Free Motion for Leave to Appeal in forma pauperis - District Court of Arizona - Arizona

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® °lC>1—G·‘—l3"·i"·l33 NOV 2 8
2 CLERK
U S DIS
3 BY DlSTFilCT OEF HT
- DEPUTY
IN TI—[E UNITED STATES DISTRICT COURT
5 FOR THE DISTRICT OF ARIZONA
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7 Gr eric ry COM %
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3 am ) cv—o·—1-101—P1—1><·SMM
9 VS. i MOTION T0 PROCEED
. *3 In c; IN FORMA PAUPERIS and
10 AM-r· 5M \r¤i>¤~¤ Q · surronrrne INFORMATION
Defendant.
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13 I, Greg or X COX , declare that I am the Plaintiff in this action;
14 that I hereby request to proceed without being required to prepay fees, costs or give security
15 therefore. I state that, because of my poverty, I am unable to pay the fees of said proceedmg;
16 that I believe I am entitled to relief
17 In further support of this application, I answer the following questions:
18 l. Are you presently employed? @ No
19 a. If the answer is "yes", state the amount of your salary or wages per month and
20 give the name and address of your employer. $237G Hq G'°5$
21 Lion QH Company
|02,3 Rivgrgidg DF.
22 Mempl-»·'s, TN 3*3706
23 b. If the answer is "no", state the date of last employment and the amount of the
24 salary and wages per month which you received.
25 N /A
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Case 2:04—cv—00101—SIVIIVI Document 50 Filed 11/28/2005 Page 1 of 4

6. Jayne,C0x, wife, 100%.
Andrew Cox, son, 100%. 0
Gregory COX
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Case 2:04—cv—00101—SIVIIVI Document 50 Filed 11/28/2005 Page 2 of 4

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2 · NOV 2 8 2005
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5 IN THE UNITED STATES DISTRICT COURT
6 FOR THE DISTRICT OF ARIZONA
7 1
S Clfeixo ry Col S
9 Plaintiff, i cv·0¤i· lol-PH><»5mM
10 l ORDER
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1 2 Defendant. g
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14 I, , District Judge/Magistrate Judge ofthe United
I5 States District Court for the District of Arizona, hereby:
16 _ GRANT the application for leave to proceed in forma pauperis, without prepayment of costs
17 or fees or the necessity of giving security therefore. Plaintiff shall be responsible for service
18 by waiver or of the summons and complaint.
19 _ GRANT the application for leave to proceed in forma pauperis, without prepayment of costs
20 or fees or the necessity of giving security therefore. Service by waiver or ofthe summons and
21 complaint shall be at government expense on the defendants by the U.S. Marshal or his
22 authorized representative.
23 ____ DENY the application for leave to proceed in forma pauperis without prepayment of costs
1 or fees or the necessity of giving security therefore. Plaintiff shall have 10 days from the
26 entry of this Order to pay the filing fee of $250.00. The Clerk of Court is directed to enter
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28 Armcrmsnr 7
Case 2:04—cv—00101—SIVIIVI Document 50 Filed 11/28/2005 Page 3 of 4

1 dismissal of this action without further notice if Plaintiff fails to pay the filing fee of $250.00
2 within 10 days ofthe entry of this Order.
3 The Clerk shall forthwith notiiy the Plaintiff of the entry of this Order.
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5 DATED this _ day of , 200__*__.
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