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Affidavit To Accompany Motion For Leave To Appeal In Forma Pauperis Form. This is a Nebraska form and can be use in District Court Federal.
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Tags: Affidavit To Accompany Motion For Leave To Appeal In Forma Pauperis, Nebraska Federal, District Court
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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:
:
Index No.
Calendar No.
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AFFIDAVIT TO ACCOMPANY MOTION SUBPOENA
JUDICIAL
Plaintiff(s)
FOR LEAVE TO APPEAL IN
-against:
FORMA PAUPERIS
:
United States District Court
:
For the District of Nebraska
Defendant(s)
:
......................................................
________________________,
Plaintiff
)
)
)
v. STATE OF NEW YORK )
THE PEOPLE OF THE
)
_________________________
)
TO
)
_________________________
)
Defendant
8:___CV____________
GREETINGS:
Affidavit in Support of Motion to Proceed
on Appeal in Forma being laid aside, you and each of you attend before
WE COMMAND YOU, that all business and excuses Pauperis
,
the Honorable
at the
Court
located at
County of
I, _____________________________ being firstthe
duly noon, and at any recessed
sworn,
in room
, on the
day of
, 20
, at
o'clock in
or adjourned date, to testify and give evidence as a witness in this action on the part of the
depose and say that I am _________________________, in the aboveentitled case; that in support of my motion to proceed on appeal
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
without being required to prepay fees, costs or $50 and all damages
the party on whose behalf this subpoena was issued for a maximum penalty ofgive security sustained as a
result of your failure to comply.
therefore, I state that because of my poverty I am unable to pay
Witness, Honorable
Court in
County,
, one of the Justices of the
the costs of said proceeding or to give security therefore; that
day of
, 20
I believe I am entitled to redress; and that the issues which I
desire to present on appeal are the following:sign above and type name below)
(Attorney must
_________________________________________________________________
Attorney(s) for
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Office and P.O. Address
_________________________________________________________________
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
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I further swear that the responses :which I have made to the
JUDICIAL SUBPOENA
Plaintiff(s)
-againstquestions and instructions below relating to my ability to pay
:
the cost of prosecuting the appeal are true.
:
1.
Are you presently employed?
:
a.
If the answer is Defendant(s)
yes, state the amount of your salary
:
......................................................
or wages per month and give the name and address of
your employer.
THE PEOPLE OF____________________________________________________
THE STATE OF NEW YORK
____________________________________________________
TO
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.
GREETINGS:
____________________________________________________
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
____________________________________________________
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
2.
Have you received within the past twelve months any income
or adjourned date, to testify and give evidence as a witness in this action on the part of the
from a business, profession or other form of self-employment, or
in the form of rent payments, interest, dividends, or other
source?
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
a.
If the answer was issued describe each source of damages sustained as a
the party on whose behalf this subpoenais yes, for a maximum penalty of $50 and all income,
and state
result of your failure to comply. the amount received from each during the past
twelve months.
Witness, Honorable
, one of the Justices of the
_____________________________________________________
Court in
County,
day of
, 20
_____________________________________________________
3.
Do you own any cash or checking or savings account? name below)
(Attorney must sign above and type
a.
If the answer is yes, state the total value of the
items owned.
Attorney(s) for
_____________________________________________________
_____________________________________________________
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
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Index No.
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4.
Do you own any real estate, stocks,: bonds, notes,
JUDICIAL SUBPOENA
Plaintiff(s)
automobiles, or other valuable property (excluding ordinary
-againsthousehold furnishings and clothing)?
:
a.
If the answer is yes, describe: the property and state
the approximate value.
:
_____________________________________________________
Defendant(s)
:
......................................................
_____________________________________________________
5.
List the persons who are dependent upon you for support and
state your THE STATE OF NEW YORK
THE PEOPLE OF relationship to those persons.
________________________________________________________________
TO
________________________________________________________________
I understand that a false statement or answer to any
GREETINGS:
questions in this affidavit will subject me to penalties for attend before
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you
,
the Honorable
at the
Court
perjury.
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
___________________________/s/
or adjourned date, to testify and give evidence as a witness in this action on the part of the
SUBSCRIBED AND comply with this subpoena me this _____ day of court and will make you liable to
Your failure to SWORN TO before is punishable as a contempt of ____________,
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
, one of the Justices of the
Court inthe applicant proceed without , prepayment of costs or fees or
County,
day of
20
Let
the necessity of giving security therefore.
(Attorney must sign above and type name below)
_____________________________
Attorney(s) for
U.S. District Judge
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
