Johnson v. Endow et al Document 2: Motion for Leave to Proceed In Forma Pauperis

Filed June 30, 2008

Back to Johnson v. Endow et al, California Northern District Court Case No. 3:08-cv-03140-JCS

MOTION for Leave to Proceed in forma pauperis filed by Charles Johnson. (gba, COURT STAFF) (Filed on 6/30/2008) (gba, COURT STAFF).

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ase 3:08-cv-03140-JCS Document2 Filed 06/30/2008 Page 1 of4

NonttAg 32D
OFTweR U Dera deking
r 3
uy purge,
UNITED STATES DISTRICT COURT A D R
NORTHERN DISTRICT OF CALIFORNIA
| cueno 608-0314 “
Abatlegvolwsow Plaintiff, | ) CASENO. Q 1 OU CO
) q
vs. ) APPLICATION TO PROCEED
) INFORMA PAUPERIS
)
)
OR Kl and Pele © Defendant. )
° Lee kS FR ENDOW )
I, , declare, under penalty of perjury that I am the plaintiff
in the above entitled case and that the information I offer throughout this application is true and
correct. I offer this application in support of my request to proceed without being required to
prepay the full amount of fees, costs or give security. I state that because of my poverty I am
unable to pay the costs of this action or give security, and that I believe that I am entitled to relief.
In support of this application, I provide the following information:
1, Are you presently employed? Yes___—s—~ No Yo
If your answer is "yes," state both your gross and net salary or wages per month, and give the
name and address of your employer:
Gross: Net:

Employer:

If the answer is "no," state the date of last employment and the amount of the gross and net salary

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fase 3:08-cv-03140-JCS Document2 Filed 06/30/2008 Page 2of4
and wages per month which you received.

2. Have you received, within the past twelve (12) months, any money from any of the
followimg sources:
a. Business, Profession or Yes___—s- No Jv
self employment?
b. Income from stocks, bonds, Yes____—~No Vv.
or royalties?
Cc. Rent payments? Yes___ No V_
d. Pensions, annuities, or Yes V_ Noes.
life insurance payments?
e. Federal or State welfare payments, Yes_-___ No Vw
Social Security or other govern-
ment source?
If the answer is "yes" to any of the above, describe each source of money and state the amount
received from each.
Dewy Reserve $98/ °* month

3. Are you married? Yes NoV
Spouse's Full Name:

Spouse's Place of Employment:

Spouse's Monthly Salary, Wages or Income:

Gross $ Net $
4. a. List amount you contribute to your spouse's support:$
b. List the persons other than your spouse who are dependent upon you for support
and indicate how much you contribute toward their support. (NOTE: For minor
-2-

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Pase 3:08-cv-03140-JCS Document2 Filed 06/30/2008 Page 3 of 4
children, list only their initials and ages. DO NOT INCLUDE THEIR NAMES.)

5. Do you own or are you buying a home? Yes Noi
Estimated Market Value: $ Amount of Mortgage: $

6. Do you own an automobile? Yess Noi
Make Year Model
Is it financed? Yes No _y/ ___Ifso, Total due: $

Monthly Payment: $
7. Do you have a bank account? Yes No 4/_ (Do not include account numbers.)
Name(s) and address(es) of bank:

Present balance(s): $
Do you own any cash? Yes No_\J_ Amount: $

Do you have any other assets? (If "yes," provide a description of each asset and its estimated

market value.) Yes___~No VJ
8. What are your monthly expenses?
Rent: $ 223. Utilities: 1S"
Food: $ 459 2— Clothing: p50"
Charge Accounts:
Name of Account Monthly Payment Total Owed on This Account
$ $
§ | §
$ $
9. Do you have any other debts? (List current obligations, indicating amounts and to whom
they are payable. Do not include account numbers.)
nid su $200 zar Cm dren an

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qlase 3:08-cv-03140-JCS Document2 Filed 06/30/2008 Page 4of4

10. | Does the complaint which you are seeking to file raise claims that have been presented in
other lawsuits? Yes No yd
Please list the case name(s) and number(s) of the prior lawsuit(s), and the name of the court in
which they were filed.
y°

I declare under the penalty of perjury that the foregoing is true and correct and understand that a
false statement herein may result in the dismissal of my claims.
6-24-08
DATE SIGNATURE OF APPLICANT

