Free Motion for Leave to Proceed in forma pauperis - District Court of Delaware - Delaware

_III I Case 1:07-cv-00757-SLR Document 4 Filed 12/28/2007 Page1 of3
IN T-HE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF
I_ I DELWARE. I I
I
0'Vl 57 I
_ (Sow)
EZEADEGO `ODUCHE STATE Attorney office, _
Dover Police Department of
V. Public Safety and ,
__ Edward Fisher,JR `
J. VELLA y
ouuche , sm # 107414 I I y
IFTHQE Plaintiff in the above Captioned matter. Has filed this action pursuant to 42 I
LI-.S..C._-1983 Without prepayment of the filling fee or a request to proceed in
Forma Pauperis.
NAI)/IE:
I, §2Qg.4X@ Qaéfég ,decIare under penalty of perjury, pursuant to28
UQS.C.section 1746, that I am the person above and that I am unable to pay the
fee. Ibelieve that my appeal/motion is valid, andl declare that the following
information is true and correct to the beest of my knowledge;
Assets * Q Expenses (including dependents)
VI/ages,SalaIy $ QI I month I I Housing I
~ Other Income $ Q month (rent, mortgage, etc.) $_Q/month
(business,profession,
(seIf—empioyed,rent Food 49 lmonth
Cash Q Clothing é lmonth
Checking or Savings Account Q Utilities Q- lmonth
‘ (phone,electric,gas,water,etc.)
gf,QII0& I Transportation (2 lmonth I I
(realestate,automobiIe,stocks,bonds) _ _
Other Fgmnciai Support $ O Debts,LiabiIities $ Q lmonth i
(public assistancealimony, . I =
child suppoIt,gift,parent, Other Q $ A? lmonth
spousejother family members,etc. (specify) V
I I
Signature I
f;<,—;Lc’»= ~g 0*3
A _ Date. y
if t, I
· ~ I

Case 1:07-cv-00757-SLR Document 4 Filed 12/28/2007 Page 2 of 3
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Case 1:07-cv-00757-SLR

Document 4

Filed 12/28/2007

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Case 1:07-cv-00757-SLR

Document 4

Filed 12/28/2007

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Case 1:07-cv-00757-SLR

Document 4

Filed 12/28/2007

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