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# 51 tj{)-G**~** CAUSE NUMBER: JE _/

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# Te:d~~o,\ t-Jo.-\\ono.\ 

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# t~<j9~ § IN THE JUSTICE COURT

# ~-s/i.r**,'\TZ** PLAINTIFF 

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### § PRECINCT 4, PLACE 2 en**'''<~,** 

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### DEFENDANT(S) & 

### ALL OCCUPANTS 

### § DALLAS COUNTY, TEXAS 

### <i!**~~:z:** 

### c.n ,..**~** (J) 

### AFFIDV AIT OF INABILITY TO PAY COSTS (TRCP 749a) IIWE the named Defendant(s) in the above styled and number forcible detainer and /or forcible entry and detainer, are/am unable to pay the court costs of appeal therein. 1/we verify that the statements made in this affidavit are true and correct, and contain complete infonnation as to the my identity, the nature and amount of governmental entitlement income, the nature and amount of employment income, other income, (interest, dividends, etc.), spouse's income if available to me, property owned (other than homestead), cash or checking account, dependents, debts, and monthly expenses (Texas Property Code §24.0052). 

### TENANT'S IDENTITY \

## fV\C\CCJf,~D 

# T O'((CS Tenant's Street_.4.ddress, City, State, Zip (:'ode



## LIGC-\**S-t-G090~** 

## L(G9 

## S}6 

# (Jqo3 Tenant's Primary Phone Tenant's Secondary Phone Tenant's Date of Birth 

### SPOUSE'S IDENTITY Spouse 's Full Name Spouse's Primary Phon Spouse's Secondary Phone Spouse's Date of irth 

### DEPENDANTS

### ~ I 

### q 

## yrs A IS \j'fs. 

### Number of Dependants Ages of Dependants

## Go3cc~f'\C'>n 

# sA G'f9.b 

# 9ro.if,·e \x 3.505\ Residence of Dependants Address, City, State, Zip Code CC-13-06190-C Justice of the Peace 4-2 841 West Irving Boulevard Irving, TX 75060**;:~~DAVI** P. (214) 589-7000 F. (214) 589-7048 2601a4 T INABILITY To PAY 

# 1111111/lllll//ll/111

# '- ...) INCOME OF TENANT & 

### SPOUSE



### ___ Se

### I~ em

### pt~e 

# -An1

Tenant's Employer Tenant's Job iTle and/or Dut1es



## ___**0~---** 

# Co n._( 0 'Q 

### s-\ 

# Gwl\ cl QIG\ .\

## ~ 

## ,e_ T " 

## -=tSos.L------------ --- ------- Tenant s Employer Address, 

### City, State, Zip Code

---·---- ·----,----------

## 'J'en(~~~~sur,e:f\~2 Na-·m_e __ _ Tenant's Supervisor's Phone Tenant's Monthly Salary/Income Tenant's Other Income**-~** 

## --0 Spouse's Employer Spouse's Job Title and/or Duties 

### -------,--------------------,----------------

Spouse's Employer Address. City, State, Zip Code Spouse's Supervisor ·s Name Spouse 's Supervisor's Phone

---·---------------

Spouse's 111onrhly Salary/Income Spouse's Orher Income 

### GOVERNMENT ENTITLEMENT INCOME

--------------

Unemployment Benefits AFDCITANF
_,___

# __________ ------ ----··--·- --· 

### -- ·-·---- Social Security Disability Veteran's Benefits Child Support

------- -- ·----- Other Amounts- Describe 

### ALL OTHER INCOME



### ----------- ··---------------

List all other sources of income and amounts. Cash on hand

--------------- 

### ------- -----·- ---····------· ...... -··--· -----

Financial lnst irution olCheckingAccount Balance Amount



### -····----------------

Financial Ins! itution o_fSavings Account Balance Amount 

### REAL PROPERTY (residential, commercial, or land owned)

----------·---------- 

### ----------- Address**(~(Real** Property Ovmed Value of Properly

- 

### ------ ------ -··-------------·-·-- Address o(Real Property Owned Value o(Property**Ju.~tice** of the Peace 4-2 841 West Irving Boulevard Irving, TX 75060 P. (214) 589-7000 F. (214) 589-7048

### PERSONAL

# PROPER~ (other than

# ltouseholdfurnishings,~thes, tools of tt 

### trade, orpersonal effects. This includes vehicles tmd other sources of transportation)

····--.. ---·--------------------:----::-=----------- Descriplion a./Property Owned Value ofProperty

---·-·-------··------------- Descriplion £dProperty Owned Value ofProperty 

### MONTHLY EXPENSES



## ---- g3C) ______ _ Rent and/or**!~'for/gage**Amount 

# ....e.-**·---------'~"""--,------------------** Vehicle/Car Payment Amount

··--·--- Insurance Amount

### ·---~ Child Care Amount



# ___**'faa~**

F'ood and/or Incidental Amount 

## __ _3_gQ Ulility Amount

### ~ Child Support Amount



# ..eMedical and/or Dental Amoun/

## --~2~~-a-~----------------------------­ Other AmoumGf\S Describe Other Amount -(hher

# ;{,~;;~t**~cce.s(t··~** Describe Other Amount Signed this the { G --day of_

### ____:A:....cu>!..§~·L.L..i r....l-J--+-·---- 70 

# L22 

# d**-~4--t?.arr(** 'o f(or(f

# 4'a~Y~d _.fib _ _ Signa/ure oj'Af/iant Printed Name ojAjjianl THE 

### STATE OF 

### TEXAS 

### § COUNTY OF 

### DALLAS 

### § BEFORE ME. the undersigned authority, on this day personally appeared the above named aftiant who upon oath, stated that he/she is the Tenant making this Pauper's Aftidavit and that the information provided is true and correct. 0 

### AND

# SUBSCRIBE~ before me on the

# /~-day of ......!...llAtk:f44fU---=-- , 

### 20_{ __ .

CERTIFICATE OF 

### DELIVERY: I the Defendant in the above and entitled to·rcible detainer 

### I torcible entry and detainer certify that I have sent the torgoing document to the opposing party on this the day of_____ , 20________ _

--·--··---- ·-----

Signature ufDefendant Printed Name ofAffianl Justice of tile Peace 4-2 841 

### West Irving Boulevard Irving, TX 75060 P. (214) 589-7000 F. (214) 589-7048