NO. 07FD2827 IN THE INTEREST OF 

### § § 

### § § § § NUMBER TWO IN THE COUNTY COURT AT LAW KERISSA TOUCHSTONE AND RICHARD DALE TOUCHSTONE CHILDREN GALVESTON COUNTY, TEXAS

RESPONDENT'S AFFIDAVIT OF INABILITY TO PAY COSTS OF APPEAL STATE OF TEXAS GALVESTON COUNTY 

### § § Before me , the undersigned nota ry , on this day personally appeared El i sa Marie Moreno , a person whose identity is known to me. 1 After I administered an oath to her , upon he r oath she said the following :

1. " My name is lisa Marie Moreno , and I am the Respondent in this case . I am of sound mind and capable of making h i s affidavit. The facts stated within this affidavit are within my personal knowledge and are true and c rrect. 2 . "On March 10 2015, t he t r i al court signed a final Order in favor of Petit i oner and against me in Cause Number 07FD28 7 . After a timely Motion for New Trial was filed by the Attorney General ' s Office , the Court signed an Or er Modify i ng the Judgment on May 15 , 2015 . I intend to appeal the court ' s final judgment to the 1 st or 14t h Co u rt of Appeals in Houston .

3 . " The esti m ate cost of the reporter' s record is $522 . 50 . I am unsure of the cost of the clerk' s record. 4 . "I am unable t pay any of the court costs of the appeal. 5. " I h ave been nemployed since February 1 , 2015 . I collect unemployment income of $25 1 weekly . I have no other incom from any othe r source . See exhibit 1 and incorporate by reference . 

### 6 " I do not have a spouse . 7 " I h ave four (4 dependents , who are my children and who I am ob l igated to support . Two of them l i ve w i th me , Eleazar Pena who is 17 and Joshua Pena who is 1 5 . Two of them , Ke ri ssa and Richa rd Touchstone , I am obi gated to support per this Court ' s order at $384 monthly plus an additional $50 monthl y in medica l suppo

8 . " I do not own ny real or personal property . 9 . " I have no ca h and no money on deposi t .

" I do own a v r hicle , a 1997 Chevy Lum i na , wh i ch is worth about $500 . I have no othe r

I 11. " My monthly expenses are : approximately $2000, and that includes $500 monthly rent , $400 in food and supplies, $300 in utilit i es and telephone, $100 in clothing and laundry, $80 car insurance , $150 i n gas and repairs , plus the $384 and $50 ordered by this Court for Child support. My total monthly income is on l y $1132 , and that i ncludes the food stamps .

10 . assets . Filed: 6/8/2015 1:07:17 PM JOHN D. KINARD - District Clerk Galveston County, Texas Envelope No. 5582618 By: Sara Redmond 6/8/2015 1:19:37 PM12 . " I am not able to obtain a loan to payfo r the costs of the appeal as I have already reached

my maximum limit for borrowing from all known sources including friends and family .

13. " I am represented by legal counsel, who is providing services to me for f ree on this appeal , but she cannot or will not pay the costs of the appeal .

14 . " I am currently receiving public benefits , including Food Stamps and C HI P . I receive $45 monthly i n food stamps. See e x hibits 2 and 3 , attached and incorporate by reference. 15 . " I have neither the access to the equipment necessary nor the skill necessary to prepare the appendix .

1 6. " Further affiant sayeth not . " 

# ~h1 · bbwtr ELISA MARIE MORENO

•• iw£X i ! , w,aAA , ~Iib«R.q~ me by Elisa Mari ~ r oreno on June 8 , 2015 . 

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. STATE OF TEXASlftuE r: t &ary Public in and for

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- ~ The State of Texas

CERTIFICATE OF SERVICE I cert ify that true a copy of t he above was served on each attorney of record or party by a method 

### permitted by Rule 2 1 a of the Texas Rules of Civil p ~ une ~

, JULIA C. HATCHER

21887 1391- 1 C 1 8666

STATEMENT OF BENEF I TS TE XAS WOR K FORC E COMMISS I ON PO BO X 22 11 MC AL L EN TX 78502-221 1 

## Statement of Wages a nd P ote nti a l B en efit Amounts R egula r Un e mpl oym e nt B enefi ts: D at e M a il ed: F ebrua ry 5 , 2015 (A ll dat es a re in m on t h/day /year o rder) UJ 

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### = 0 == .I>- 0 UJ OJ i iii i iiiii ii 0 

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## = ELISA M MORENO 14804 GAMBLE RD SANTA FE TX 77517 - 316 6 

## 1 1'11 1 1'11 1 .1 .1 •••• 1 1 I••• 1 •• 

## 11'11 . 11 . 11 ••• 11•• 11, ," 1 •• 1•• 11 . 1 Socia l Securi ty N umber : 

## XXX-XX-7070 Dea r 

### ELISA M MORENO Chec k your reco rds ! TWC h as t h e wages below on fi le for yo u for the fo ur q u art ers of your base per i o d . We u se yo ur b ase per i o d wages t o f i gure o ut wh et he r you earne d e n oug h m o n ey to qua l ify for unemploym e nt i n su ra n ce be n e fits a n d how m u c h you cou l d receive if you are elig i ble . After TWC looks at w h ether you ea rn e d eno u gh m oney t o qua li fy, TWC l ooks at t he reaso n yo u a re n o lo n ger wo rk ing to deci d e whether yo u ca n receive be n e · f i ts. R eme m be r, even if yo u e a rned enough wa g es , 

