Question not identified

No question identified. : AFFIDAVIT OR DECLARATION IN SUPPORT OF MOTION FOR LEAVE TO PROCEED IN FORMA PAUPERIS I, Fidel Alcantar Soto , am the petitioner in the above-entitled case. In support of my motion to proceed in forma 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 g_30g = gg Self-employment $ $s Gg ; Income from real property $l GS Gg (such as rental income) Interest and dividends $C SC“ ; Gifts $ GS SoG Alimony $C OGL GG Child Support . $e OGG GL , Retirement (such as social $C GL Gg security, pensions, annuities, insurance) Disability (such as social $ $l GL CSF security, insurance payments) Unemployment payments $ $$ “8g Public-assistance $o GG G . (such as welfare) Other (specify); == == $s GL Gg Total monthly income: $ 30 $ 0 gs 0 g¢ 0 1 2. List your employment history for the past two years, most recent first. (Gross monthly pay is before taxes or other deductions.) : . E id mployer yall Sete Prison Employ ont Gross monthly pay Kitchen worker EOE 82 93610 Jan. 2021 $ 30. oe a ee S$ ee —— a $0 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 . WA) Eg 0 a oo ee So eg 4. How much cash do you and your spouse have? $__100. Below, state any money you or your spouse have in bank accounts or in any other financial : institution. Type of account (e.g., checking or savings) Amount you have Amount your spouse has none $ a wee ce 5. List the assets, and their values, which you own or your spouse owns. Do not list clothing and ordinary household furnishings. 0 Home C1) Other real estate Value Valueo Oo Motor Vehicle #1 C] Motor Vehicle #2 Year,make & model Year,make & model. Value Value LO Other assets . Description meee Value : : 2 é + 6. State every person, business, or organization owing you or your spouse money, and the amount owed. . Person owing you or Amount owed to you Amount owed to your spouse your spouse money None $ (e) $ 0 ee $e $e a $e S$ 7. State the persons who rely on you or your spouse for support. For minor children, list initials instead of names (e.g. “IS.” instead of “John Smith”). Name Relationship Age None ; 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. You Your spouse Rent or home-mortgage payment 0 : (include lot rented for mobile home) gs OF $. Are real estate taxes included? [Yes [No : : Is property insurance included? [Yes [INo Utilities (electricity, heating fuel, water, sewer, and telephone) go = gg Si _ Home maintenance (repairs and upkeep) $ 0 $ 0 Food ge gO _ : Clothing go S$ ° : ; 0 0 Laundry and dry-cleaning $e $ : . ane) 0 Medical and dental expenses $ $ . J . 3 . You Your spouse Transportation (not including motor vehicle payments) gs 9 $0 : Recreation, entertainment, newspapers, magazines, ete. go g OO . Insurance (not deducted from wages or included in mortgage payments) Homeowner’s or renter’s so so Life . , . gO gs 8 Health : gs oe gs Oo ; : Motor Vehicle go gs Oo Other: es ‘ gO sO Taxes (not deducted from wages or included in mortgage payments) (specify); go gs Oo Installment payments . Motor Vehicle | . | s gs Oo Credit card(s) . Z so gs 9 Department store(s) ; gO gs 0 Other; so so Alimony, m