FORMA PAUPERIS
The petitioner asks leave to file the attached petition for a writ of certiorari without prepayment of costs and to proceed in forma pauperis.
Please check the appropriate boxes:
SI Petitioner has previously been granted leave to proceed in forma pauperis in the following court(s):
290th Judicial District Court,Bexar County Texas; 4th Court of
Appeals,San Antonio,Texas, U.S. District Court and 5th Circuit
Petitioner has not previously been granted leave to proceed in forma pauperis in any other court.
[x] Petitioner's affidavit or declaration in support of this motion is attached hereto.
Petitioner's affidavit or declaration is not attached because the court below appointed counsel in the current proceeding, and:
The appointment was made under the following provision of law: or
I a copy of the order of appointment is appended.
(Signature) AFFIDAVIT OR DECLARATION IN SUPPORT OF MOTION FOR LEAVE TO PROCEED IN FORMA PAUPERIS
I, Hiram Miles t am the petitioner in the above-entitled case. In support of my motion to proceed in 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 I 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 weekly, biweekly, quarterly, semiannually, or annually to show the monthly rate. Use gross amounts, that is, amounts before any deductions for taxes or otherwise.
Income 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
n/a n/a $ n/a $ n/a Self-employment $ $
Income from real property $ n/a $ n/f" $ n/a $ n/a (such as rental income)
Interest and dividends $ n/a $ n/a $ n/a $ n/a
n/a n/a n/a n/a Gifts $ $ $ $
Alimony $ n/a $ n/a $ n/a $ n/a
n/a n/a $ n/a $ n/a Child Support $ $
n/a n/a n/a n/a Retirement (such as social $ $ $ $ security, pensions, annuities, insurance)
n/a n/a n/a $ n/a Disability (such as social $ $ $ security, insurance payments)
Unemployment payments $ n/a $ n/a $ n/a $ n/a
n/a n/a $ n/a $ n/a Public-assistance $ $ (such as welfare)
Other (specify): Mom $_35Q.Q0_ $ n/fl $ 40.00 $ n/a
Total 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.)
Employer Address Dates of Gross monthly pay Employment n/a n/a n/a $ "/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.)
Employer Address Dates of Gross monthly pay Employment n/a n/a n/a $_ n/a
$. $.
4. How much cash do