Application To Proceed In Forma Pauperis
Application To Proceed In Forma Pauperis Form. This is a Nevada form and can be use in Clark County.
Tags: Application To Proceed In Forma Pauperis, Nevada County, Clark
1 (your name) 2 (your street address) 3 (your city, state, and zip code) 4 (your phone number) 5 JUSTICE COURT, LAS VEGAS TOWNSHIP CLARK COUNTY, NEVADA 6 7 8 Plaintiff/Landlord, 9 10 ) ) ) ) ) ) ) ) ) ) Name: -vsName: 11 Defendant/Tenant 12 CASE NO.: DEPT. NO.: APPLICATION TO PROCEED IN FORMA PAUPERIS COMES NOW the undersigned, in Proper Person, and requests pursuant to NRS 65.040 and NRS 12.015 to be 13 permitted to proceed without paying costs or fees in this action as I am unable to prosecute or defend the action because I am 14 unable to pay the costs of so doing; 15 adults and 1. Including myself, there are 2. children in my household. My monthly income, after taxes, is as follows: 16 17 a. Monthly Income from Employment: $ 20 b. Monthly income from social security, unemployment benefits, worker’s compensation, child support, Welfare, Clark County Social Services, etc . . . $ 21 c. Monthly income from any other household member: $ 22 d. Other Income (explain): $ 18 19 23 TOTAL MONTHLY INCOME…………………………………………………………. $ 24 3. 25 26 27 28 My monthly expenses are as follows: a. b. c. d. e. f. g. h. Rent/Mortgage: Phone, gas, electricity and other utilities: Food: Child Care and/or Child Support Paid to someone else: Insurance: Medical: Transportation Other Expenses (explain): $ $ $ $ $ $ $ $ TOTAL MONTHLY EXPENSES………………………………………………………. $ 1 American LegalNet, Inc. www.FormsWorkFlow.com 1 4. My assets are as follows: (Year, make, and model) $ (Market price less loan balance) (Size, type and year of home) $ (Market price less loan balance) a. Automobile(s): 2 3 b. Home, mobile home or other real estate: 4 5 c. Bank Account(s): $ (Name of bank and account type) 6 $ d. Other Assets (explain): 7 (Account Balance) (Value) 8 9 10 I declare under penalty of perjury under the laws of the State of Nevada that the foregoing is true and correct. (date) (type or print name) (signature) 11 12 EACH LINE ON THIS FORM MUST BE COMPLETED. IF A PARTICULAR ITEM DOES NOT APPLY, WRITE “0” OR “N/A.” 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 2 American LegalNet, Inc. www.FormsWorkFlow.com JUSTICE COURT, LAS VEGAS TOWNSHIP CLARK COUNTY, NEVADA 1 2 Name: 3 Plaintiff/Landlord, 4 -vs- 5 Name: 6 Defendant/Tenant ) ) ) ) ) ) ) ) ) CASE NO.: DEPT. NO.: ORDER REGARDING APPLICATION TO PROCEED IN FORMA PAUPERIS 7 Upon consideration of the Application to Proceed In Forma Pauperis filed in the instant case, and good cause appearing 8 therefore, 9 [ ] 10 11 12 IT IS HEREBY ORDERED that the application is GRANTED. The applicant shall be permitted to proceed with fees and costs waived in this action as permitted by NRS 12.015. He/she shall proceed without the prepayment of costs or fees and the Clerk of Court shall file or issue any necessary writ, process, pleading, or paper without charge. The sheriff or other appropriate officer within this state shall make personal service of any necessary writ, pleading, or paper without charge. 13 14 OR [ ] IT IS HEREBY ORDERED that the application is DENIED for the following reasons: 15 [ ] The applicant is not indigent within the meaning of NRS 12.015; 16 [ ] Other: 17 18 19 20 DATED JUSTICE OF THE PEACE 21 22 23 24 25 26 27 28 3 American LegalNet, Inc. www.FormsWorkFlow.com