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### .t!Y fi-· :J,;.t:Jyc:;IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF TEXAS DIVISION 

## mrdt?;J t?oboJ ff/Ylcyo/ RECEIVED Plaintiff's name and ID Number FEB 0 4 2015

Place of Confinement COURT OF APPEALS SECOND DISTRICT OF TEXAS DEBRA SP!SA!{, CLERK
CASE NO.-,-;:;,-;--.,.,.-----,--:.,----:-..,- (Clerk will assign the number)

APPLICATION TO PROCEED IN FORMA PAUPERIS

I,**$&q]W£fc~** 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 or from self-employment? Yes D**No~** b. Rent payments, interest or dividends? Yes D No
c. Pensions, annuities or life insurance payments? Yes Noi.5"**~** Gifts or inheritances? Yes D No 

### G--
u. e. Family or friends? Yes [§/ NoD f. Any other sources? Yes D No c:Y

2. Do you own cash, or do you have money in a checking or savings account, including any funds in prison accounts? Yes D**No~-**
If you answered YES to any of the questions above, state the total value of the items owned.

### ~

1 1\-ATCIFP (REV. 9/02)3. Do you own real estate, stocks, bonds, note, automobiles, or other valuable property, excluding ordinary household furnishings and clothing?

Yes 0**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

__ · _..:.,J_·· 

# ..,?

___ day of

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.



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ARCHER CLAY COOKE DENTON EASTLAND ERATH HOOD JACK JOHNSON MONTAGUE PALO PINTO PARKER SOMERVELL STEPHENS TARRANT WICHITA WISE YOUNG Mr. Theodis Dodson #1490901 Connally Unit 899 FM 632 Kenedy, Tx, 78119

Dear Mr. Dodson Office of Presiding Judge
5th Floor, Tarrant County Justice Center Fort Worth, Texas 76196

December 10,2014

Re: 1072134 Theodis Dodson V, The State DAVID L. EVANS Presiding Judge Telephone (817) 884-1558

OUIDA STEVENS Administrative Assistant

TRACY KEMP Assistam
Telephone (817) 884"!558 FAX (817) 884-1560

E-Mail: SthAdmin @8thJudicia!Region.com

I have received your request I don't have jurisdiction to rule on your request I copying the triai judge with this letter and sending her the original of your request, Thank you,

cc: Judge Elizabeth Beach Mr. Robert Ford Mr. William Ray Mr. Sean Colston**"~',-"""E!VED** FEB 0 4 2015
COURT OF APPEALS SECOND DISTRICT OF TEXAS DEBRA SPISAK, CLERK



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