P.D^SoX \9vSO? Co.Oi(^l+ SMztTuart «i3?nie

Oc^nr &rs or M.4m^ ***o*(*m

C VxtLOt uonM\ fcO-feuT IVtw ft Irk*.

iDofk-iACju fico - S*~~ & hfiu)C b*L<e~/\ S^sid

iM a tubW&\ ~tbr Di^CoUtfCj iro- hopeJ^Ku

oa +kc uj(tnil! £Mk^uL*& , ty^t-ust^

/Ail 1AAOLtr\C^L *& CAsitik loAjLO<L 4-L£

axit/LdiLqW ax nD euiLit dt ih<t ^-mjl&lclclx sl^Wi Q£LQ££i&f\&[[ q 4kest,. sush<tk,&r do Wa.pp&\ ';£• ajdS f^lfcei [Ah hiking d pita cca rzpMjiAt. ed&er pUaliaq i0

Si clm. T >

\xoiLfI supervisory pD^r -fo ^ak^iUfL

lo F i
4>Mlu-<kPe-f\btr CO/lSp^d-fo bck^mja^ cl(\ iaaz)l^p^, iAO>if^^

4d( ol aoo& rtpor Oottk ^ac Q<-A«£ af^ce/

tfuJolm <Mc curt, ^afhciSL SuShe/n toeS uzcrk

Ly Actu#k Ua Jr fk&n ^ c(fi f^

<D°l^ Duff, eh . _

3yd0 C.Sa/o A/u-bA'^ bo*-* loo

tfi/odf &^Cf\€ft QkcLUtZ^0 0.D* Bar* C^^OO

a<?^ ^
IN THE UNITED STATES DISTRICT COURT

FOR THE 3 DISTRICT OFTEXAS

^DIVISION

Plaintiff's name and ID Number

Pl&e ofConfinement> ; ~^. Q

V.

CASE NO.

(Clerk will assign the number)

APPLICATION TO PROCEED

IN FORMA PAUPERIS

Defendant's name and address

I, X)aSC-l\k \-te>\0ic C4t , declare, depose, and say I am the Plaintiff in the above entitled case. In support

of my motion to proceed without being required to prepay fees, costs, or give security therefor, I state because of my

poverty, I am unable to pay in advance the filing fee for said proceedings or to give security for the filing fee. I believe I

am entitled to relief.

I, further declare the responses which I have made to the questions and instructions below are true.

1. Have you received, within the last 12 months, any money from any of the following sources?

a. Business, profession orfrom self-employment? Yes • No 0/-

b. Rent payments, interest ordividends? Yes • No ET/ c. Pensions, annuities orlife insurance payments? Yes • No S^S

d. Gifts or inheritances?

e. Family or friends?

f. Any other sources?

Yes •

Yes •

Yes •

No 0^

No FT

No FT

If you answered YES to any of the questions above, describe each source of money and state

the amount received from each during the past 12 months.

Do you owncash, or do you have money in a checking orsavings account, including any funds

inprison accounts? /

Yes • No 1%/

If you answered YES to anyof the questions above, statethe total value of the items owned.

•&ATCIFP (REV. 9/02)
Do you own real estate, stocks, bonds, note, automobiles, or other valuable property, excluding

ordinary household furnishings and clothing?

Yes • No &

If you answered YES, describe the property and state its approximate value.

I understand a false statement in answer to any question in this affidavit will subject me to penalties for

perjury. I declare (certify, verify, or state) under penalty of perjury that the foregoing is true and correct

(28 U.S.C. §1746).

Signed this the 3 \ [% day of iM {if AW ,20 [&

Dr,0 ®$T^~ \-nVJ9f!

Signature of Plaintiff ID Number

YOU MUST ATTACH A CURRENT SIX (6) MONTH HISTORY OF

YOUR INMATE TRUST ACCOUNT. YOU CAN ACQUIRE THE

APPROPRIATE INMATE ACCOUNT CERTIFICATE FROM THE

LAW LIBRARY AT YOUR PRISON UNIT.

•&ATCIFP(REV. 9/02)
CSINIBOS/CINIB02 TEXAS DEPARTMENT OF CRIMINAL JUSTICE ©4/01/15

LH30/SRA6141 IN-FORMA-PAUPERIS DATA 13:48:40

TDCJ#: 01273988 SID#s 06630035 LOCATIONS JAMES LYNAUGH INDIGENT DTEs 11/07/14

NAME: ROBERTS,.DARRELL BEGINNING PERIOD: 10/01/14

PREVIOUS TDCJ NUMBERS:

CURRENT BALs 0.70 TOT HOLD AMT:

6MTH DEPs 30.70 6MTH flVG BAL:

MONTH HIGHEST BALANCE TOTAL DEPOSITS

03/15 0.70 0.00

02/15 0.70 0.00

01/15 0.70 0.70

50.00 3MTH TOT DEPs

0.34 6MTH AVG DEP:

MONTH HIGHEST BALANCE TOTAL

IS/14 0.00

11/14 30.00

10/14 0.00

0. 70

DEPOSITS

0.00

50. 00

0. 00

PROCESS DATE HOLD AMOUNT HOLD DESCRIPTION

STATE OF TEXAS COUNTY OF Peaf*

ON THIS THE J_ DAY OF &££,

C^^

,££, I CERTIFY THAT THIS DOCUMENT IS A TRUE,

COMPLETE,AND UNALTERED COPY MADE BY ME OF INFORMATION CONTAINED IN THE

COMPUTER DATABASE REGARDING THE OFFENDER'S ACCOUNT. NP SIGs

PF1-HELP PF3--END ENTER NEXT TDCJ NUMBER: OR SLBHMUMBER:

t/iq -3^(3 &-/TAcS f/ £>739-?i

mi

N-m1J»»' V wl,hf"'

SAWU6L G. »

Motiry Public. State «' Texas « My Commissi"'! Expires •

03 21 201* *

o e o « « « *

, owd