PDF Page 1	PlainSite Cover Page

PDF Page 2	q o oa NY Dn AD FF WD YH = Le ee wow NY -—- & Oc] 16 17 18 19 20 21 22 23 24 25 26 27 28 ase 3:08-cv-03140-JCS Document2 Filed 06/30/2008 Page 1 of4 NonttAg 32D OFTweR U Dera deking r 3 uy purge, UNITED STATES DISTRICT COURT A D R NORTHERN DISTRICT OF CALIFORNIA \| cueno 608-0314 “ Abatlegvolwsow Plaintiff, \| ) CASENO. Q 1 OU CO ) q vs. ) APPLICATION TO PROCEED ) INFORMA PAUPERIS ) ) OR Kl and Pele © Defendant. ) ° Lee kS FR ENDOW ) I, , declare, under penalty of perjury that I am the plaintiff in the above entitled case and that the information I offer throughout this application is true and correct. I offer this application in support of my request to proceed without being required to prepay the full amount of fees, costs or give security. I state that because of my poverty I am unable to pay the costs of this action or give security, and that I believe that I am entitled to relief. In support of this application, I provide the following information: 1, Are you presently employed? Yes___—s—~ No Yo If your answer is "yes," state both your gross and net salary or wages per month, and give the name and address of your employer: Gross: Net: Employer: If the answer is "no," state the date of last employment and the amount of the gross and net salary

PDF Page 3	oOo Oo JI NHN vA SF WY WW 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 fase 3:08-cv-03140-JCS Document2 Filed 06/30/2008 Page 2of4 and wages per month which you received. 2. Have you received, within the past twelve (12) months, any money from any of the followimg sources: a. Business, Profession or Yes___—s- No Jv self employment? b. Income from stocks, bonds, Yes____—~No Vv. or royalties? Cc. Rent payments? Yes___ No V_ d. Pensions, annuities, or Yes V_ Noes. life insurance payments? e. Federal or State welfare payments, Yes_-___ No Vw Social Security or other govern- ment source? If the answer is "yes" to any of the above, describe each source of money and state the amount received from each. Dewy Reserve $98/ °* month 3. Are you married? Yes NoV Spouse's Full Name: Spouse's Place of Employment: Spouse's Monthly Salary, Wages or Income: Gross $ Net $ 4. a. List amount you contribute to your spouse's support:$ b. List the persons other than your spouse who are dependent upon you for support and indicate how much you contribute toward their support. (NOTE: For minor -2-

PDF Page 4	Oo CO nN DB WOW BF WD NO — NY NO NY HO N NY NV NN PMO \| FF \| Se FEF fF Fe ES oOo nN BAO ON Fk BY NY KH OD Oo He NN BDH AW BP WD NYO —- OS Pase 3:08-cv-03140-JCS Document2 Filed 06/30/2008 Page 3 of 4 children, list only their initials and ages. DO NOT INCLUDE THEIR NAMES.) 5. Do you own or are you buying a home? Yes Noi Estimated Market Value: $ Amount of Mortgage: $ 6. Do you own an automobile? Yess Noi Make Year Model Is it financed? Yes No _y/ ___Ifso, Total due: $ Monthly Payment: $ 7. Do you have a bank account? Yes No 4/_ (Do not include account numbers.) Name(s) and address(es) of bank: Present balance(s): $ Do you own any cash? Yes No_\J_ Amount: $ Do you have any other assets? (If "yes," provide a description of each asset and its estimated market value.) Yes___~No VJ 8. What are your monthly expenses? Rent: $ 223. Utilities: 1S" Food: $ 459 2— Clothing: p50" Charge Accounts: Name of Account Monthly Payment Total Owed on This Account $ $ § \| § $ $ 9. Do you have any other debts? (List current obligations, indicating amounts and to whom they are payable. Do not include account numbers.) nid su $200 zar Cm dren an

PDF Page 5	mn & Ww N Oo COC “I NW 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 qlase 3:08-cv-03140-JCS Document2 Filed 06/30/2008 Page 4of4 10. \| Does the complaint which you are seeking to file raise claims that have been presented in other lawsuits? Yes No yd Please list the case name(s) and number(s) of the prior lawsuit(s), and the name of the court in which they were filed. y° I declare under the penalty of perjury that the foregoing is true and correct and understand that a false statement herein may result in the dismissal of my claims. 6-24-08 DATE SIGNATURE OF APPLICANT


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