Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_06-cv-01803/USCOURTS-caed-2_06-cv-01803-7/pdf.json

Nature of Suit Code: 530
Nature of Suit: Prisoner Petitions - Habeas Corpus
Cause of Action: 28:2254 Petition for Writ of Habeas Corpus (State)

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IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF CALIFORNIA

SARHAN AHMAD AHMAD,

Petitioner, No. CIV S-06-1803 GEB JFM P

vs.

THOMAS FELKER, Warden,

Respondent. ORDER

 /

Petitioner, a state prisoner proceeding pro se, sought relief pursuant to 28 U.S.C.

§ 2254. During the pendency of this action, petitioner did not seek leave to proceed in forma

pauperis. This action was terminated on September 6, 2007. 

On September 24, 2007, petitioner filed a notice of appeal and application for

certificate of appealability. On October 10, 2007, petitioner’s application for certificate of

appealability was denied. On December 26, 2007, petitioner filed an application to proceed in

forma pauperis on appeal.

Rule 24(a) of the Federal Rules of Appellate Procedure provides as follows:

(1) Motion in the District Court. Except as stated in Rule 24(a)(3),

a party to a district-court action who desires to appeal in forma

pauperis must file a motion in the district court. The party must

attach an affidavit that:

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(A) shows in the detail prescribed by Form 4 of the Appendix of

Forms the party's inability to pay or to give security for fees and

costs;

(B) claims an entitlement to redress; and

(C) states the issues that the party intends to present on appeal.

Fed. R. App. 24(a)(1). Although petitioner has filed an application to proceed in forma pauperis,

petitioner has not provided the detailed information required in Form 4, and has not addressed

the items required in Fed. R. App. 24(a)(1)(B) and (C). Petitioner’s application to proceed in

forma pauperis on appeal will be denied without prejudice. A copy of Form 4 is appended to this

order. 

Accordingly, IT IS HEREBY ORDERED that petitioner’s December 26, 2007

application to proceed in forma pauperis on appeal is denied without prejudice. 

DATED: January 24, 2008.

/001; ahma1803.dn

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Affidavit Accompanying Motion for Permission to Appeal In Forma Pauperis

United States District Court for the _____ District of ______

_____________, Plaintiff

v. Case No. ____________

_____________, Defendant

Affidavit in Support of Motion Instructions

I swear or affirm under penalty of perjury that,

because of my poverty, I cannot prepay the

docket fees of my appeal or post a bond for

them. I believe I am entitled to redress. I swear

or affirm under penalty of perjury under United

States laws that my answers on this form are

true and correct. (28 U.S.C. § 1746; 18 U.S.C. §

1621.)

Complete all questions in this application and

then sign it. Do not leave any blanks: if the

answer to a question is “0,” “none,” or “not

applicable (N/A),” write in that response. If you

need more space to answer a question or to

explain your answer, attach a separate sheet of

paper identified with your name, your case's

docket number, and the question number.

Signed:

__________________________________

Date:

_____________________________________

My issues on appeal are:

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 the past 12 months

Amount expected next month

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4

You Spouse You

Spouse

Employment $______ $______ $______ $______

Self-employment $______ $______ $______ $______

Income from real property

(such as rental income)

$______ $______ $______ $______

Interest and dividends $______ $______ $______ $______

Gifts $______ $______ $______ $______

Alimony $______ $______ $______ $______

Child support $______ $______ $______ $______

Retirement (such as social

security, pensions, annuities,

insurance)

$______ $______ $______ $______

Disability (such as social

security, insurance payments)

$______ $______ $______ $______

Unemployment payments $______ $______ $______ $______

Public-assistance (such as

welfare) $______ $______ $______ $______

Other (specify):

______________

$______ $______ $______ $______

Total monthly income: $______ $______ $______ $______

2. List your employment history, most recent employer first. (Gross monthly pay is before taxes

or other deductions.)

Employer Address Dates of employment Gross monthly pay

_____________________

_

____________

_____________________

_

___________________

__

_____________________

_

____________

_____________________

_

___________________

__

_____________________

_

____________

_____________________

_

___________________

__

3. List your spouse's employment history, most recent employer first. (Gross monthly pay is

before taxes or other deductions.)

