Free Appeal Document - District Court of Arizona - Arizona

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ABELARDO SEPULVEDA URIBEzmb Um Bt ég
r Q . . A Zi-Wm APPLICATION TO PROCEED IN
r=*~»i»*’“*?‘ 1=o12MA Pauvems, supponrmo ·
y_ - DQCUMENTATION AND ORDER
1 CASE NUMBER CR Oli 319 O2 PHX SRB
UNITED STATE OF AMERICA .
l, declare that-I am the (check appropriate box)
U E] petitioner/plaintiff I iq movant (filing 28 U.S.C. 2255 motion)
Q respondent./defendant Q .
Other _
in the above-entitled proceeding; that, in support of my request to proceed without being
I'€qUlI'Ed to [JTEPBY {EBS, cost Of glVE 5ECU{iI'§¢'·Il"IEf'Ef0f, l state that because of ITIY POVETIY, l
am unable to pay the costs of said proceeding or give security therefor; that I believe I am Q
entitled to relief. The nature of my action, defense, or other proceeding or the issues I intend
to present on appeal are briefly stated as follows:
INEFFECTIVE ASSISTANCE OF COUNSEL
A in further support of this application, I answer the following questions.
1. Are you presently employed? Yes Q No fl
. a. if the answer is “yes," state the amount of your salary or wages per month, and - ·
‘ give the name and address of your employer. (list both gross and net salary}
b. If the answer is "no," state the date of last employment and the amount of the
salary and wages per month which you received.
2. Have you received within the past twelve months any money from any of the follow- ‘
ing sources?
a. Business, profession or other fom: of selhemployment Yes Q No E
b. Rent payments, interest or dividends? Yes Q No Ei
c. Pensions, annuities or life insurance payments? Yes Q No _
d. Gifts or inheritances? _ Yes Q No K]
` e. Any other sources? A Yes {E No Q
A i- :04—cr—00319—SRB Document 125-2 Filed 11/27/2006 Pa e 1 of 3 -
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40 Reverse .....;L. ;·; :
` `If the answer to any of the above is "yes," describe each source of money and state the
amount received from each during the past twelve months.
Whenever my family have some available money they send me some for
hygiene and phone calls.
3. Do you own any cash, or do you have money in checking or savings accounts?
Yes l:] No [X] (Include any funds in prison accounts.)
y lf the answer is "yes," state the total value of the items owned.
l 4. Do you own or have any interest in any real estate, stocks, bonds, notes, _
automobiles or other valuable property texcluding ordinary household furnishings
and clothing)?
Yes Q No [X]
lf the answer is "yes," describe the property and state its approximate value.
5. List the persons who are dependent upon you for support, state your relationship to I
I those persons, and indicate how much you contribute toward their support.
I declare under penalty of perjury that the foregoing is true and correct.
Executed on l
{Date] Signature of Applicant
CERTIFICATE
{Prisoner Accounts Only) . _
45
I certify that the applicant n ed h in has the si m of$
- on account to his credit at the _ _
institution where he is confined. I furthr certify that the applllgant likewise has the following securities to
his credit according to the records of said institution:
I further certify that during the last six months the ». pp|icant's average balance was 5
_ lip']; as s Q ·
W Autho iz · • I r of I s itution
. - .. . .,,, .. ij-*241...., _,__ ll We ..
ORDER OF COURT
g • The application is hereby granted. Let the .
applicant proceed without prepayment of
The application is hereby denied cost or fees or the necessity of giving secur-
_ · ity therefor.

= United States rudge Date United States Judge Date
· ' or Magistrate l
‘ _ _ Case 2:04—cr—00319-SRB Document 125-2 Filed 11/27/2006 Page 2 of 3

PROOF OF SERVICE
l certify that on Z5; Q6 Q (date) I mailed a copy of this brief and ati
attachments via first class mail to the following parties at the addresses listed below:
U.S. DEPARTMENT OF JUSTICE
UNITED STATES ATTORNEY .
FOR THE DISTRICT OF ARIZONA
230 FIRST AVE. , ROOM A000
PHOENIX, AZ 85025-0230
PROOF OF SERVICE FOR-INSTITUTIONALIZED OR
INCARCERATED LITIGANTS
in addition to the above proof of service all litigants who are currently
institutionalized or incarcerated should include the following statement on all documents to be
filed with this Court:
I certify that this document was given to prison officials on /g/Eg' wg (date) for
fonivarding to the Court of Appeals. I certify under penalty of perjury that e foregoing is true
and correct. 28 Ll.S.C. §1746. ‘
Aggggggxh ‘5'>g;0 w eomu O
Signature
ABELARD0 SEPULVEDA URIBE
REG. N0. 81916-008
_ LSCI ALLENWOOD
Dam- P. 0. Box 1000
WHITE DEER, PA 17887
Rev. D9/05
7
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