Opinion
No. CIV S-08-0453 WBS DAD P.
April 6, 2009
ORDER
Petitioner, a state prisoner proceeding pro se, has filed an application for a writ of habeas corpus pursuant to 28 U.S.C. § 2254. Petitioner has not, however, filed an in forma pauperis affidavit or paid the required filing fee ($5.00). See 28 U.S.C. §§ 1914(a); 1915(a). Petitioner will be provided the opportunity to either submit the appropriate affidavit in support of a request to proceed in forma pauperis or submit the appropriate filing fee.
In accordance with the above, IT IS HEREBY ORDERED that:
1. Petitioner shall submit, within thirty days from the date of this order, an affidavit in support of his request to proceed in forma pauperis or the appropriate filing fee; petitioner's failure to comply with this order will result in a recommendation for dismissal of this action; and
2. The Clerk of the Court is directed to send petitioner a copy of the in forma pauperis form used by this district. APPLICATION TO PROCEED IN FORMA PAUPERIS BY A PRISONER CASE NUMBER:
UNITED STATES DISTRICT COURT EASTERN DISTRICT OF CALIFORNIA Petitioner vs. Respondent(s) I, _____________________________, declare that I am the petitioner in the above-entitled proceeding; that, in support of my request to proceed without prepayment of fees under 28 U.S.C. § 1915, I declare that I am unable to pay the fees for these proceedings or give security therefor and that I am entitled to the relief sought in the petition.In support of this application, I answer the following questions under penalty of perjury: Have the institution fill out the Certificate portion of this application. and
1. Are you currently incarcerated: [] Yes [] No (If "No" DO NOT USE THIS FORM) If "Yes" state the place of your incarceration. ______________________________ 2. Are you currently employed? [] Yes [] No a. If the answer is "Yes" state the amount of your pay. 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. 3. In the past 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 [] No c. Pensions, annuities or life insurance payments [] Yes [] No d. Disability or workers compensation payments [] Yes [] No e. Gifts or inheritances [] Yes [] No f. Any other sources [] Yes [] No If the answer to any of the above is "Yes" describe by that item each source of money and state the amount received what you expect you will continue to receive. Please attach an additional sheet if necessary. 4. Do you have cash or checking or savings accounts? [] Yes [] No If "Yes" state the total amount: _________________ 5. Do you own any real estate, stocks, bonds, securities, other financial instruments, automobiles or other valuable property? [] Yes [] No If "Yes" describe the property and state its value. ___________________________________________ 6. Do you have any other assets? [] Yes [] No If "Yes" list the asset(s) and state the value of each asset listed. 7. 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. I declare under penalty of perjury that the above information is true and correct. __________________ ____________________________________________________ DATE SIGNATURE OF APPLICANT