Petition For Leave To Proceed In Forma Pauperis Form. This is a Pennsylvania form and can be use in Lehigh Local County.
Tags: Petition For Leave To Proceed In Forma Pauperis, Pennsylvania Local County, Lehigh
IN THE COURT OF COMMON PLEAS OF LEHIGH COUNTY, PENNSYLVANIA CIVIL DIVISION : : Plaintiff vs. : : File No. : : Defendant : PETITION FOR LEAVE TO PROCEED INFORMA PAUPERIS TO THE HONORABLE, THE JUDGES OF SAID COURT: The Petition of 1. respectfully represents: I am the plaintiff/defendant in the above matter and because of my financial condition am unable to pay the fees and costs of prosecuting or defending the action or proceeding. 2. I am unable to obtain funds from anyone, including my family and associates, to pay the costs of litigation. 3. I represent that the information below relating to my ability to pay the fees and costs is true and correct: (a.) Name: American LegalNet, Inc. www.FormsWorkFlow.com Address: (b.) Employment: If you are presently employed, state: Employer: Address: Salary or wages per month: Types of work: If you are presently unemployed, state: Date of last employment: Salary or wages per month: Type of work: (c.) Other income within the past twelve months: Business of profession: Other self-employment: Interest: Dividends: Pension and annuities: Social Security benefits: Support payments: Disability payments: Unemployment compensation and supplemental benefits: American LegalNet, Inc. www.FormsWorkFlow.com Workman’s compensation: Public assistance: Other: (d.) Other contributions to household support: Wife’s/Husband’s Name: If your wife/husband is employed, state: Employer: Salary or wages per month: Type of work: Contributions from children: Contributions from parents: Other Contributions: (e.) Property owned Cash: Checking account: Savings account: Certificates of deposit: Real Estate (including home): Motor vehicle: Make: Cost $ Year: Amount Owed $ Stocks; bonds: American LegalNet, Inc. www.FormsWorkFlow.com Other: (f.) Debts and obligations Mortgage: Rent: Loans: Other: (g.) Persons dependent upon you for support Wife’s/Husband’s Name: Children, if any: Name: Age: Age: Age: Other persons: Name: Relationship: 4. I understand that I have a continuing obligation to inform the court of improvement in my financial circumstances that would permit me to pay the costs incurred herein. 5. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904, relating to unsworn falsification to authorities. American LegalNet, Inc. www.FormsWorkFlow.com WHEREFORE, Petitioner respectfully prays that the Honorable Court allow the petitioner to proceed in forma pauperis. Date: Petitioner American LegalNet, Inc. www.FormsWorkFlow.com