Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_08-cv-02093/USCOURTS-azd-2_08-cv-02093-0/pdf.json

Nature of Suit Code: 440
Nature of Suit: Other Civil Rights
Cause of Action: 42:1983 Civil Rights Act

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WO

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Eugenio Guerrero, 

Plaintiff, 

vs.

Joseph Arpaio, Sheriff, MCSO; and

Betty Adams, Director of Correctional

Health Services, 

Defendants. 

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No. CV-08-2093-PHX-DGC

ORDER

Plaintiff Eugenio Guerrero commenced this action by filing a civil rights complaint

against Maricopa County Sheriff Joe Arpaio and Betty Adams, a county jail official.

Plaintiff alleges that he was denied basic necessities and standard medical care while he was

incarcerated at the 4th Avenue and Durango Jails. Dkt. #1.

Plaintiff has filed an application to proceed in forma pauperis by a prisoner. Dkt. #3.

A review of the Court’s docket shows that Plaintiff is no longer incarcerated. If Plaintiff still

wishes to proceed in forma pauperis, he shall complete and file with the Court the attached

financial affidavit by January 23, 2009. Plaintiff is advised that if he does not file the

completed financial affidavit or pay the applicable filing fee for civil actions by January 23,

2009, this action will be dismissed without prejudice.

IT IS ORDERED:

1. Plaintiff’s application to proceed in forma pauperis by a prisoner (Dkt. #3) is

denied as moot.

Case 2:08-cv-02093-DGC Document 4 Filed 01/08/09 Page 1 of 5
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2. If Plaintiff wishes to proceed in forma pauperis, he shall complete and file with

the Court the attached financial affidavit by January 23, 2009.

3. The Clerk is directed to dismiss this action without prejudice if Plaintiff does

not file the completed financial affidavit or pay the applicable filing fee by

January 23, 2009.

4. The Clerk is directed to mail a copy of this order to Plaintiff.

DATED this 8th day of January, 2009.

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Name 

Address 

City, State, Zip 

Telephone number 

IN THE UNITED STATES DISTRICT COURT
 

FOR THE DISTRICT OF ARIZONA
 

Plaintiff, 

cv 

vs. 

MOTION TO PROCEED 

IN FORMA PAUPERIS and 

SUPPORTING INFORMATION 

Defendant. 

I, ____________________, declare that I am 

the Plaintiff in this action; that I hereby request to proceed 

without being required to prepay fees, costs or give security 

therefore. I state that, because of my poverty, I am unable 

to pay the fees of said proceeding; that I believe I am 

entitled to relief. 

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. 

ATTACHMENT 6
 

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b.	 If the answer is "no", state the date of last 

employment and the amount of the salary and wages 

per month which you received. 

2.	 Is your spouse employed? Yes No 

a.	 If the answer is "yes" , state the amount of your 

spouse's salary or wages per month and give the name 

and address of your spouse's employer. 

b.	 If the answer is "no" , state the date of last 

employment and the amount of the salary and wages 

per month which your spouse received. 

3.	 Have you received within the past twelve months any money 

from any of the following sources? 

a.	 Business or other form of self employment Yes No 

b.	 Rent payments, interest or dividends Yes No 

c.	 Pensions, annuities or life insurance payments 

Yes No 

d.	 Gifts or inheritances Yes No 

e. Any other sources Yes 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 twelve months. 

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4.	 Do you own any cash, or do you have money in checking or 

savings accounts? Yes No 

If the answer is "yes", what is the amount of money you 

own in cash checking account 

savings account 

5.	 Do you own any real estate, stocks, bonds, notes, 

automobiles, or other valuable property (excluding 

household furnishing and clothing)? Yes No 

If the answer is "yes", describe and give estimated value 

of each. 

6.	 List the number of persons who are dependent upon you for 

support, state your relationship to those persons, and 

indicate how much you contribute towards their support. 

I declare under penalty of perjury that the forgoing is 

true	 and correct. 

DATED this day of _________, 2 aa 

Your signature in ink 

Your name typed or printed 

Address 

Telephone Number 

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