defendant.

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Case Nos.:

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COST ARREST WARRANT

THE STATE OF OKLAHOMA TO LAW ENFORCEMENT OFFICER WITHIN THE STATE OF OKLAHOMA:

You are COMMANDED to arrest:

Defendant: ________________________ SSN: XXX-XX-_____ Sex: _____ Hair: ____

Address: ________________________ DOB: __/__/_____ Eyes: _____ Weight: ____

________________________ Height: ____

and bring him/her before the Court or if the court is adjourned or is not in session, that you retain him/her in your custody or deliver him/her to the lawful custodian of inmates of the ___________ County Jail subject to further order of the Court.

ATTENTION BOOKING DEPARTMENT:

The Defendant may also be released upon payment of One Hundred Dollars ($100) remitted to the Court Clerk of _______ County towards his/her Court Financial Obligations and obtaining a new cost hearing date from said Clerk.

The Defendant is entitled to a cost hearing or willfulness hearing before the Court within seventy-two (72) hours of arrest. If the Defendant remains in your custody after seventy-two (72) hours from the time of arrest without appearance before the Court for a cost hearing or willfulness hearing, you are directed to contact the ________ County Court Clerk to obtain a cost hearing date for the Defendant, provide the Defendant with this information, and release the Defendant on his/her own recognizance.

Given under my hand this _____ day of _________, 20___.

By Order of the Court:

The Clerk shall refer this case to the cost compliance program.

By: _________________________

Judge of the District Court

OFFICER'S RETURN OF SERVICE

Received this ___ day of ___________, 20__, at ____ o'clock ___.M. and served the same by taking the above named person into custody on the _______ day of ______________________, 20____, and delivering the person to the judge named.

Serving Warrant:$_______
Copy: $_______

Mileage: $_______

(_______ Miles @ ____ per mile)

Total: $_______

____________________________, Sheriff

____________________________, County, Oklahoma

By: __________________, Deputy

WARRANT NUMBER:

Form 13.17e Cost Arrest Warrant (Municipal)

IN THE MUNICIPAL COURT OF THE CITY/TOWN OF ___________

STATE OF OKLAHOMA

THE CITY/TOWN OF_________________
Plaintiff,

___________________________,
Defendant.

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Case Nos.:

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COST ARREST WARRANT

[This warrant may be served at any place within the State of Oklahoma. 11 O.S. § 27-113.]

THE CITY/TOWN OF ______________ TO ANY LAW ENFORCEMENT OFFICER WITHIN THE STATE OF OKLAHOMA:

You are COMMANDED to arrest:

Defendant: ________________________ SSN: XXX-XX-_____ Sex: _____ Hair: ____

Address: ________________________ DOB: __/__/_____ Eyes: _____ Weight: ____

________________________ Height: ____

ATTENTION BOOKING DEPARTMENT:

The Defendant may be released upon payment of One Hundred Dollars ($100) remitted to the Court Clerk of the City/Town of ___________ towards his/her Court Financial Obligations and obtaining a new cost hearing date from said Clerk.

The Defendant is entitled to a cost hearing or willfulness hearing before the Court within seventy-two (72) hours of arrest. If the Defendant remains in your custody after seventy-two (72) hours from the time of arrest without appearance before the Court for a cost hearing or willfulness hearing, you are directed to contact the Court Clerk of the City/Town of __________ to obtain a cost hearing date for the Defendant, provide the Defendant with this information, and release the Defendant on his/her own recognizance.

Given under my hand this _____ day of _________, 20___.

By Order of the Court:

The Clerk shall refer this case to the cost compliance program.

By: _________________________

Judge of the Municipal Court

OFFICER'S RETURN OF SERVICE

Serving Warrant:$_______
Copy: $_______

Mileage: $_______

(_______ Miles @ ____ per mile)

Total: $_______

____________________________, Sheriff

____________________________, County, Oklahoma

By: __________________, Deputy

WARRANT NUMBER:

Form 13.17f Cost Cite and Release Warrant (District)

IN THE DISTRICT COURT OF ___________ COUNTY

STATE OF OKLAHOMA

STATE OF OKLAHOMA,
Plaintiff,

___________________________,
Defendant.

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Case Nos.:

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COST CITE AND RELEASE WARRANT

[No fees shall accrue to Defendant due to the issuance or service of this warrant. 22 O.S. § 983(C)(4)]

TO ANY LAW ENFORCEMENT OFFICER WITHIN THE STATE OF OKLAHOMA:

Upon encountering:

