"" C c ~ 31) 51 tj{)-G ~ CAUSE NUMBER: JE _/ 3~0;.::__\ ---.:q:__q~6::::..___L U 4 2[113 Te:d~~o,\ t-Jo.-\\ono.\ M o t~<j9~ § IN THE JUSTICE COURT ~-s/i.r ,'\TZ PLAINTIFF §§ CL~. ElfAV DlSTf!l(! ~ .- <- c:: > ~m § PRECINCT 4, PLACE 2 en '''<~, 

§ (..) ' .. ::::.:-np 

vs. 

o s-<::s::f"'' 

§ ~ ~p~s § :X ::'- 1"'1 ;;D _,;:or<l 

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 olChecking Account Balance Amount 

-····----------------

Financial Ins! itut ion 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, 

or personal 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 A mount 

-(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