Certificate Of Custodial Institution
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Certificate Of Custodial Institution Form. This is a New Hampshire form and can be use in District Court Federal.
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Tags: Certificate Of Custodial Institution, New Hampshire Federal, District Court
UNITED STATES DISTRICT COURT
DISTRICT OF NEW HAMPSHIRE
___________________________
v.
Case No. _______________________
___________________________
ATTACHMENT TO MOTION/AFFIDAVIT TO PROCEED
IN FORMA PAUPERIS WITHOUT PREPAYMENT OF FEES
CERTIFICATE OF CUSTODIAL INSTITUTION
Name of Inmate:
___________________________________________
Name of Institution:
___________________________________________
Address of Institution:
___________________________________________
___________________________________________
1.
I hereby certify that for the six-month period immediately preceding this
date the applicant has had average monthly deposits to his/her account of
$_____________.
2.
Further, I certify that for the six-month period immediately preceding this
date the applicant has maintained an average monthly balance in his/her account of
$_____________.
3.
I attach a certified copy of the applicant's trust account statement for the
six months preceding the submission of this certificate.
___________________________________
Authorized Officer of Institution
__________________________________
Title
___________________________________
Date
USDCNH-14 (Revised 8-00) (Previous Editions Useable)
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