Request Not to Pay Fees for Appeal Page 1 of 2 If you do not have enough money to pay for the court costs to start your appeal, you may fill out this form. You may have to pay court costs at the end of the case. I, , do solemnly swear that I am a resident of the State of Tennessee, and that owing to my poverty, I am not able to bear the expense of an appeal from the judgment of the Court in the above styled case and that I am justly entitled to the relief sought to the best of my belief. Read below then sign: I declare under penalty of perjury under the laws of the State of Tennessee that: I swear that I do not have enough money or assets to pay the court costs for my appeal before the court date. I ask the court to allow me to appeal without paying the fees at this time. The information on this form is true to the best of my knowledge. Party Appealing : Date: Sworn and subscribed before me, this day of , 20. Deputy Clerk: Notice: Loss of appeal results in obligation to pay court costs. Lawyer for Plaintiff Lawyer for Defendant Lawyer222s Address Lawyer222s Address City, State, Zip City, State, Zip Plaintiff(s) Defendant(s) Home Address and Telephone Home Address and Telephone City, State, Zip City, State, Zip Place of Employment and Telephone Place of Employment and Telephone State of Tennessee Court (Must Be Completed) County (Must Be Completed) Request Not to Pay Fees for Appeal (Pauper222s Oath in Lieu of Appeal Bond) File No. (Must Be Completed) Division (Large Counties Only) Plaintiff (Name: First, Middle, Last of person/company that filed lawsuit) Defendant (Name: First, Middle, Last of the other person) American LegalNet, Inc. www.FormsWorkFlow.com Request Not to Pay Fees for Appeal Page 2 of 2 IMPORTANT! Take any proof that supports your case to the hearing, including: witnesses, photos, papers, receipts, etc. The court will not accept written statements from witnesses. The person must go to court in person. If you think a witness may not want to go to court, ask the clerk for subpoena forms. Complete the subpoena as soon as possible so the sheriff can serve them before court. The court and clerks are not allowed to give you legal advice, even if you don222t have a lawyer. This form is a public record. It is not legal advice. The law may change and it is best to consult with a lawyer. American LegalNet, Inc. www.FormsWorkFlow.com