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Affidavit And Order To Accompany Motion For Leave To Appeal In Forma Pauperis Form. This is a Nevada form and can be use in Supreme Court Statewide.
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Tags: Affidavit And Order To Accompany Motion For Leave To Appeal In Forma Pauperis, 4, Nevada Statewide, Supreme Court
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
Index No.
Calendar No.
Form 4. Affidavit and Order to Accompany Motion for :Leave to Appeal inSUBPOENA
JUDICIAL Forma
Plaintiff(s)
Pauperis
-against-
No. ……………
:
:
Dept. No. ……….
IN THE ................ JUDICIAL DISTRICT COURT OF THE
:
STATE OF NEVADA IN AND FOR
THE COUNTY OF ................
Defendant(s)
:
......................................................
STATE OF NEVADA
}
v.
}
A. B.
} NEW YORK
THE PEOPLE OF THE STATE OF
AFFIDAVIT IN SUPPORT OF MOTION TO PROCEED
ON APPEAL IN FORMA PAUPERIS
TO
State of Nevada
GREETINGS:
County of ………………
}
}ss.
}
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
Court
I, ................................ being first at the sworn, depose and say that I am the
duly
located at
County of
................................ in the above-entitled case; that in support of my motion to proceed on appeal
in room
, on the
day of
,
o'clock the
noon, and
without being required to prepay fees, cost or 20 security therefor, instate that because at any recessed
give , at
I
of my
or adjourned date, to testify and give evidence as a witness in this action on the part of the
poverty I am unable to pay the costs of said proceeding or to give security therefor; that I believe
I am entitled to redress; and that the issues which I desire to present on appeal are the following:
Your failure to comply the responses whichpunishable as a contempt of court and will make you liable to
I further swear that with this subpoena is I have made to the questions and instructions
the partyrelating tobehalf this subpoena was issued for a maximum appeal are $50 and all damages sustained as a
below on whose my ability to pay the cost of prosecuting the penalty of true.
result of your failure to comply.
1. Are you presently employed?
Witness, answer is
, one of month and give
a. If theHonorable yes, state the amount of your salary or wages perthe Justices of the the
Court inand address of your employer.of
County,
day
, 20
name
b. If the answer is no, state the date of your last employment and the amount of the
salary and wages per month which you received.
(Attorney must sign above and type name below)
2. Have you received within the past twelve months any income from a business,
profession or other form of self-employment, or in the form of rent payments, interest, dividends,
or other source?
Attorney(s) for
a. If the answer is yes, describe each source of income, and state the amount received
from each during the past twelve months.
3. Do you own any cash or checking or savings account?
Office and P.O. Address
a. If the answer is yes, state the total value of the items owned.
4. Do you own any real estate, stocks, bonds, notes, automobiles, or other valuable
Telephone
property (excluding ordinary household furnishings and clothing)? No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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www.USCourtForms.com
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
Index No.
Calendar No.
:
a. If the answer is yes, describe the property and state its approximate value.
JUDICIAL SUBPOENA
Plaintiff(s)
-against5. List the persons who are dependent upon you for: support and state your relationship to
those persons.
:
I understand that a false statement or answer to any question in this affidavit will subject
:
me to penalties for perjury.
Defendant(s)
:
......................................................
….………………………………….
SUBSCRIBED AND SWORN NEW YORK
THE PEOPLE OF THE STATE OFto before me this ................ day of ………………………, 20......
….………………………………….
Notary Public
TO
ORDER
GREETINGS:
Let the applicant proceed without prepayment of costs or fees or the necessity of giving
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
security therefor.
,
the Honorable ................ day of ………………………, 20...... Court
at the
DATED this
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any
….…………………………………. recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
District Judge
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
Witness, Honorable
Court in
County,
, one of the Justices of the
day of
, 20
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
