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Application To Proceed In Forma Pauperis Under Section 706(f) Of Civil Rights Act Of 1964 (Non-Prisoner) Form. This is a Louisiana form and can be use in District Court Federal.
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Tags: Application To Proceed In Forma Pauperis Under Section 706(f) Of Civil Rights Act Of 1964 (Non-Prisoner), Louisiana Federal, District Court
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Rev. 7/93
Index No.
:
Calendar No.
:
JUDICIAL SUBPOENA
UNITED STATES DISTRICT COURT
WESTERN
-against-
Plaintiff(s)
DISTRICT OF :LOUISIANA
:
:
Plaintiff
Defendant(s)
:
. . . . . . . . . . . . versus . . . . . . . . . . . . . . . . . . Civil. . Action. No.
........
...... .......
/
Defendant
Judge
THE PEOPLE OF THE STATE OF NEW YORK
Mag.Judge
TO
APPLICATION TO PROCEED IN FORMA PAUPERIS
UNDER SECTION 706(f) OF CIVIL RIGHTS ACT OF 1964
GREETINGS:
1.
FULL NAME
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
2.
ADDRESS
,
the Honorable
at the
Court
(Street Address or P. O. Box)
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
(City)
3.
(State)
(Zip Code)
MARITAL STATUS:
Single
Married
Separated
Divorced is punishable as a contempt of court and will make you liable to
Widowed
Your failure to comply with this subpoena
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
4.
Are you comply.
No
result of your failure topresently employed? Yes
Court in
If the answer is "yes," give your occupation, the name and
address of your employer and the gross and net amount of your
Witness, Honorable
, one of the Justices of the
salary.
County,
day of
(Occupation)
, 20
(Gross Salary)
(Net Salary)
(Attorney must sign above and type name below)
(Name and address of Your employer)
5.
Attorney(s)
If you are not presently employed, state for
the date of your last
employment, the name and address of your employer and your
salary.
Office and P.O. Address
(Date last employed)
(Salary)
Telephone No.:
(Name and Address of last Employer)
Facsimile No.:
1
E-Mail Address:
Mobile Tel. No.:
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www.USCourtForms.com
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
6.
Calendar No.
If you are married and if your spouse is employed, state his/her
:
JUDICIAL SUBPOENA
Plaintiff(s)
name, occupation, employer, address of employer and salary.
-against-
:
:
(Occupation)
(Name of spouse)
7.
Index No.
(Salary)
:
Approximately how much money have you received in the past twelve
months from the following sources:
Defendant(s)
:
......................................................
as wages, salary, commissions or earned income of any kind?
as OF THE STATE OF NEW YORK
THE PEOPLEworkman's compensation or disability insurance?
TO
as rent payments, interest, dividends?
as pensions, annuities or life insurance payments?
GREETINGS:
from social security, unemployment compensation of
WE COMMAND YOU, that all business and excuses being laid aside, you and each oryouwelfare
attend before
payments?
,
the Honorable
at the
Court
located at
County of
in room as gifts the inheritance? , 20
, on or
day of
, 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
from other sources?
8.
How much money do you own or have in any checking or savings
account?
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 own or have any interest in any real estate, automobiles
9.
Do you to comply.
or other vehicles, boats, stocks, bonds, notes, or any other
valuable property (excluding ordinary household furnishings and
Witness, Honorable
, one of the Justices of the
clothing)? Yes _____ No _____
Court in
County,
day of
, 20
If "yes", give a description of the property and its estimated
value.
(Attorney must sign above and type name below)
Attorney(s) for
10.
Is anyone dependent on you for support? Yes _____ No _____
If "yes", give names, ages, relationship to you, and the amount
you contribute toward their support.
Office and P.O. Address
2
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
11.
Index No.
Calendar No.
List any debts you have and the amount owed.
:
JUDICIAL SUBPOENA
Plaintiff(s)
-againstCreditor
Amount Owed
:
:
:
Defendant(s)
:
......................................................
12.
List your monthly living expenses.
THE PEOPLE OF THE STATE OF NEW YORK
TO
GREETINGS:
I certify under penalty of perjury that the above information is
true WE COMMAND YOU, theall business and excuses being laid aside, you and each of you attend before
and correct to that best of my knowledge.
,
the Honorable
at the
Court
___________________________________
located at
County of
in room
, on the
day of
, 20 (Signature of the
, at
o'clock in Applicant) at any recessed
noon, and
or adjourned date, to testify and give evidence as a witness in this action on the part of the
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.:
3
American LegalNet, Inc.
www.USCourtForms.com
