Hearn #066155 v. Ryan et al

Filing 34

ORDER adopting in part and rejecting in part 19 Report and Recommendation of the Magistrate Judge. The Court adopts the Magistrate Judge's reasoning and recommendations on all of Petitioner's claims, with the exception of Petitioner' s claim for denial of his constitutional right to self-representation. If Petitioner wishes this Court to appoint counsel, he must notify the Court within thirty days of the date of this Order. See PDF document for details. An evidentiary hearing wil l be held to consider whether Petitioner expressly consented to standby counsel's solo participation at the jury-note conferences. The evidentiary hearing will be scheduled after the matter of whether Petitioner will be represented by counsel is resolved. Signed by Judge Mary H Murguia on 3/31/11. (Attachments: # 1 Affidavit re Motion to Appeal In Forma Pauperis). (LSP)

Hearn v. Schriro et al

Doc. 34 Att. 1

Form 4.

Affidavit Accompanying Motion for Permission to Appeal In Forma Pauperis

United States District Court for

District of

A.B., Plaintiff v. C.D., Defendant Case No.: ________________________________

Affidavit in Support of Motion I swear or affirm under penalty of perjury that, because of my poverty, I cannot prepay the docket fees of my appeal or post a bond for them. I believe I am entitled to redress. I swear or affirm under penalty of perjury under United States laws that my answers on this form are true and correct. (28 U.S.C. § 1746; 18 U.S.C § 1621.)

Instructions Complete all questions in this application and then sign it. Do not leave any blanks: if the answer to a question is "0," "none," or "not applicable (N/A)," write in that response. If you need more space to answer a question or to explain your answer, attach a separate sheet of paper identified with your name, your case's docket number, and the question number. Date: _______________________

Signed:

My issues on appeal are: (e) For both you and your spouse estimate the average amount of money received from each of the following sources during the past 12 months. Adjust any amount that was received weekly, biweekly, quarterly, semiannually, or annually to show the monthly rate. Use gross amounts, that is, amounts before any deductions for taxes or otherwise.

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Average monthly amount during the past 12 months Income Source Employment Self-employment Income from real property (such as rental income) Interest and dividends Gifts Alimony Child Support Retirement (such as social security, pensions, annuities, insurance) Disability (such as social security, insurance payments) Unemployment payments Public-assistance (such as welfare) Other (specify) ___________ Total monthly income: $ $ $ $ $ $ $ $ You $ $ $ $ $ $ $ $ Spouse

Amount expected next month You $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Spouse

$ $ $ $ $

$ $ $ $ $

$ $ $ $ $

$ $ $ $ $

2.

List your employment history, most recent employer first. (Gross monthly pay is before taxes or other deductions.)
Employer Address Dates of Employment Gross Monthly Pay

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3.

List your spouse's employment history, most recent employer first. (Gross monthly pay is before taxes or other deductions.) Employer Address Dates of Employment Gross Monthly Pay

4.

How much cash do you and your spouse have? $

Below, state any money you or your spouse have in bank accounts or in any other financial institution. Financial Institution Type of Account Amount You Have Amount Your Spouse Has

If you are a prisoner, you 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. 5. List the assets, and their values, which you own or your spouse owns. Do not list clothing and ordinary household furnishing. Home Value Other real estate Value

Motor Vehicle 1

Value

Make & Year

Model

Registration #

Motor Vehicle 2

Value

Make & Year

Model

Registration #

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Other Assets

Value

6.

State every person, business, or organization owing you of your spouse money, and the amount owed. Person owing you or your spouse Amount owed to you Amount owed to your spouse

7.

State the persons who rely on you or your spouse for support. Name Relationship Age

8.

Estimate the average monthly expenses of you and your family. Show separately the amounts paid by your spouse. Adjust any payments that are made weekly, biweekly, quarterly, semiannually, or annually to show the monthly are. You $ Your Spouse $

Rent or home-mortgage payment (include lot rented for mobile home) · Are real estate taxes included? Yes / No · Is property insurance included? Yes / No Utilities (electricity, heating fuel, water, sewer and telephone) Home maintenance (repairs & upkeep) Food Clothing Laundry and dry-cleaning Medical and dental expenses Transportation (not including motor vehicle payments) Recreation, entertainment, newspapers, magazines, etc. -4-

Insurance (not deducted from wages or included in Mortgage payments) · Homeowner's or renter's · Life · Health · Motor Vehicle · Other: ________________________________________________ Taxes (not deducted from wages or included in Mortgage payments) (Specify: ________________________________________________) Installment payments · Motor Vehicle · Credit card (name): · Department Store (name): · Other: _________________________________________________ Alimony, maintenance, and support paid to others Regular expenses for operation of business, profession, or farm (attache detailed statement) Other (specify): ___________________________________________ Total Monthly Expenses: 9. Do you expect any major changes to your monthly income or expenses or in your assets or liabilities during the next 12 months? __________ Yes ____________ No

If yes, describe on an attached sheet. 10. Have you paid ­ or will you be paying ­ an attorney any money for services in connection with this case, including the completion of this form? __________ Yes ____________ No

If yes, how much? $_________________________ If yes, state the attorney's name, address, and telephone number.

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11.

Have you paid ­ or will you be paying ­ anyone other than an attorney (such as a paralegal or a typist) any money for services in connection with this case, including the completion of this form? __________ Yes If yes, how much? $ If yes, state the person's name, address, and telephone number. ____________ No

12.

Provide any other information that will help explain why you cannot pay the docket fees for your appeal.

13.

State the address of your legal residence.

Your daytime phone number: (______)

Your age: _______________ Your years of schooling: Your social security number:

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