Phillips v. Burris

Filing 3

MEMORANDUM AND ORDER: IT IS HEREBY ORDERED that the Clerk of Court shall change this action to one brought pursuant to 28 U.S.C. 2241 as Petitioner is litigating his pretrial confinement. IT IS FURTHER ORDERED that the Clerk shall change the Respondent in this action to Doug Burris, the Director of the St. Louis County Justice Center. (SEE ORDER FOR DETAILS). (Amended/Supplemental Pleadings due by 2/28/2024.) Signed by Magistrate Judge Patricia L. Cohen on 2/7/2024. (Attachments: #1 Form 2241 Habeas Corpus Petition, #2 Form Mtn IFP Habeas Cases)(LNJ)

Clear Form

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
____________ DIVISION
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) Case No. _____________________
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Petitioner,
v.

Respondent.

MOTION TO PROCEED IN FORMA PAUPERIS
AND AFFIDAVIT IN SUPPORT - HABEAS CASES
I
declare (1) that I am the petitioner in this case; (2) that because of
my poverty I am unable to pay the filing fee; and (3) that I
believe I am entitled to relief. The nature of my action and the
issues are briefly stated as follows.

In further support of this application, I answer the following
questions:
1. Place of confinement of petitioner:

2. Crime(s) for which you have been convicted, date and sentence on
each:

3. Are you presently employed?
a.

Yes

No

If the answer is 'yes’ state the amount of your salary or
wages per month and give the name and address of your
employer.

b.

If the answer is 'no’ state the date of last employment
and the amount of the salary and wages per month which you
received.

4. Have you received within the past twelve (12) months, money
from any of the following sources?
Yes No
Business profession or form of self-employment,
Rent payments interest or dividend,
Pensions annuities or life insurance payments,
Gifts or inheritances,
Any other sources.

,

If the answer to any of the above is 'yes’ describe the source
and amount of money received from each during the past twelve
(12) months.

5. Do you own any cash or do you have money in a checking or
savings account? Include any funds in your prison account.
No
Yes
If the answer is 'yes’ state the total amount of cash owned,
and the balance in all checking savings or prison accounts.

6. Do you own real estate stocks bonds notes automobiles,or
other valuable property (excluding ordinary household
furnishings and clothing)
No
Yes
If the answer is 'yes’ describe the property and state its
approximate value.

2

I

7. List the persons who are dependent upon you for support,
state your relationship to those persons, and indicate how
much you contribute toward their support:

I DECLARE UNDER PENALTY OF PERJURY THAT THE ABOVE INFORMATION
IS TRUE AND CORRECT. I UNDERSTAND THAT PROVIDING FALSE
INFORMATION MAY SUBJECT ME TO CRIMINAL PROSECUTION, IMPOSITION
OF A FINE, OR OTHER SANCTION THAT MAY ADVERSELY AFFECT MY
ABILITY TO PURSUE THIS CASE OR OTHER CASES. I HAVE REVIEWED MY
ANSWERS TO INSURE THEIR ACCURACY.
Executed (signed) this
day of
20______.

(Signature of petitioner)

Certificate
I certify that the applicant named herein has the sum of
on account to his or her
$
credit at the
institution where he or
she is confined. I further certify that the applicant likewise
has the following securities to his or her credit according to
the records of said institution:

Authorized Officer of Institution

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