Whether the petitioner's constitutional rights were violated by the lower court's denial of in forma pauperis status

No question identified. : ae _ oe OO . ; , , , , AFFIDAVIT OR DECLARATION. ; ~---. . IN. SUPPORT OF MOTION. FOR LEAVE TO PROCEED IN FORMA PAUPERIS.__.__ I, No) C3 BA am the petitioner in the above-entitled case. In support of my motion to procded in formd pauperis, I state that because of my poverty I am unable to pay the costs of this case or to give security therefor; and I believe I am entitled to redress, 1 For both you and your spouse estimate the average amount of money received from each of ! the following sources during the past 12 months. Adjust any amount that was received weekly, biweekly, quarterly, semiannually, or annually to show the monthly rate. Use gross amounts, that is, amounts before any deductions for taxes or otherwise. | ~ Income source Average monthly amount during Amount expected the past 12 months next month | You Spouse You Spouse Employment s_ © gO sO — §$ 7 Self-employment s_ © gs OC a oa $. . | ‘Income from real property -5 © gO , ¢ -O— an oe | (such as rental income) : vet | Interest and dividends s © gs" gg D $ ¥ cits sg CO $ Dost Mploug . | Alimony ¢_O_ sO s_ Oo $__ | Child Support s © 5 OC g$_O . ' Retirement (such as social $ $__gg Og : security, pensions, = . . . os } annuities, insurance) . Disability (such as social -$_© $. : $_ oO $___ . security, insurance payments) ; Unemployment payments $ © $_ is) ~ $= oO $ Public-assistance $_ © $ © s_ © _ § (such as welfare) bese © ne ee = re | Other (specify); = S$ s © $ Total monthly income: $ $ $ O_ —~ S$ 2. List your employment history for the past two years, most recent first. (Gross monthly pay ~~. .--~is-before. taxesor other deductions.) ——--——-——___-__»_ ce Employer Address Dates of ' Gross monthly pay” , : so Employment . ' $ $ : rc fi. $ 3. List your spouse’s employment history for the past two years, most recent employer first. (Gross monthly pay is before taxes or other deductions.) : Employer Address Dates of Gross monthly pay : : Employment . $ ; $ ; A a a $ 4, How much cash do you and your spouse have? $__ Below, state any money you or your spouse have in bank accounts or in any other financial _ institution. : ae . : Financial institution Type of account Amount you have Amount your spouse has ~ , —— OGG — OGG ee eee OG CG 5. List the assets, and their values, which you own or your spouse owns. Do not list clothing and ordinary household furnishings. . Oi Home CO Other real estate So Value CValue ~~ . (1 Motor Vehicle #1 O Motor Vehicle #2 Year, make & model ~_Year, make & model €2. . Value ~ Value_<—<>——— . O Other assets Deseription re Value Oe . + . . . 6. State every person, business, or organization owing you or your spouse money, and the pe BATU 0 WO sae Person owing you or ; Amount owed to you Amount owed to your spouse _ your spouse money . ; | 72= wim § | $. a $_ $e 7. State the persons who rely on you or your spouse for support. ; . | Name Relationship Age ; ; 8. Estimate the average monthly expenses of you and your family. Show separately the amounts paid by your spouse. Adjust any payments that are made weekly, biweekly, quarterly, or +, ~.: . annually to show the monthly rate. . ; Lo . : ; -You _ Your spouse _ “ Rent or home-mortgage payment ~—(include lot rented for mobile home) $ \"—s§ Are real estate taxes included? © Yes [No : ua ; Is property insurance included? [J Yes []No Utilities (electricity, heating fuel, co water, séwer, and telephone) _ Oo $__. Home maintenance (repairs. and upkeep) $. L _. § Food ; $ ) Clothing $ 7 $ ‘Laundry and dry-cleaning: ve $-637 —-§ oe aa Medical and dental expenses ; $. A) $e re , s . : . ; . | You Your spouse Transportation (not including motor vehicle payments) $ $ j Recreation, entertainment, newspapers, magazines, ete. § | $ . Insurance (not deducted from wages or included in mortgage payments) Homeowner’s or renter’s . $. : $. : | Life § § Health ) § § Motor. Vehicle $ $ , Other; “FL GL Taxes (not deducted from wages or included in mortgage payments) ST (specify): ——$_. $.