Petiton For Leave To Proceed In Forma Pauperis Form. This is a Pennsylvania form and can be use in Erie Local County.
Tags: Petiton For Leave To Proceed In Forma Pauperis, Pennsylvania Local County, Erie
COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. ______________________________ IN THE COURT OF COMMON PLEAS : Index No. Plaintiff v. OF ERIE COUNTY, PENNSYLVANIA : Calendar No. CIVIL DIVISION : ______________________________ JUDICIAL SUBPOENA Plaintiff(s) Defendant NO. -against: PETITION FOR LEAVE TO PROCEED IN FORMA PAUPERIS : 1. I am the (Plaintiff) (Defendant) listed above. Because of my financial condition, I am unable : to pay the required fees. Defendant(s) 2. Have you ever applied for an In Forma Pauperis (IFP) in :the past? _______ yes _______ no. ...................................................... If so, was it granted? _______ yes _______ no. If not, please state why. _____________________________________________________ 3. If you have petitioned for an IFP in the past, have your financial circumstances changed THE PEOPLE OF THE STATE OF NEW YORK since the last request? _______ yes _______ no. If yes, please briefly explain that change. _______________________________________ TO _________________________________________________________________________ _________________________________________________________________________. 4. I am unable to obtain funds from anyone, including my family and friends, to pay the costs. GREETINGS: 5. I represent that the information below relating to my ability to pay the fees and costs is true WE and correct: COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court a. Name:of _________________________________________________________________ located at County Address: _______________________________________________________________ in room , on the day of , 20 , at o'clock in the noon, and at any recessed City, State,date, to testify and give evidence as a witness in this action on the part of the or adjourned & ZIP: ________________________________________________________ Social Security Number: ___________________________________________________ b. EMPLOYMENT Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable If presently employed, state Employer: _______________________________________ to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a Address: _______________________________________________________________ result State, & ZIP: comply. City, of your failure to ________________________________________________________ Wages/salary per month: __________________________________________________ Witness, Honorable , one of the Justices of the Type of work: ____________________________________________________________ If presently unemployed, state date of last employment: __________________________ Court in County, day of , 20 Wages/salary per month: __________________________________________________ Type of work: ____________________________________________________________ Reason no longer employed at last job: _______________________________________ (Attorney must sign above and type name below) c. OTHER INCOME WITHIN PAST TWELVE MONTHS Business/Profession: ______________________________________________________ Attorney(s) for Other self-employment: ___________________________________________________ Interest: ___________________________ Dividends: ___________________________ Pension and annuities: _____________________________________________________ Social Security benefits: ___________________________________________________ Office and P.O. Address Support payments: _______________________________________________________ Disability payments: ______________________________________________________ Unemployment compensation and supplemental benefits: _________________________ Workers’ compensation: ___________________________________________________ Telephone No.: Public Assistance: ________________________________________________________ Facsimile No.: Other: ________________________________________________________________ E-Mail Address: d. OTHER CONTRIBUTIONS TO HOUSEHOLD SUPPORT Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. Name of spouse/significant other: ____________________________________________ : Index No. If your spouse if employed, state employer: ____________________________________ Wages/salary per month: __________________________________________________ : Calendar No. Type of work: ____________________________________________________________ : Contributions from Children: ________________________________________________ JUDICIAL SUBPOENA Plaintiff(s) Contributions from Parents: ________________________________________________ -against: Other contributions: ______________________________________________________ : e. PROPERTY OWNED Cash: __________________________________________________________________ : Checking Account: ________________________________________________________ Savings Account: _________________________________________________________ Defendant(s) : Certificates . of .Deposit: .____________________________________________________ ........... .. ........ .............................. Real Estate (including home): _______________________________________________ Motor vehicle: Make: ______________________________ Year: __________ Cost: _______________ Amount now owed: _______________ THE PEOPLE OF___________________________________________________________ THE STATE OF NEW YORK Stocks/bonds: Other: _________________________________________________________________ TO f. DEBTS AND OBLIGATIONS Mortgage: ______________________________ Rent: ___________________________ Loans: _________________________________________________________________ GREETINGS: Other: _________________________________________________________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before g. PERSONS DEPENDENT UPON YOU FOR SUPPORT , the Honorable at the Court Name of spouse: _________________________________________________________ located at County of Children, if any: on the in room , __________________________________________________________ day of , 20 , at o'clock in the noon, and at any recessed Name: ___________________________________________ Age:of the or adjourned date, to testify and give evidence as a witness in this action on the part _________________ ___________________________________________ Age: _________________ ___________________________________________ Age: _________________ Other persons: Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable Name: _________________________________ Relationship: _____________________ 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. 6. I understand that I have a continuing obligation to inform the Court of any improvement in my financial circumstances which would permit me to pay the costs. Witness, Honorable , one of the Justices of the 7. I verify that the statements made in this Affidavit are true and correct. I understand that Court in County, day of , 20 false statements are made subject to the penalties of 18 Pa.C.S. 4904 relating to unsworn falsification to authorities. Wherefore, I request this Honorable Court to enter an Order granting me leave to file an action (Attorney must sign above and type name below) as an indigent party without the necessity of paying any filing fees or costs. Attorney(s) for DATE: ____________________ Petitioner: _________________________________________ ORDER Office and P.O. Address AND NOW, to-wit, this _______ day of __________________, the above Petition for Leave to Proceed In Forma Pauperis is ____________ as it pertains to the filing fees of the Prothonotary office in this matter. BY THE COURT: Telephone No.: Facsimile No.: ___________________________ E-Mail Address: Judge Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com