STATE OF SOUTH CAROLINA, COUNTY OF
vs.
) ) ) ) ) Plaintiff ) ) ) ) ) Defendant. )
IN THE FAMILY COURT JUDICIAL CIRCUIT MOTION AND AFFIDAVIT TO PROCEED IN FORMA PAUPERIS
FILE NO.
I,
, being duly sworn, state that I am the Plaintiff and that I do not have the funds available to
pay the costs of filing and service in the present matter. I hereby request that the complaint be filed and service made without costs. Sworn to and Subscribed before me this day of ,2 . ) ) ) ) ) ) )
Notary Public for South Carolina My Commission expires
Signature of Plaintiff or Person Filing Complaint on Behalf of Plaintiff
ORDER Leave is granted to proceed in forma pauperis.
Leave is denied to proceed in forma pauperis. This case will be dismissed without further order of the court if the filing fee and associated costs are not paid on or before Dated: , ,2
JUDGE/CLERK OF COURT
. (Family Court Only)
South Carolina
NOTICE TO PLAINTIFF:
The Court may assess costs against either party at hearing.
SCCA 405F (5/08)