### TWC p ays b e n e f its only if you meet th e wee kly re qu i re m e nts. Please check t h e wage informat ion carefu l ly . If t he employer name o r the wage amoun t is incor rect, or if an employe r you wor ked for is missing , please contact a TWC T e l e-Center immediately . More information about co r recting yo u r wages is on the back of t his for m . B as ed o n th e wages l i sted in the box below: 

# [X l Yo u e ar ne d e n o u gh in your b a s e period to 

# 0 rece i ve u nemp l oyme n t benef its . i f you are otherwise E!ligib l e . 

### i i You did not earn eno u gh i n you r b ase period to qua l i fy fo r be n efits.

0 . 00 0 . 00 0.00 0 . 00

2 , 933 . 44 0 . 00 0.00

1 , 36 1 . 44 4 , 9 14 . 0 0 5 , 803 . 1 3 0 . 0 0 0 . 0 0 5 ,80 3 .13

4 .294 . 88 4,91 4 . 00 O c t -Dee 20 1 3 ~ a n - M a r 20 14 Ap r -Jun 20 14 Ju l - Sep 20 14 F L UO R DANI EL SERVI C E S TX FAMI L Y DOLLAR S TO ~!ES OF T E XA S LL C 

# I TX S AF WAY S E RVI C ES L L C . TX



## ' * You will r ec eive a se p a rate n oti ce expl a inin g w hy w e did not use th ese wages . Th e m ax im u m we e kly b ene fit am o unt i n T exas th is ye ar i s $ 4 65 . Base d o n th e wa g es ab ove , yo u r wee kl y be n e fit am oun t is $ 2 5 1 . T he max imum amo u n t you could re ce i ve dur i ng your benefit yea r is 

## s ...,; 4 ;.;: 0 ;.;: 5 ... ; . 4

__ . Your benefit 

### year is t he 52 weeks f rom 02-01 - 15 t o 01 - 3 0- 1 6 Keep in mind your benefits may run out before the benefi t ye a r ends. S ee the back of t hi s pag e fo r m o re info r m at io n.

Cl aim 10 . : TWC T ale
- ph o no N o . : 0 2-{) l - 15 (& 00)939 - 6 6 3 1 FOR HE A RIN G IMPAIRED C LIENT S R elay T exa s TOO N o . : 1 - 800-7 3 5-2989

Voice N o . : 1- 800 - 735-2988 BM 1 00E 1 2/1 2/

0 7Fo rm TF0001 August 2014 HHSC - MIDLA N D PO BOX 14900 MIDLAND TX 79711-4900
D ate: 

### 03/

2 3/2015 

### Need help ? Call 2 - 1-1 or 1-877-541 - 7905 I f you have a hear i ng or speech disability, cal l 7-1 - 1 or any relay service. 

### A l l num b ers are free 

## to ca ll. 

# ~ ,TEXAS

~ ~

_I. . Heattth and Human; •• • ( SewicesCommis sron

C ase Numbe r: 

### 101 05 2 628 7

E LI SA MAR I E M OR E NO 14804 G AMBLE R D SANTA FE TX 7751 7 

# N ot ice a b out your case : SNAP Food Benefits EDG number: 101496605 

## Who gets SNAP Food Ben efits N ame D ate Monthly Amount 

### E l eaza r Pe na Jr ; Jo sh u a Pena ; Elis a Ma r i e 03/01/2015 - 07/31 /2015 

## $ 4 5. 0 0 More no Elisa Marie Mo reno; Joshua Pena; Eleaza r P ena 02/2 0/2015 - 

### 02 / 2 8 / 20 1 5 

## $ 93.00 Jr 

## Wh o can't g et SNA P Food Benefits N ame Date 

### Ri cha rd D al e To u c h ston e I I I; Kerissa Ren a e Touchstone 02/20/2 015 N otes : 

### Ke ri s s a Renae Touchston e can't be part of this benefits case. - (TW A-231 , 1 TAC 372 . 151; 3 72 . 152; 372.1 5 3; 372 . 1508, 7 CFR 273 . 1 ) Richard Dale Touchstone I I I can't be part of th i s benefits case. - (TW A-231 , 1 TAC 372.151; 372.152; 372. 15 3 ; 372 . 1508 , 7 CFR 273.1 )



# . H e alth Care Benefits P a ge 1 of 3 3769Form TF0001 August 2014 

## W 'ho g ets h eal th ca re ben ef i ts Name EDG number Program Date 

### Children's Health 05/01/2015 - Eleazar Pena Jr 631863789 Insurance Program 10/31/2015 (CHIP) Children's Health 05/01/2015 - Joshua Pena 631863790 Insurance Program 10/31/2015 (CHIP) 

## Wh o can 't g et hea l th care be nef i ts Name EDG Number Program Date 

### Eleazar Pena Jr 637885791 Children's Medicaid 02/01/2015 Reason : 

### You are not eligible for benefits. -(TWA- 2350, 1 TAC 366 . 215; 366.311; 366 . 409; 366.511 ; 366.615 ; 366.711; 366.811 ; 366 . 903, 42 CFR 435.919) (Joshua Pena, Eleazar Pena Jr) isn't: (1) age 20 or younger, (2) age 65 or older, (3) pregnant , (4) someone with a disability, (5) a dependent child on this case, OR (6) a child who didn't get SSI (Supplemental Security Income) due to the August 1996 change in disabil i ty rules. - (TW A-825; A-221B 475.1 . 2 , 1 TAC 366.307 ; 366.507; 36 6 .611; 366 . 707; 366.807 , 42 CFR 435.301)

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