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Application To Sue As A Poor Person Form. This is a Illinois form and can be use in Jackson Local County.
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Tags: Application To Sue As A Poor Person, Illinois Local County, Jackson
STATE OF ILLINOIS
IN THE CIRCUIT COURT OF THE ___________ JUDICIAL CIRCUIT
__________________ COUNTY
IN RE THE MATTER OF:
_____________________
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_____Application granted
_____Application denied
No. _______
__________________, 20__
________________________
JUDGE
APPLICATION TO SUE AS A POOR PERSON
I, _____________________________________, on my own behalf, on oath state:
1. My current address is _________________________________________________.
2. My occupation, source of income, amount of public benefits is ________________.
3. My other sources of income or support are ________________________________.
4. My income for the preceding year was approximately ________________________.
5. The sources and amounts of income I expect to receive in the future are:
_____________________________________________________________________.
6. Person(s) who are dependent on me for support are: ________________________
_____________________________________________________________________
_____________________________________________________________________.
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7. I own no real estate. The total value of all my personal property does not exceed
$___________ in value and consists of clothing and furniture, and other household
items, including a 20____, ____________ motor vehicle, valued at $____________.
8. I filed no applications for leave to sue or defend as a poor person during the
preceding year, and none were filed on my behalf.
9. I am unable to pay the costs of commencing and prosecuting this action.
10. I have a meritorious claim.
WHEREFORE, Applicant prays the Court to permit her/him to commence and
prosecute this action as a poor person under 735 ILCS 5/5-105 of the Code of Civil
Procedure.
___________________________________
Plaintiff
Under penalties as provided by law pursuant to Section 5/1-109 of the
Code of Civil Procedure, the undersigned certifies that the statements set forth in this
instrument are true and correct, except as to matters therein stated to be on information
and belief and as to such matters the undersigned certifies as aforesaid that he/she
verily believes the same to be true.
___________________________________
Plaintiff
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