Parrish v. National Geospatial Intelligence Agency

Filing 5

MEMORANDUM AND ORDER: IT IS HEREBY ORDERED that plaintiff shall have thirty (30) days from the date of this Order to pay the statutory filing fee of $400, or to submit a fully-completed CJA Form 23 (financial affidavit). IT IS FURTHER ORDERED t hat, upon plaintiffs submission of a fully-completed CJA Form 23, the Clerk shall cause this case to be resubmitted for review under 28 U.S.C. § 1915. IT IS FURTHER ORDERED that if plaintiff fails to pay the filing fee or to submit a fully-completed CJA Form 23 within thirty days, this case shall be dismissed, without prejudice. (Response to Court due by 4/12/2015.) Signed by District Judge Ronnie L. White on March 13, 2015. (Attachments: # 1 CJA 23 Form)(BRP)

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Reset O CJA 23 FINANCIAL AFFIDAVIT Rev. 5/98 IN SUPPORT OF REQUEST FOR ATT ORNEY, EXPERT OR OTHER COURT SERVICES WITHOUT PAYMENT OF FEE IN UN IT ED S TA TES IN THE CASE MAGISTRATE DISTRICT APP EALS COURT or OTHER PANEL (Specify below) LOCA TION NU M BER * FOR V.S. AT 1 De fend ant - J uve nile Ap p ellant Probation Violator Parole Violator Felony 6 Hab eas P etit ioner M isdemeanor 7 8 225 5 P etit ioner M aterial Witness 9 CH A RG E/ O F F EN SE (des cr ib e i f ap p li ca ble & c hec k box ÿ ) De fend ant —A dult 2 3 4 5 * PER SON REP RESENT ED ( Show y our full name) DOCK ET NU M BERS M agistrate Ot her * District Court Co urt of A p p eals ANSWERS TO QUESTIONS REGARDING ABILITY TO PAY Are yo u no w empl o ye d? Ye s No Am Self-Employed Name and address of employer: EMPLO YMENT IF YES, how much do you earn per month? $ IF NO, give month and year of last employment How much did you earn per month? $ No Ye s If m arr ie d is yo ur Spo us e e mpl o ye d? IF YES, how much does your Spouse earn per month? $ If a minor under age 21, what is your Parents or Guardian’s approximate monthly income? $ Have you received within the past 12 months any income from a business, profession or other form of self-employment, or in the form No Yes the form of rent payments, interest, dividends, retirement or annuity payments, or other sources? RECEIVED OTHER INCOME ASSETS IF YES, GIVE THE AMOUNT RECEIVED & IDENTIFY THE SOURCES CAS H S OURCES $ Have yo u an y cas h on han d or money in sav ings or checking a ccou nts ? Ye s N o IF Y ES , state total amoun t $ Do you own any real estate, stocks, bonds , notes, automobiles, or other valuable property (excluding ordinary hous ehold furnish ings and clo th ing )? Ye s No VALUE PROPERTY 9 M ARITAL STATUS DEPENDENTS 9 OBLIGATIONS & DEBTS 9 DESCRIPTION IF YES, GIVE THE VALUE AND $ DESCRIBE IT DEB TS & MONTHLY B ILLS SINGLE M ARRIED WIDO WED SEPARATED OR DIVORCED APARTMENT OR HO M E: Total No. of Dependents List p ersons y ou act ually sup p ort and y our relationship to them 9 Creditors Tot al Debt M onthly Paymt. $ $ $ IN CLU D IN G BA N K S, $ $ LO A N CO MP A N IE S, $ $ (L IST AL L CR ED IT O RS, CH A RG E A CCO U N TS, ET C.) 9 I certify under penalty of perjury that the foregoing is true and correct. Executed on (date) SIGNATURE OF DEFENDANT (OR PERSON REPRESENTED) * $

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