i&Ara-o)
DATE: _62^ffl
FILE IN WRIT FILE
BY:__L^l
FEB 02 2015
TV<#^ CUv¥^,
*C\r\cU¥>*A y\?a?!2fJnv\c\ \A^ova^-h^ Ucrkov^-W
TDC\ do. jamdl
TQCY ILILUT kin/ Uiurm\*
Cav&& ^° • \n rn\k\r\\\A (pxo*>
^J
"v^iAaA-L-tD TVV -(W ' CWv^ T?voc •^uA-l j^ I•/v^ •—-j
i^ "VdAoWavX "uakf a¥co^v\^ti
Or) ,1 appotvw
/~l nnri"/?',
AVyxA.
'udcy yv\# \^A\rAf*?- l>^la,v^r\l6V) i K^
.oWrl -\ \hcov pQvz^fQ In^V-eAo
afb €yWi/?AT f
.^Vj
JLa ,-y^rt
'v>JfWvrW>A. \A^><^
a&f^>
CtV^OCckf cJf*5SYVLC£
\ocaLa MnoA ex fbpcl of AK W^fiouv^j
(j^ At/^
ewWiku4 I A Oi^iw ViaV-^ to-^vn maA^H
Wx\acA r\^iiv^L^>
d^M , \Aa^
"pWjtA \r\Ci\nr\Jb
TDC TU\^ »-t " Ulcyv^cJ
^5cA"5
b/WbA \ q
V-vO\\M_ Ad T^7 Pv"vWzAaov^ %>U\ Co\av\^e\
>AvA l 0^61., \*ko^> CcA* cm Cvlwx^c^ -pvoc/cW
Ool 1^rii^Ao^pv<»^vAz^o\^ V?
pact AW 0Dtu4 PO^A^ V\n Mr\{f^rQvL\rv\Lv\cA O£^\ov\ \
icou-iri ^W)to AW Ooi^tvA AW AytIoi/juaPi
LAu/V£iC I1/jalA. D'-Sj- lpya^T^p£t\4.YVV \/A (>\ Cv\atv\uv\c\\
\j^Mp&- lowv^7 \ AH \/ /" TVpA
oA Cvu^v\lv\c\I \u^*AlC£ VWxV^ ^P^V/ri^tppv^vcrvi'
mAAiy f^coc£*b,bo\^pW>. o\r \oar\ ^hcaccoxa^
Cl ) VVyxV^ AoA^lI Xev^riarA^ vo^ui^'-W .fcrvPbuwbe(
-to Afb^i*^ V^t^r (ir r"olv/LrP\ p^rpiu^Pl CWx^t^/
\v\ AW avxv£ -^Al A/P^ Paut-bPAp (/r^biyia\M. Ad T> /.
CocU Cviw\ /Tvac. av4 io^lTw^ PbiA^vA Y\Qy^> \AWuJ^f'
(\Myrda\r"^A^\^o\n in ^Axpp^vA oX vwy\\ -to
•^pvt"nWiOK). Vx4 CovJv^xrl (v/v^al^s W\a4A<^ ^
A i^ Wr/iou- /
CVpW/p1 AWaA a^ AAd^w\ec4 ^WaU V?/7 ajyoi/mi
Ad YQOvi^tArk ^)Ao^\c\av\ y"iavxl -b>' UyPCcdp
pAAovWcA \^ Wv/l -
\k \f^> AuvAtA/v dvz\ t*r?AA^aA a Copt ioi AA/\i5b
GrAPV ^W^il/A> '^vMcA&T>4"" ^A
U
P5 •y
.— .*!
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF TEXAS
DIVISION
Plaintiff's name and ID Number
Place of Confinement I
CASE NO.
(Clerk will assign the number)
V.
/ APPLICATION TO PROCEED
IN FORMA PAUPERIS
Mils n fiotj 3ls iba oci"> c\oA&m&' *h/ ~7u^o?
