Application to Proceed Without Prepayment of Fees & Affidavit
If a plaintiff is an affiant in a case and wishes to become relieved of paying the expenses for the proceeding, he/she can use this affidavit to make that request.
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AO 240 (Rev. 07/10) Application to Proceed in District Court Without Prepaying Fees or Costs (Short Form) U NITED S TATES D ISTRICT C OURT for the __________ District of __________ ) ) ) ) ) Plaintiff/Petitioner v. Civil Action No. Defendant/Respondent APPLICATION TO PROCEED IN DISTRICT COURT WITHOUT PREPAYING FEES OR COSTS (Short Form) I am a plaintiff or petitioner in this case and declare that I am unable to pay the costs of these proceedings and that I am entitled to the relief requested. In support of this application, I answer the following questions under penalty of perjury: 1. If incarcerated. I am being held at: . If employed there, or have an account in the institution, I have attached to this document a statement certified by the appropriate institutional officer showing all receipts, expenditures, and balances during the last six months for any institutional account in my name. I am also submitting a similar statement from any other institution where I was incarcerated during the last six months. 2. If not incarcerated. If I am employed, my employer’s name and address are: My gross pay or wages are: $ , and my take-home pay or wages are: $ per (specify pay period) . 3. Other Income. In the past 12 months, I have received income from the following sources (check all that apply) : (a) Business, profession, or other self-employment ’ Yes ’ No (b) Rent payments, interest, or dividends ’ Yes ’ No (c) Pension, annuity, or life insurance payments ’ Yes ’ No (d) Disability, or worker’s compensation payments ’ Yes ’ No (e) Gifts, or inheritances ’ Yes ’ No (f) Any other sources ’ Yes ’ No If you answered “Yes” to any question above, describe below or on separate pages each source of money and state the amount that you received and what you expect to receive in the future. AO 240 (Rev. 07/10) Application to Proceed in District Court Without Prepaying Fees or Costs (Short Form) 4. Amount of money that I have in cash or in a checking or savings account: $ . 5. Any automobile, real estate, stock, bond, security, trust, jewelry, art work, or other financial instrument or thing of value that I own, including any item of value held in someone else’s name (describe the property and its approximate value) : 6. Any housing, transportation, utilities, or loan payments, or other regular monthly expenses (describe and provide the amount of the monthly expense) : 7. Names (or, if under 18, initials only) of all persons who are dependent on me for support, my relationship with each person, and how much I contribute to their support: 8. Any debts or financial obligations (describe the amounts owed and to whom they are payable) : Declaration: I declare under penalty of perjury that the above information is true and understand that a false statement may result in a dismissal of my claims. Date: Applicant’s signature Printed nameRelevant article from our knowledge database
It's possible for you to send us your application at any time prior to the close of the application period, even when university's official application period hasn't yet begun. Normally, an application is examined a few months after filing. Even when you already know your application isn't yet complete, for example as you still haven't got your leaving certificate or language certificate, it's still possible to apply with the remainder of your documents. A writ application needs to be filed quickly.
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The form can be found from the court clerk. This form is contained in the packet. It may also be used in a divorce case where there is an agreement as to the children's issues. It is included in this packet. You may use this form for civil, family members, landlord-tenant, and little claims cases.
The amount varies by variety of case and sort of court. If you drop the situation, you may get charged with court expenses. Following that, your court case is going to be dismissed.
Alternatively you may call us on 0870 145 3935. If you aren't sure whether you're going to need all them waived, check all of them. It's not required at the right time of submitting the instance, only at the finished hearing. You've only 7 days to determine what to do.