1f you need additional space for ANY section, please attach an additional sheet and reference that section.l

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF ILLINOIS

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Defendant(s

2. I declare that I have contacted the following attorneys/organizations seeking representation: 

.

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3. I declare that (check all that apply):

Case Number:

Judge:

l.

MOTION FOR ATTORNEY REPRESENTATION

(NOTE: Failure to complete all items may result in the denial of this motion. )

declare that I am the (check appropriate box)

plaintiff tl defendant in this case and that I am unable to afford the services of an

attorney. I hereby ask the Court for an attorney to represent me in this case.

(Naw:)

d I amnor currently represented by an attorney requested by the Court in any federal

criminal or civil case.

OR

tr | am cunently represented by an attorney requested by the Court in a federal criminal

or civil case. The case is described on the back of this page.

rlier: )

I have nol previously been represented by an attorney requested by the Court in any

federal criminal or civil case.

I have previously been represented by an attorney requested by the Court in a federal

criminal or civil case. The case is described on the back of this page.

4. I dgclare that (check .one):

I have attached an original Application for Leave to Proceed In Forma Pauperis

detailing my financial status.

Rev. 0612312016

(Ea d

OR

n

[lf you need additional space for ANY section, please attach an additional sheet and reference that section.]

FILED 3/31/2020

THOMAS G. BRUTON CLERK, U.S. DISTRICT COURT

20CV2111

Case: 1:20-cv-02111 Document #: 6 Filed: 03/31/20 Page 1 of 2 PageID #:113
fI

tr

5. {

[f you need additional space for ANY section, please attach an additional sheet and reference that section.]

I have previously filed an Application for Leave to Proceed In Forma Pauperis in thrs

case, and it is still true and correct.

I have previously filed an Application for Leave to Proceed In Forma Pauperis in this

case. However, my financial status has changed and I have attached an Amended

Application to Proceed In Forma Pauperis to reflect my current financial status.

I declare that my highest level of education is (check one):

El- Grammar school

d So*. college

E Some high school

E College graduate

tr High school graduate

tr Post-graduate

tr

tr

6.

7.

I declare that my ability to speak, write, and/or read English is limited because

English is not my primary language. (Check only if applicable.)

I declare that this form and/or other documents in this case were prepared with the

help of an attorney from the U.S. District Court Pro Se Assistance Program. (Check

only if applicable.)

8. I declare under penalty ofperjury that the foregoing is true and correct.

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Date Ctty, State, Ztp

Other cases in which an attorney requested by this Court has represented me:

Street Address

Rev.06/2312016

Signature of Movant

City, State, Zip

Attorney's Name: This case is still pending fl Yes tr No

The aooointment was limited to settlement assistance: fl Yes tr No

Case Name:

Attorney's Name: This case is still pending E Yes El No

The appointment was limited to settlement assistance: E Yes tr No

Attorney's Name: This case is still pending EI Yes tr No

The aonointment was limited to settlement assistance: fl Yes tr No

[lf you need additional space for ANY section, please attach an additional sheet and reference that section.]

Case: 1:20-cv-02111 Document #: 6 Filed: 03/31/20 Page 2 of 2 PageID #:114