Defendant: ________________________ SSN: XXX-XX-_____ Sex: _____ Hair: ____

Address: ________________________ DOB: __/__/_____ Eyes: _____ Weight: ____

________________________ Height: ____

You are COMMANDED to issue to the Defendant a Warning/Notice to have Defendant appear before the Court Clerk of _____________ County for the purposes of setting cost hearing within ten (10) days of the issuance of the Warning/Notice. You SHALL NOT ARREST the Defendant based on this warrant. However, this does not prevent you from arresting the Defendant based on another warrant, or upon probable cause. If you arrest the Defendant based on another warrant or upon probable cause, the Warning/Notice shall provide ten (10) days to report to the Court Clerk of __________ County upon Defendant's release from custody.

If the Defendant shows you proof of another Warning/Notice issued for this warrant in the previous ten (10) days, you SHALL NOT issue an additional Warning/Notice.

Given under my hand this _____ day of _________, 20___.

By Order of the Court:

The Clerk shall refer this case to the cost compliance program.

By: _________________________

Judge of the District Court

OFFICER'S RETURN OF SERVICE

[If the Officer electronically transmits to the relevant Court Clerk a Warning/Notice issued based on the above warrant, the Officer is excused from completing this return of service.]

On the ____ day of ____________, 20___, I issued a Warning/Notice to the above-named Defendant, directing him/her to report to the Court Clerk of _________ County within ten (10) days. A copy of the Warning/Notice is attached. I returned this warrant and warning/notice to the appropriate person within my agency on the ____ day of _________, 20___, for transmission to the appropriate Court Clerk. [within 5 days]

____________________________, Law Enforcement Agency

By: __________________, Law Enforcement Officer

WARRANT NUMBER:

Form 13.17g Cost Cite and Release Warrant (Municipal)

IN THE MUNICIPAL COURT OF THE CITY OF ___________

STATE OF OKLAHOMA

THE CITY/TOWN OF_________________
Plaintiff,

___________________________,
Defendant.

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Case Nos.:

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COST CITE AND RELEASE WARRANT

[No fees shall accrue to Defendant due to the issuance or service of this warrant. 22 O.S. § 983(C)(4)]

TO ANY LAW ENFORCEMENT OFFICER WITHIN THE STATE OF OKLAHOMA:

Upon encountering:

Defendant: ________________________ SSN: XXX-XX-_____ Sex: _____ Hair: ____

Address: ________________________ DOB: __/__/_____ Eyes: _____ Weight: ____

________________________ Height: ____

You are COMMANDED to issue to the Defendant a Warning/Notice to have Defendant appear before the Court Clerk of the City/Town of ___________ for the purposes of setting cost hearing within ten (10) days of the issuance of the Warning/Notice. You SHALL NOT ARREST the Defendant based on this warrant. However, this does not prevent you from arresting the Defendant based on another warrant, or upon probable cause. If you arrest the Defendant based on another warrant or upon probable cause, the Warning/Notice shall provide ten (10) days to report to the Court Clerk of the City/Town of ___________ upon Defendant's release from custody.

If the Defendant shows you proof of another Warning/Notice issued for this warrant in the previous ten (10) days, you SHALL NOT issue an additional Warning/Notice.

Given under my hand this _____ day of _________, 20___.

By Order of the Court:

Optional: [ ] Refer to cost compliance program.

By: _________________________

Judge of the Municipal Court

OFFICER'S RETURN OF SERVICE

[If the Officer electronically transmits to the relevant Court Clerk a Warning/Notice issued based on the above warrant, the Officer is excused from completing this return of service.]

On the ____ day of ____________, 20___, I issued a Warning/Notice to the above-named Defendant, directing him/her to report to the Court Clerk of the City/Town of ______________ within ten (10) days. A copy of the Warning/Notice is attached. I returned this warrant and warning/notice to the appropriate person within my agency on the ____ day of _________, 20___, for transmission to the appropriate Court Clerk. [within 5 days]

____________________________, Law Enforcement Agency

By: __________________, Law Enforcement Officer

WARRANT NUMBER:

¶2 IT IS SO ORDERED.

¶3 WITNESS OUR HANDS AND THE SEAL OF THIS COURT this 8th day of November, 2023.

/S/SCOTT ROWLAND, Presiding Judge

/S/ROBERT L. HUDSON, Vice Presiding Judge

/S/GARY L. LUMPKIN, Judge

/S/DAVID B. LEWIS, Judge

/S/WILLIAM J. MUSSEMAN, Judge

ATTEST:

/s/John D. Hadden

Clerk


Court:
Case Number: