coURT oF cRIMINAL AP`PEALS_ RESPONDENT(S)
MOTION FOR LEAVE TO PROCEED IN FORMA PAUPERIS
The petitioner asks leave to file the attached petition for a writ of certiorari ' without prepayment of costs and to proceed 'L`u forma pauperis
Please check the appropriate boxes:
Petitioner has previously been granted leave to proceed iu forma pauperis in the following court(s):
290th Judicial District Court,Bexar County Texas; 4th Court of
Aooeals,$an Antonio,Texas, U.S. District Court and 5th Circuit
leetitioner has not previously been granted leave to proceed iu forma pauperis in any other court.
Petitioner's affidavit or declaration in support of this motion is attached hereto.
[:l Petitioner's afiidavit or declaration is not attached because the court below appointed counsel in the current proceeding, and:
l:l The appointment was made under the following provision of law: ' , or
:l a copy of the order of appointment is appended.
Signature) .
AFFDAVT OR DECLARATON _ N SUPPORT OF MOTON FOR LEAVE TO PROCEED IN FORMA PAUPERlS
l, Hiram Mil€S , am the petitioner in the above-entitled case. my motion to proceed iu forma pauperis I state that because of my poverty I am unable to pay
the costs of this case or to give security therefor; and l believe I am entitled to redress.
1. For both you and your spouse estimate the average amount of money received from each of the following sources during the past 12 months.
Adjust any amount that was received
In support of
weekly, biweekly, quarterly, semiannually, or annually to show the monthly rate. Use gross amounts, that is, amounts before any deductions for taxes or otherwise ncome source Average monthly amount during Amount expected the past 12 months next month
You Spouse . You Spouse Employment $ n/a $ n/a $ n/a $ n/a' Sef-employment $ n/a $ n/a $ n/a $ n/a ncome from real property v $ n,/A $ n,za $ n/a $ n/a (such as rental income) lnterest and dividends $ n/a v $ n/a $ n/a $ n/a Gifts $ n/a $ n/a $ n/a $ n/a Aimony $ n/a $ n/a $ n/a $ n/a Chid Support $ n/a $ n/a $ n/a _$ n/a Retirement (such as social $ n/a $ n/a $ n/a $ n/a security, pensions, annuities, insurance) Disability (such as social $ n/a $ "/a $ n/a $ n/a security, insurance payments) Unempoyment payments $ n/a $ n/a $ n/a $ n/a Pubic-assistance $ n/a $ n/a $ n/a $ n/a (such as Welfare) th€r (Sp€Cify)f __Mom__ $_aso.oo_ $ n/a $ 40.00 $ n/a
Tota monthly income: $ 40-00 $ $ 40~00 $
2. List your employment history for the past two years, most recent first. (Gross monthly pay is before taxes or other deductions.)
Empoyer Address Dates of Gross monthly pay Empoyment n/a n/a n/a $ n/a $ $
3. List your spouse's employment history for the past two years, most recent employer first. (Gross monthly pay is before taxes or other deductions.)
Empoyer Address Dates of