Affidavit And Application To Proceed In Forma Pauperis
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Affidavit And Application To Proceed In Forma Pauperis Form. This is a Nebraska form and can be use in 3rd District Local County.
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Tags: Affidavit And Application To Proceed In Forma Pauperis, Nebraska Local County, 3rd District
STATE OF NEBRASKA
FORM NO. DC 6:7(1)
Rev. 1/08 Neb. Rev. Stat.
25-2301 to 25-2310
AFFIDAVIT AND APPLICATION TO
PROCEED IN FORMA PAUPERIS
CASE NUMBER:
(assigned by Clerk of Court)
IN THE DISTRICT COURT OF _______________________ COUNTY, NEBRASKA
(county where Complaint filed)
___________________________,
(your full name)
Plaintiff,
vs.
___________________________,
(spouse’s full name)
Defendant.
STATE OF NEBRASKA
COUNTY OF ___________________
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AFFIDAVIT AND APPLICATION
TO PROCEED
IN FORMA PAUPERIS
(Request to Proceed Without
Payment of Fees)
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(county where signed)
The undersigned, being first duly sworn on oath, deposes and says that:
1.
I am the plaintiff in an action for Dissolution of Marriage, and I am of lawful
2.
I bring this action in good faith, and I am entitled to redress.
3.
I am unable to pay the cost of litigation, including the cost of publication,
age.
and am unable to provide security.
4.
I have a net income of only $____________________
(your net monthly income)
per month, derived from ________________________________,
(i.e., employment, public benefits, Social Security, etc.)
and I support a household of ________ people.
(number of people you support)
5.
My living expenses wholly absorb my income, and I
have no assets that can be liquidated.
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WHEREFORE, pursuant to Neb.Rev.Stat. §§ 25-2301 to 25-2310, I request that
the Court authorize me to proceed in forma pauperis and direct ___________________
(name of county where Complaint filed)
County, Nebraska, to pay my costs, including fees and other expenses related to this
action and waive provision of security.
________________________________
Plaintiff (print name)
________________________________
Signature
SUBSCRIBED AND SWORN to before me this _____day of ________________,
20___.
________________________________
Notary Public
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