Court Opinion

ID: 4038192
Source: CourtListenerOpinion
Date Created: 2016-09-28 21:51:00.720207+00
Date Added: 2024-06-11T14:28:12.502041
License: Public Domain

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                                                       JAN 14 2UJ5*_ _________:._ _ _ _ ____:______

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 r!'YVJ::~I ~ r(Correcti~it name)                                                                                  (City)
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                  ..........                                                                                     I declare under penalty of
  (County)                                  (State)                     (Zip Code)

perjury that the f~ng i• true and correct.

Executed on the
                       61          7day of Oec;?)k ~er, 20-4:-

···················································*··························
        An example of an unsworn declaration pursuant to Federal law is as follows:

 _ _ _ _ _ _ _ _ _ _ _ _ _ _.(insert offender name and TDCJ number), being
presently incarcerated in                                (insert TDCJ unit name), in
_ _ _ _ _ _ _ _ _County, Texas, declare under penalty of perjury that the foregoing is true
and correct.

Executed on the _ _ _day of
                         )                     _______                      ,, 20 __ .
                                                                                                          (Offender Signature)
                                                                                                                                              "

******************************************************************************
                                                    NOTICE
                                          NOTARY PUBLIC SERVICE DENIAL

Regarding your request for Notary Public service, insufficient justification was provided
necessitating Notary Public service. However, you may proceed with an Unsworn Declaration.

         (Signature- Notary)                                                                                          (Date)
                                    IN THE UNITED STATES DISTRICT COURT
                                    FOR THE NORbHERN DISTRICT OF TEXAS
                                            lbt-leth . DIVISION     .

~-#Jq;,rsoq
Piail1tiffS ;aJ1diD Number
J)lck l.Jare,. thz/f .
Place ofConfinement
                                                                     CASE NO.i     I;?LtlQ -I}
                                                                       (Clerk will assign the nwnber)

                                                                     APPLICATION TO PROCEED
                                                                        IN FORMA PAUPERIS

          l,  1Ja/J-;t;_{]uch         ,
                                    declare, depose; and say that l am the Plaintiff in the above entitled case. In support
of my motion top      ed Without bemg reqwred to prepay fees, costs or giVe secunty therefor, I state that 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 that the responses which I have made to questions and instructions below are true.

         1.      Have you received, within the past 12 months, any money from any ofthe following sources?

                 a.   Business, profession or form of self-employment?                Yes   0          No~
                 b.   Rent payments, interest or dividends?                           Yes   0          No LJ/
                 c.   Pensions, annuities or life insurance payments?                 Yes   0          No~
                 d.   Gifts or inheritances?                                          Yes   0          No~/
                 e.   Family or friends?                                              Yes   0           No,~··
                 f.   Any other sources?                                              Yes   0          No   E:l

                 Ifyou answered YES to any of the questions above describe each source of money and state t:he amount
                 received from each during the past 12 months.

                          .                        JVIJ!
        2.       Do you own cash, or do you have money in a checking or savings account, including any ftmds in prison
                 accounts?
                                                 Yes 0            No~·
                 If you answered YES, state the total value of the items owned.

                                          d/A
                                                                  - I -
       3.      Do you own any real estate, stocks, bonds, notes, automobiles, or other valuable property, excluding
               ordinary household furnishings and clothing?

                                       Yes D           No~

I understand that a false statement or answerto any questions in this affidavit will subject me to penalties for
perjury. I declare (or certify, verify, or state) under penalty of perjury that the foregoing is true and correct (28
u.s.c. § 1746).

               Signedthisthe _ _ _ _ dayof          December                   , 20 /Lf
                                              -13JJ'!iik.h -IF/9.2~fuq
                                               Signature   Plamti.ff           ·     10 Number

       YOU MUST ATIACH A CURRENT SIX (6) MONTH HISTORYOFYOUR INMATE TRUST
       ACCOUNT.    YOU CAN ACQUIRE THE APPROPRIATE INMATE ACCOUNT
       CERTIFICATE FROM THE LAW LIBRARY AT YOUR PRISON UNIT (OR OTHER
       DESIGNATED LOCATION AT YOUR INSTITUTION).

                                                            - 2-
      '    .
gsiN~B02/CINIB02     TEXAS DEPARTMENT OF CRIMINAL JUSTICE             12/17/14
~DW33/PJ00097               IN-FORMA-PAUPERIS DATA                    12:24:51
TDCJ#: 01928809 SID#: 061303~8 LOCATION: WARE TRANSFER      INDIGENT DTE: 06/06/14
NAME: BUCK,BOBBY                         BEGINNING PERIOD: 05/01/14
PREVIOUS TDCJ NUMBERS: 00920805 01738380
CURRENT BAL:          0.00 TOT HOLD AMT:           0.00 3MTH TOT DEP:          0.00
6MTH DEP:             0.00 6MTH AVG BAL:           0.00 6MTH AVG DEP:          0.00
MONTH HIGHEST BALANCE TOTAL DEPOSITS      MONTH HIGHEST BALANCE TOTAL DEPOSITS
10/14        0.00             0.00        07/14        0.00             0.00
09/14        0.00             0.00        06/14        0.00             0.00
08/14        0.00      /
                              0.00        05/14        0.00             0.00
PROCESS DATE    HOLD AMOUNT     HOLD DESCRIPTION

                              khe. Jf
STATE OF TEXAS COUNTY OF --'VV, j
ON THIS THE .tl_ DAY OF :0eAAbvL /_fj_, I CERTIFY THAT THIS DOCUMENT IS A TRUE,
COMPLETE,AND UNALTERED COPY 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:

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                                                g='*!' ::,..n,;: : Notary Public
                                                                               Stat EK
                                                ~ 't,.;.., ~l*i My Comml~ 1 8 Of Texas
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                                                               ~THOUTBOND
                                                                            wlR  S, 2017

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