Defendant's name and address J ' J
I, C-vtH-JqI -r%~lUt*?Z>C$£zhavQ, depose, and say I am the Plaintiff in the above entitled case. In support
of my motion to proceed without being required to prepay fees, costs, or give security therefor, I state because of my
poverty, I am unable to pay in advance the filing fee for said proceedings or to give security for the filing fee. I believe I
am entitled to relief.
I, further declare the responses which I have made to the questions and instructions below are true.
1. Have you received, within the last 12 months, any money from any of the following sources?
a. Business, profession or from self-employment? Yes •
b. Rent payments, interest or dividends? Yes •
c. Pensions, annuities or life insurance payments? Yes •
d. Gifts or inheritances? Yes n,
e. Family or friends? Yes j&j
f. Any other sources? YesO
If you answered YES to any of the questions above, describe each source of money and state
amount received from each during the past 12 months.
-tzuvuM hir/ \^V\wt tix-in-i:
£0* i tip*
a
Do you own cash, or do you have money in a checking or savings account, including any funds
in prison accounts?
Yes • No
If you answered YES to any of the questions above, state the total value of the items owned.
&ATCIFP (REV. 9/02)
3. Do you own real estate, stocks, bonds, note, automobiles, or other valuable property, excluding
ordinary household furnishings and clothing?
Yes • No
If you answered YES, describe the property and state its approximate value.
I understand a false statement in answer to any question in this affidavit will subject me to penalties for
perjury. I declare (certify, verify, or state) under penalty of perjury that the foregoing is true and correct
(28 U.S.C. §1746).
Signed this the
ID Number
YOU MUST ATTACH A CURRENT SIX (6) MONTH HISTORY OF
YOUR INMATE TRUST ACCOUNT. YOU CAN ACQUIRE THE
APPROPRIATE INMATE ACCOUNT CERTIFICATE FROM THE
LAW LIBRARY AT YOUR PRISON UNIT.
&ATC1FP (REV. 9/02)
CSINIB0S/CINIB02 TEXAS DEPARTMENT OF• CRIMINAL JUSTICE 01/£S/I 5
LM34/AvI85££ IN--FORMA-PAUP ERIS DATA 09 ; Ah9;5|0
TDCJ#: 01811941 3ID#; 03401307 LOCATIONIs MURRAY INDIGENT DTE:
NAME; ANDERSON,CHAMEL NICOLE BEGINNING PERIOD; 07/01./14
PREvIOUS TDCJ NUMBERS: 01630537
CURRENT BAL; IS.01 TOT HOLD AMT; . 00 ;3MTH TOT DEP; 90. 00
6MTH DEP; £70.00 6MTH AVG BAL: 53.06 «EvMTH AVG DEP: 45. 00
MONTH HIGHEST BALANCE TOTAL DEPOSITS MONTH HIGHEST BALANCE TOTAL DEPOS ITS
1£/14 31. 71 70.00 09/14 143,a \i / 40. 00
11/14 13. 98 0. 00 08/14 1£7., 37 80. 00
10/14 47. 18 £0.00 07/14 73,. 94 60. 00
PROCESS DATE HOLD AMOUNT HOLD DESCRIPTION
STATE OF TEXAS COUNTY OF_ Qonji\\
ON THIS " HE 2g#)DAY OF C5^jaUQCy_ ?2QiS I CERTIFY THAT THIS DOCUMENT TRUE
COMPLETE, AND UNALTERED COPY WRDE BY ME OF INFORMATION CONTftJUMED^JN
COMPUTER DATABASE REGARDING THE OFFENDER'S ACCOUNT. NP SIG o?
PF1-HELP PF3-END ENTER NEXT TDCJ NUMBER; OR SID NUMBER;
ANGELA S.VINCENT
Notary Public
STATE OF TEXAS
My Comm. Exp. 02/24/2015
Notary without Bond
