Opinion
Case No.: 1:11-at-00496.
August 15, 2011
ORDER GRANTING APPLICATION TO PROCEED IN FORMA PAUPERIS (Doc. 5)
Plaintiff Airy S. Klaudt filed a complaint on August 12, 2011, along with an application to proceed in forma pauperis pursuant to 28 U.S.C. § 1915. Plaintiff's application demonstrates entitlement to proceed without prepayment of fees.
Accordingly, IT IS HEREBY ORDERED THAT:
1. Plaintiff's application to proceed in forma pauperis is GRANTED;
2. The Clerk of Court is DIRECTED to issue a summons; and
3. The United States Marshal is DIRECTED to serve a copy of the complaint, summons, and this order upon the defendant as directed by the plaintiff.
IT IS SO ORDERED.
APPLICATION TO PROCEED WITHOUT PREPAYMENT OF FEES AND AFFIDAVIT
I, Airy Klaudt declare that I am the (check appropriate box)
[X] petitioner/plaintiff/movant [ ] other in the above-entitled proceeding; that in support of my request to proceed without prepayment of fees or costs under 28 USC § 1915 I declare that I am unable to pay the costs of these proceedings and that I am entitled to the relief sought in the complaint/petition/motion.In support of this application, I answer the following questions under penalty of perjury:
1. Are you currently incarcerated? [ ] Yes [X] No (If "No," go to Part 2) If "Yes," state the place of your incarceration ________________________________________________ Are you employed at the ________ Do you receive any payment from the _______ Attach a ledger sheet from the institution(s) of your incarceration showing at least the past six months' transactions. 2. Are you currently employed? [ ] Yes [X] No a. If the answer is "Yes," state the amount of your take-home salary or wages and pay period and give the name and address of your employer. b. If the answer is "No," state the date of your last employment, the amount of your take-home salary or wages and pay period and the name and address of your last employer. I LAST WORKED IN 2007 MAKING $19.00 AN HOUR. THE CITY I WORKED WAS BIG BEAR AT S/R FRAMING. 3. In the past 12 twelve months have you received any money from any of the following sources? a. Business, profession or other self-employment [ ] Yes [ ] No b. Rent payments, interest or dividends [ ] Yes [X] No c. Pensions, annuities or life insurance payments [ ] Yes [X] No d. Disability or workers compensation payments [ ] Yes [X] No e. Gifts or inheritances [ ] Yes [X] No f. Any other sources [X] Yes [ ] No If the answer to any of the above is "Yes," describe, on the following page, each source of money and state the amount received and what you expect you will continue to receive. I RECEIVE FOOD STAMPS $843/MO. WIFE RECEIVES CHILD SUPPORT IN THE AMOUNT OF $1206/MO. SHE ALSO GETS SCHOLARSHIP MONIES $11,000. A YEAR. MY DAUGHTER SIERRA RECEIVES $747/MO FROM SSI. IN REGARDS TO THE GRANT/SCHOLARSHIP MONIES MY WIFE RECIEVEDIT IS ALL SPENTSON SCHOOL. 4. Do you have any cash or checking or savings accounts? [ ] Yes [X] No If "Yes," state the total amount. ______________________ 5. Do you own any real estate, stocks, bonds, securities, other financial instruments, automobiles or any other thing of value? [X] Yes [ ] No If "Yes," describe the property and state its value. 1999 Toyota Tacoma 1,500 6. List the persons who are dependent on you for support, state your relationship to each person and indicate how much you contribute to their support. A/KLAUDT, D. KALUDT, K. KALUDT, D. WEST, F. WEST, AND S. WEST. I declare under penalty of perjury that the above information is true and correct. 7-23-11 ______________________ __________________________________________________________ Date Signature of Applleant NOTICE TO PRISONER: A Prisoner seeking to proceed IFP shall submit an affidavit stating all assets. In addition, a prisoner must attach a statement certified by the appropriate institutional officer showing all receipts, expenditures, and balances during the last six months in your institutional accounts. If you have multiple accounts, perhaps because you have been in multiple institutions, attach one certified statement of each account.