SUPERIOR COURT OF THE DISTRICT OF COLUMBIA PROBATE DIVISION _________ _________ _________ _________ _________ ADM SEB INT IDD GDN _________ _________ _________ _________ _________ In re Estate of ________________________________ Minor/deceased/ward MOTION TO PROCEED IN FORMA PAUPERIS* Comes now the _________________________________________________ to ask the court to allow him/her to proceed without prepayment of costs for the following reason(s): _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ ____________________________________ Typed Name ____________________________________ _________________________________________ Address (Actual address/not Post Office box) _________________________________________ Signature _________________________________________ Telephone number _________________________________________ Business telephone number POINTS AND AUTHORITIES (Write the reasons why the Court should grant your motion and include Court rules, laws, and cases, if any, that support your reasons.)_______________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ ____________________________________ Signature *This motion is filed with the Probate Division if the waiver is being requested to file a Notice of Appeal or to obtain a transcript for purposes of filing an appeal. For all other purposes, it is filed at the office of Judge-In-Chambers, 4th Floor, 500 Indiana Avenue, N.W., Washington, D.C. 20001. Jan. 2010 American LegalNet, Inc. www.FormsWorkFlow.com CERTIFICATE OF SERVICE I hereby certify that on this ____ day of ____________________, 20____, I have mailed copies of the foregoing motion, postage prepaid, by first class mail, to the following interested persons (list names and addresses of all interested persons): __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ _____________________________________ Signature Jan. 2010 American LegalNet, Inc. www.FormsWorkFlow.com SUPERIOR COURT OF THE DISTRICT OF COLUMBIA PROBATE DIVISION _________ _________ _________ _________ _________ ADM SEB INT IDD GDN _________ _________ _________ _________ _________ In re Estate of ________________________________ Minor/deceased/ward ORDER RE MOTION TO PROCEED IN FORMA PAUPERIS Upon consideration of the Motion To Proceed In Forma Pauperis filed on the ____ day of ______________, 20__, by ____________________________, it is this _____ day of __________________________________, 20__, hereby ORDERED that said motion is [ ] Granted, and the prepayment of Court costs is hereby waived. [ ] Denied without prejudice, on the grounds that ___________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _______________________________ JUDGE cc: __________________________________ __________________________________ __________________________________ ____________________________________ ____________________________________ ____________________________________ __________________________________ __________________________________ __________________________________ ____________________________________ ____________________________________ ____________________________________ __________________________________ __________________________________ __________________________________ ____________________________________ ____________________________________ ____________________________________ __________________________________ __________________________________ __________________________________ ____________________________________ ____________________________________ ____________________________________ Jan. 2010 American LegalNet, Inc. www.FormsWorkFlow.com SUPERIOR COURT OF THE DISTRICT OF COLUMBIA PROBATE DIVISION _________ _________ _________ _________ _________ ADM SEB INT IDD GDN _________ _________ _________ _________ _________ In re Estate of ________________________________ Minor/deceased/ward AFFIDAVIT IN SUPPORT OF MOTION TO PROCEED IN FORMA PAUPERIS I swear that the responses that I have made to questions and instructions below relating to my ability to pay the cost of proceeding in this action are true. 1. Are you presently employed? Yes No a. If the answer is yes, state the amount of your gross salary or gross wages per month, and give the name and address of your employer. b. If the answer is no, state the date of last employment and the amount of the salary and wages per month which you received. 2. Have you received within the past twelve months any money from any of the following sources? a. Business, profession, or form of self-employment? Yes No b. Rent payments, interest, or dividends? Yes No c. Pensions, annuities, or life insurance payments? Yes No d. Gifts or inheritance? Yes No e. Any other sources, including unemployment benefits? Yes No If the answer to any of the above is yes, describe each source of money, and state the amount received from each during the past twelve months. Jan. 2010 American LegalNet, Inc. www.FormsWorkFlow.com 3. Do you have any cash, or do you have money in checking or savings account? (Include any funds in prison accounts.) Yes No 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 property (excluding ordinary household furnishings and clothing)? Yes No If the answer is yes, describe the property and state its approximate value. 5. List the persons who are dependent upon you for support, state your relationship to those persons, and indicate how much you contribute toward their support. VERIFICATION ________________________________________, being first duly sworn, on oath, depose and say that I have read the foregoing affidavit by me subscribed and that the facts therein stated are true to the best of my knowledge, information, and belief. Signature Subscribed and sworn to before me this day of _______ , 20 __. Notary Public/Deputy Jan. 2010 American LegalNet, Inc. www.FormsWorkFlow.com