Dockery v. Rooters et al

Filing 3

ORDER directing the clerk to file the complaint and in forma pauperis application, with matter of service to be determined at a later time; further directing Plaintiff to complete, sign and return the attached questionnaire by 6/22/07. Signed by Judge Barry A. Bryant on 6/7/07. (cap)

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Dockery v. Rooters et al Doc. 3 Case 4:07-cv-04055-HFB Document 3 Filed 06/07/2007 Page 1 of 5 IN THE UNITED STATES DISTRICT COURT WE S T E R N DISTRICT OF ARKANSAS T E X A R K A N A DIVISION Y V O N N E DOCKERY v. CLIFTON ROOTERS; R O B E R T HECTOR; WILLIE NASH; DEBRA R O O T E R S ; GLORIA DEAN JA M E S ; DONNIE DUDLEY; M A R T H A FRANKLIN; TARZAN BANKS; and BERNARD ARNOLD, SR. C iv il No. 4:07-cv-04055 PLAINTIFF D E FE N D A N T S ORDER Y vo nn e Dockery submitted this pro se action for filing. The clerk is directed to file the in forma p a u p eris (IFP) application and complaint. The matter of service will be determined at a later time. In order to determine if the plaintiff qualifies for IFP status, the court needs additional information. Accordingly, it is ordered that plaintiff, Yvonne Dockery, complete and sign the attached questionnaire, and return the same to the court by June 22, 2007. Plaintiff is advised that should she fail to return the completed and executed questionnaire by June 22, 2007, her complaint may be dismissed without prejudice for failure to prosecute and/or for failure to obey an order of the court. IT IS SO ORDERED this 7th day of June 2007. /s/ Barry A. Bryant HON. BARRY A. BRYANT UNITED STATES MAGISTRATE JUDGE Dockets.Justia.com Case 4:07-cv-04055-HFB Document 3 Filed 06/07/2007 Page 2 of 5 IN THE UNITED STATES DISTRICT COURT WESTERN DISTRICT OF ARKANSAS T E X A R K A N A DIVISION Y V O N N E DOCKERY v. CLIFTON ROOTERS; R O B E R T HECTOR; WILLIE NASH; DEBRA R O O T E R S ; GLORIA DEAN JA M E S ; DONNIE DUDLEY; M A R T H A FRANKLIN; TARZAN BANKS; and BERNARD ARNOLD, SR. C iv il No. 4:07-cv-04055 PLAINTIFF D E FE N D A N T S QUESTIONNAIRE TO: YVONNE DOCKERY This form is sent to you so that you may assist the court in making a determination of whether you qualify for in forma pauperis (IFP) status. Accordingly, it is required that you fill out this form and send it back to the court by June 22, 2007. Failure to do so will result in the dismissal of your complaint. The response must be legibly handwritten or typewritten, and all questions must be answered completely in the proper space provided on this form. If you need additional space, you may attach additional sheets of paper to this addendum. RESPONSE 1. In your IFP application you indicate you have take home wages of $1,734 per month and also receive $539 per month of Social Security. Please list your approximate monthly expenses for items such as rent, utilities, food, etc. Answer: Case 4:07-cv-04055-HFB Document 3 Filed 06/07/2007 Page 3 of 5 ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 2. You indicate you provide the full support for four individuals. However, you failed to indicate your relationship to each of these individuals. Please list the name of each of the four individuals, state the age of each, indicate your relationship to each (for example, mother, etc.), and indicate whether each lives with you, and whether they are dependent on you for support. Answer: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 3. You were asked whether you had any cash or checking or savings accounts. You responded: "Yes." However, when asked to state the total amount of money you had you indicated zero. Please explain your answer. Be specific. For each type of account you have, state the approximate balance. Answer: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Case 4:07-cv-04055-HFB Document 3 Filed 06/07/2007 Page 4 of 5 ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 4. You were asked if you owned any real estate, automobiles or things of value. You responded: "No." Please state: (a) whether you own or rent your home or apartment; and (b) whether your own, rent, or lease your automobile. Answer: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 5. Do you have a spouse, significant other, or some other person who lives with you and helps pay your rent, utilities or other monthly expenses? Answer: Yes _________ No __________. If you answered yes, please explain who lives with you and what portion of the monthly expenses they pay. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Case 4:07-cv-04055-HFB Document 3 Filed 06/07/2007 Page 5 of 5 ______________________________________________________________________________ I CERTIFY THAT THE INFORMATION CONTAINED HEREIN IS COVERED BY THE VERIFICATION MADE BY ME ON MY INITIAL IFP APPLICATION. _________________________________________ YVONNE DOCKERY _________________________________________ DATE

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