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Employer Address Dates of employment Gross monthly pay

_____________________

_

____________

_____________________

_

___________________

__

_____________________

_

____________

_____________________

_

___________________

__

_____________________

_

____________

_____________________

_

___________________

__

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.

Financial institution Type of account Amount you have

Amount your spouse

has

_____________________

_

________________

$________________

_

$__________________

___

_____________________

_

________________

$________________

_

$__________________

___

_____________________

_

________________

$________________

_

$__________________

___

If you are a prisoner, you must attach a statement certified by the appropriate institutional

officer showing all receipts, expenditures, and balances during the last six months in your

institutional accounts. If you have multiple accounts, perhaps because you have been in

multiple institutions, attach one certified statement of each account.

5. List the assets, and their values, which you own or your spouse owns. Do not list clothing and

ordinary household furnishings.

Home (Value) Other real estate (Value) Motor vehicle #1 (Value)

_________________________

_

_________________________

__

Make & year:

__________

_________________________ _________________________ Model: __________

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_ __

_________________________

_

_________________________

__

Registration #: __________

Motor vehicle #2 (Value) Other assets (Value) Other assets

(Value)

Make & year: _________

_________________________

__

_________________________

___

Model: _________

_________________________

__

_________________________

___

Registration #: _________

_________________________

__

_________________________

___

6. State every person, business, or organization owing you or your spouse money, and the amount

owed.

Person owing you or your

spouse money

Amount owed to you Amount owed to your spouse

_________________________

_

_________________________

_

_________________________

__

_________________________

_

_________________________

_

_________________________

__

_________________________

_

_________________________

_

_________________________

__

7. State the persons who rely on you or your spouse for support.

Name Relationship Age

_________________________

_

_________________________

_

__________

_________________________

_

_________________________

_

__________

_________________________

_

_________________________

_

__________

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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,

semiannually, or annually to show the monthly rate.

You

Your Spouse

Rent or home-mortgage payment (include lot

rented for mobile home) $______ $______

Are real-estate taxes included? G Yes G No

Is property insurance included? G Yes G No

Utilities (electricity, heating fuel, water, sewer,

and Telephone) $______ $______

Home maintenance (repairs and upkeep) $______ $______

Food $______ $______

Clothing $______ $______

Laundry and dry-cleaning $______ $______

Medical and dental expenses $______ $______

Transportation (not including motor vehicle

payments)

$______ $______

Recreation, entertainment, newspapers,

magazines, etc. $______ $______

Insurance (not deducted from wages or

included in Mortgage payments)

$______ $______

Homeowner's or renter's $______ $______

Life $______ $______

Health $______ $______

Motor Vehicle $______ $______

Other:

___________________________________

$______ $______

Taxes (not deducted from wages or included in

Mortgage payments) (specify):

______________

$______ $______

Installment payments $______ $______

Motor Vehicle $______ $______

Credit card (name): $______ $______

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________________________

Department store (name):

___________________

$______ $______

Other:

___________________________________

$______ $______

Alimony, maintenance, and support paid to

others $______ $______

Regular expenses for operation of business,

profession, or farm (attach detailed statement) $______ $______

Other (specify):

____________________________

$______ $______

Total monthly expenses: $______ $______

9. Do you expect any major changes to your monthly income or expenses or in your assets or

liabilities during the next 12 months?

G Yes G No If yes, describe on an attached sheet.

10. Have you paid--or will you be paying--an attorney any money for services in connection with

this case, including the completion of this form? Yes No

If yes, how much? $__________

If yes, state the attorney's name, address, and telephone number:

______________________________________________________________________________

______

______________________________________________________________________________

______

______________________________________________________________________________

______

11. Have you paid--or will you be paying--anyone other than an attorney (such as a paralegal or a

typist) any money for services in connection with this case, including the completion of this

form?

G Yes G No

If yes, how much? $__________

If yes, state the person's name, address, and telephone number:

______________________________________________________________________________

______

______________________________________________________________________________

______

______________________________________________________________________________

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______

12. Provide any other information that will help explain why you cannot pay the docket fees for

your appeal.

13. State the address of your legal residence.

______________________________________________________________________________

______

______________________________________________________________________________

______

Your daytime phone number: ___ _______________

Your age: ________ Your years of schooling: ________

Your social-security number: _______________

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