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HomeMy WebLinkAbout02-2296 APPLICATION TO PROCEED £N FOR~L& PAUPERIS, SUPPORTING DOCUMENTATION AND ORDER CASE NUMBER: ~ ~'petitioner/plai ntiff declare that I am the (check appropriate box) [] movant (filing 28 U,$.C. 2255 motion) [] respondent/defendant other in the above-entitled proceeding; that, in support of my request to proceed without being · required to prepay fees, cost or give security therefor, am unable to pay the costs of said proceeding or give security therefor; that I believe I am · entitled to re{Jer. The nature of my action, defense, or other proceeding or the issues I intend ..... to present on appeal are briefly stated as follows: In further support of this application, I answer the following questions. I. Are you presently employed? Yes [] No ~ a. If the answer is "yes," state the amount of your salary or wages per month, and give the name and address of your employer. (list both 8ro~s and net salary) b. If the answer is "no," state the date of last employment and the amount of the sala~ and wag~ rper month which you received. 19~'7 ~ ~.0,~ p~z m¢,c4k 2. Have you received within the past twelve months any money From any of the follow- a. 13usiness, pro(ession or other form o¢ self-empioyment' Ye~ [] b. Rent :ayments, interest or dividends? Yes [] ¢. Pensions, annuities or life insurance payments? Yes ~ d. Gifts or inheritances? Yes [] e. Any other source? Yes ~ If the answer to any of the above is "yes "describe each source oi money and state the amount received from each during the past twelve months. 3. Do you own any ~"ash, or do you have money in cher. kin~ or savin~s accounts? Yes ¢ No [] (include any funds in prison accounts.) If the answer i~ "yes," state the total value of the items owned. 4. Do you own or '"'hav~ any interest in any real estate, stocks, bonds, notes, auto'mobiles Or other valuable property (excluding ordinag' household furnishings and cIothin~,)? _/ ~'es F'I No ~- If the answer is "ye~," describe the property and state its approximate value. 5. List the persons who are dependent upon you for support, state your relationship to those persons, and indicate how much you contribute toward their support. I declare under penalty of perjury that the foregoin~ is true and correct. (Date). ~7 SiBnature of App)ic~nt CERTIFICATE . (Prisoner Accounts Only) I certify that the applicant n~med herein has the sum of $ on account to his credit at the institution where he is confined. I further certify that the applicant likewise has the following securities to his credit according to the records of said institutio6: further certify that durint[ the Jast six months the applicant's average balance was S Authorized Officer of Institution ORDER OF COURT The application is hereby denied The application is hereby granted. Let the applicant proceed without prepayment Of cost or fees or the necessity of giving secur- ity therefor. RODGER T. ATVVOOD, II, PLAINTIFF IN THE COURT OF COMMON PLEAS OF · CUMBERLAND COUNTY, PENNSYLVANIA CUMBERLAND COUNTY COURT, DEFENDANT · 02-2296 CIVIL TERM ORDER OF COURT AND NOW, this ~'~'~'" day of May, 2002, the petition of Rodger T. Atwood, II, to proceed in forma pauperis IS DENIED, because the complaint in mandamus is frivolous? Rodger T. Atwood, II, 06454-067 Unit 2A U.S.P. Allenwood P·O. Box 3000 White Deer, PA 17887 :saa Edgar B3~Bay~j. ~ The complaint seeks a writ of mandamus against the Pennsylvania Board of Probation and Parole over which this court has no jurisdiction. MAY 1 0 2002 t ! V. APPLICATION TO PROCEED IN FOR~Lk PAUPERIS, SUPPORTING DOCUbIENTATION AND ORDER c^sE NUMa~:R: ~ ~AY 1 0 20112 I~]"~petitioner/plainfiff [] respondent/defendant declare that I am the (check appropriate box) [] movant (film8 28 U.5.C. 2255 motion) other in the above-entitled proceeding; that, in support of my request to proceed without bein8 required to prepay fees, cost ar give security therefor, I state that because of my poverty, I am unable to pay the cost~ of said proceeding or give security therefor; that I believe I am · entitled to relief. The nature of my action, defense, or other proceeding or the issues I intend to present on appeal are briefly stared as follows: In further support of this application, I answer the following questions. 1. Are you presently employed? Yes [] No ~ a. If the answer is "yes," state the amount of your salary or wages per month, and give the name and address of your employer. (list both gross and net salary) b. If the answer is "no," state the date of last employment and the amount of the sa!aW and wage per month which you received. /997 2. Have you receJv~ within the past ~elve momhs any money from any of the fallow- in8 sources? ' a. Business, profession or other form of self-employment- Yes [~ b. Rent payments, interest or dividends? Yes ~ c. Pensions, annuities or life insurance payment? Yes [] d. Gifts or inheritances? Yes Fq e. Any other sources_? Yes ~ No ~ No ~ If the answer to any of the above is "yes," describe each source of money and state the amount received from each during the past twetve months. B. Do you own any cash, or do you have money in checking or savings accounts7 Yes'[~''f'- No [] '(include any funds in prison accounts.) If the answer ['s "yes," state' the total value of the items owned. 4. Do you own or 'have any interest in any real estate, stocks, bonds, notes, automobiles ~)r other valuable property (excluding ordinal' household furnishings and clothing)?~ Yes [] No If the answer is "ye~," describe the property and state its approximate value. List the persons who are dependent upon you for support, state your relationship to those persons, and indicate how much you contribute toward their support. I declare under penalty of perjury that the foregoing is true and correct. (Date~ (~ SiBnature'of Applicant . CERTIFICATE . (Prisoner Accounts Only) I certify that the applicant named herein has the sum of $ on account to his credit at the institution where he is confined. I further certify that the applicant likewise has the foll0win8 securities to his credit according to the records of said institutior~: I further certify that during the last six months the applicant's average balance was $ Authorized Officer of Institution ORDER OF COURT The application is hereby denied L.¢ni~ed 5'a[% Iud? Dale The application is hereby granted. Let the applicant proceed without prepayment Of cost or fees or the necessity of givin~ secur- ity therefor. Uni[ed S!a[es iudFe Date or t,4a~i:,trate