Opinion
21-cv-530-jdp
08-23-2021
VALERIE KREGER, Plaintiff, v. DAVID FLORES, et al Defendants.
ORDER
PETER OPPENEER, MAGISTRATE JUDGE
Plaintiff Valerie Kreger has filed a proposed civil complaint. Plaintiff has not paid the $402 filing fee nor asked for leave to proceed without prepayment of fees or costs. In the event that plaintiff wishes to proceed without prepayment of the filing fee, the enclosed petition and affidavit must be completed to determine whether plaintiff qualifies as indigent.
Effective December 1, 2020, the total fee for filing a civil action is $402 (the $350 statutory fee plus the $52 miscellaneous administrative fee).
ORDER
IT IS ORDERED that plaintiff Valerie Kreger may have until September 13, 2021, in which to either pay the $402 filing fee or to submit an affidavit of indigency and return it to the court. If, by September 13, 2021, plaintiff fails to respond to this order, I will assume that plaintiff wishes to withdraw this action voluntarily. In that event, the case will be closed without prejudice to plaintiff filing the case at a later date.
NON-PRISONER REQUEST TO PROCEED IN DISTRICT COURT WITHOUT PREPAYING THE FILING FEE
Answer the following questions to the best of your ability.
Note: If you do not tell the truth, the court may dismiss your lawsuit.
I. Personal Information
1) Are you employed? [ ]Yes [ ] No
2) Are you married? [ ] Yes [ ] No
If “Yes, ” is your spouse employed? [ ] Yes [ ] No
3) Do you have any dependents that you are responsible for supporting? [ ] Yes [ ] No
If “Yes, ” list them below:
II. Income - If you are married, your answers must include your spouse's income. (When calculating income, include any wages, salary, rent, child support, public assistance, unemployment compensation, disability payments, life insurance payments, pensions, annuities, workers' compensation, stock dividends and interest, gifts and inheritance, or other money you receive from any source.)
1) State your total monthly wages or salary? $ ___
2) Provide the name and address of your employer(s):___
3) State your spouse's total monthly wages or salary? $ ___
State the amount of money you have received from any other source in the last twelve months, such as the sources listed above. Please attach an additional sheet if necessary.
III. Expenses - If you are married or have dependents, your expenses should also include your household's expenses. (When calculating household expenses, you may include groceries, clothing, medical costs, utilities that are not included in your rental payments, transportation, and insurance.)
1) Identify the following amounts that you pay per month:
[ ] Rent or [ ] Mortgage $ ___
Car payment(s) $ ___
Alimony or court-ordered child support $ ___
Credit card payment(s) $ ___
2) Do you have any other monthly expenses that you have not already listed?
[ ] Yes [ ] No
If “Yes, ” list them below:
3) What are your total monthly expenses? $ ___
IV. Property - If you are married, your answers must include your spouse's property.
1) Do you own a car? [ ] Yes [ ] No If “Yes, ” list car(s) below:
2) Do you own your home(s)? [ ] Yes [ ] No
If “Yes, ” state the approximate value(s). $
What is the amount of equity (assessed value of residence minus outstanding mortgage balance) in the home(s)? $
3) Do you have any cash or checking, savings, or other similar accounts?
[ ] Yes [ ] No
If “Yes, ” state the total of such sums. $ ___
4) Do you own any other property of value, such as real estate, stocks, bonds, trusts, or individual retirement accounts (e.g., IRA, 401 k), artwork or jewelry?
[ ] Yes [ ] No
If “Yes, ” describe the property and the approximate value(s).
V. Other Circumstances - Describe any other financial circumstance(s) that you would like the court to consider when reviewing this petition.
I, ___, declare that I am the plaintiff bringing this complaint. I declare that I am unable to prepay the fee and that I am entitled to the relief sought in the complaint.