State of Minnesota
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District Court
Judicial District: Court File Number: Case Type: General
Petitioner
vs.
Supplemental Affidavit for Proceeding In Forma Pauperis (Minn. Stat. ยง 563.01)
Respondent
STATE OF MINNESOTA
) ) SS COUNTY OF ) (County where Affidavit signed) 1. 2. I am a party in this action and make this request in good faith. (Check one of the following:) An order allowing me to proceed in forma pauperis without paying filing fees, service and publication fees, and copy fees has previously been issued in this case. Or I have completed and attached an "Affidavit for Proceeding In Forma Pauperis." 3. I am asking for an order directing the payment of the following costs by the state courts: a. Witness/expert witness for: Trial Deposition Name and address of witness:
I expect this witness to provide the following evidence or testimony (please give a general description):
I estimate the costs for this witness to be: Subpoena $ Service Fee $ Mileage $ Attendance Fee $ Other $
IFP103 State ENG Rev 8/08 www.mncourts.gov/forms Page 1 of 2
b.
Transcript expenses: Date of hearing, trial or deposition: I need a copy of this transcript for the following reasons:
I estimate the costs of obtaining this transcript to be: Court reporter fees $ Copy fees $ $ Other; c. Other expenses:
These expenses are necessary because:
Estimated costs:
$
Dated:
Signature (Sign only in front of notary public or court administrator.)
Name: Subscribed and sworn to before me this day of
Notary Public \ Deputy Court Administrator
Address: . City/State/Zip: Telephone:
,
IFP103
State
ENG
Rev 8/08
www.mncourts.gov/forms
Page 2 of 2