Opinion
No. CV-08-2093-PHX-DGC.
January 8, 2009
ORDER
Plaintiff Eugenio Guerrero commenced this action by filing a civil rights complaint against Maricopa County Sheriff Joe Arpaio and Betty Adams, a county jail official. Plaintiff alleges that he was denied basic necessities and standard medical care while he was incarcerated at the 4th Avenue and Durango Jails. Dkt. #1.
Plaintiff has filed an application to proceed in forma pauperis by a prisoner. Dkt. #3. A review of the Court's docket shows that Plaintiff is no longer incarcerated. If Plaintiff still wishes to proceed in forma pauperis, he shall complete and file with the Court the attached financial affidavit by January 23, 2009. Plaintiff is advised that if he does not file the completed financial affidavit or pay the applicable filing fee for civil actions by January 23, 2009, this action will be dismissed without prejudice.
IT IS ORDERED:
1. Plaintiff's application to proceed in forma pauperis by a prisoner (Dkt. #3) is denied as moot.
2. If Plaintiff wishes to proceed in forma pauperis, he shall complete and file with the Court the attached financial affidavit by January 23, 2009.
3. The Clerk is directed to dismiss this action without prejudice if Plaintiff does not file the completed financial affidavit or pay the applicable filing fee by January 23, 2009.
4. The Clerk is directed to mail a copy of this order to Plaintiff.
ATTACHMENT 6
MOTION TO PROCEED IN FORMA PAUPERIS and SUPPORTING INFORMATION Name Address City, State, Zip Telephone number IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF ARIZONA ) ) ) Plaintiff, ) ) CV vs. ) ) ) ) Defendant. ) ) ) I, ____________________, declare that I am the Plaintiff in this action; that I hereby request to proceed without being required to prepay fees, costs or give security therefore. I state that, because of my poverty, I am unable to pay the fees of said proceeding; that I believe I am entitled to relief.In further support of this application, I answer the following questions:
1. Are you presently employed? Yes No 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. 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. Is your spouse employed? Yes No a. If the answer is "yes", state the amount of your spouse's salary or wages per month and give the name and address of your spouse's employer. b. If the answer is "no", state the date of last employment and the amount of the salary and wages per month which your spouse received. 3. Have you received within the past twelve months any money from any of the following sources? a. Business or other form of self employment Yes No b. Rent payments, interest or dividends Yes No c. Pensions, annuities or life insurance payments Yes No d. Gifts or inheritances Yes No e. Any other sources Yes No 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. 4. Do you own any cash, or do you have money in checking or savings accounts? Yes No If the answer is "yes", what is the amount of money you own in cash __________, checking account __________, savings account __________. 5. Do you own any real estate, stocks, bonds, notes, automobiles, or other valuable property (excluding household furnishing and clothing)? Yes No If the answer is "yes", describe and give estimated value of each. 6. List the number of persons who are dependent upon you for support, state your relationship to those persons, and indicate how much you contribute towards their support. I declare under penalty of perjury that the forgoing is true and correct. DATED this ___ day of _______________, 200__. ________________________________________ Your signature in ink ________________________________________ Your name typed or printed ________________________________________ ________________________________________ Address ________________________________________ Telephone Number