IN THE UNITED STATES DISTRICT COURT

FOR THE /7>>/ DISTRICT OF TEXAS

/3*//zs DIVISION

\)/AWr hf(\o\f\rs ftd/tasWi^ff' M78Mb

Plaintiff's name and ID Number

9f\LL DQJnd UffiV

Place of Confinement

V.

QS-Of- 0/£66~C/C

case No.rO^-^7-- aiss^^r/i

(Clerk will assign the number)

Defendant's name and address ~Z7-

APPLICATION TO PROCEED

IN FORMA PAUPERIS

SEP 14 2015

I, Ulfl/lr&r fflMflid' JCt^Ti;vaeclare. 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, Istat®Sfja^|)^fem^|j

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

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?

b. Rent payments, interest or dividends?

c. Pensions, annuities or life insurance payments?

d. Gifts or inheritances?

e. Family or friends?

f. Any other sources?

Yes •

Yes •

Yes •

Yes •

Yes •

Yes •

No \^

No \^r

No H<-

No q/

No Q/y

No Q/

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.

2. Do you own cash, or do you have money in a checking or savings account, including any funds

in prison accounts? .

Yes • No M

If you answered YES to any of the questions above, state the total value of the items owned.

AATCIFP (REV. 9/02)

II!
/ 3. Do you own real estate, stocks, bonds, note, automobiles, or other valuable property, excluding

£ ordinary household furnishings and clothing?

Yes • No M

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 A^3<aVT cS day of AaSiaSSC ,20 iS .

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)
Aa&usY 2£.2m£

'OiftT/.Oifitiridr CltrK.

1\d.£,j, no, \H7H%_

*f dl\ Transcripts (j&aH^ , CkfKs (Wo^s , /(r^st fceorf3

and Cdujt+ •Nortecs K^o^s., .ihdudinQ inaidwrfV ar\A

in^losei.is a" wor) ^ i_a.tomA faaPtris form,

and DdTa , S-taKns rvw In^UlVN jo fctf ros^ or-fc^'

Tor -thwt £ou<r+- Doturv]^h.

TVtartK Voa 6r Voar -Assis+ani

1/5.

£«_-. Co aft of tfPtojis nurnbtr; Qs-07-olsstf-££
(A) tdc01bs8 - PASSPORT Tuesday, September 01, 2015, 15:38:36 PM

CSINIB02/CINIB02 TEXAS DEPARTMENT OF CRIMINAL JUSTICE

1BS8/FJ00021 IN-FORMA-PAUPERIS DATA

TDCJ#: 01.478496 SID#: 07803910 LOCATION: DANIEL INDIGENT

03/01/15

09/01/15

15:38:27

DTE: 01/16/15

NAME: SAGASTUME,WALTER ARNOLD

PREVIOUS TDCJ NUMBERS:

0.01 TOT HOLD AMT

1.4 7 6MTH AVG BAL

BALANCE TOTAL

01

01

,01

HOLD AMOUNT

BEGINNING PERIOD:

CURRENT BAL:

6MTH DEP:

MONTH HIGHEST

08/15 0

07/15 0

06/15 0

PROCESS DATE

0.00 3MTH TOT DEP:

0.09 6MTH AVG DEP:

DEPOSITS MONTH HIGHEST BALANCE TOTAL

0.00 05/15

0.00 04/15

0.00 03/15

HOLD DESCRIPTION

0

0

3

01

01

16

0,

0,

DEPOSITS

0.00

0.00

1.47

STATE OF TEXAS COUNTY OF ^CAnf*/

ON THIS THE _[_ DAY OF t^bC'^~l CERTIFY THAT'

COMPLETE,AND UNALTERED^ COPY

THIS DOCUMENT IS A TRUE,

)PY MADE BY ME OF INFORMATION CONTAINED IN THE

COMPUTER DATABASE REGARDING THE OFFENDER'S ACCOUNT. NP SIG:

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

^"S^;

00

25