COURT OF COMMON PLEAS DIVISION OF DOMESTIC RELATIONS CLERMONT COUNTY, OHIO _____________________ Plaintiff CASE No:__________________ Date:______________________ VS. Judge Michael J. Voris _____________________ Defendant MOTION TO PROCEED IN FORMA PAUPERIS Now comes ___________________ and moves this court for an order granting the privilege to proceed in forma pauperis. ____________________ makes this motion on the ground that his/her indigency prohibits the payment of filing fees and court costs for this action. ___________________ acknowledges that the Court will undertake further review of the issue of costs and make a final determination regarding payment. ________________________ Signature of requesting Party ________________________ Address ________________________ City ST Zip 10/06 Form DR-124-A American LegalNet, Inc. www.FormsWorkFlow.com