TRUMP v. PLAYBOY ENTERPRISES, INC. et al

Filing 1

Complaint Received. (Attachments: # 1 Application IFP, # 2 Text of Proposed Order, # 3 Notice of Motion, # 4 Certificate of Service, # 5 Civil Cover Sheet, # 6 Envelope)(gl)

Page I ol’ 5
AO 239 (Rev. 01/15) Application to Proceed in District Court Without Prepaying Fees or Costs (Long Form)

UNITED STATES DISTRICT COURT
for the

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Plaintfi7Petitioner
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Civil Action No.

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APPLICATION TO PROCEED IN DISTRICT COURT WITHOUT PREPAYING FEES OR COSTS
(Long Form)

Affidavit in Support of the Application

Instructions

I am a plaintiff or petitioner in this case and declare
that I am unable to pay the costs of these proceedings
and that I am entitled to the relief requested. I declare
under penalty of perjury that the information belotv is
true and understand that a false statement may result in
a dismissal of my claims,

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 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.

(2

Date:

Signe
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—

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-

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1.

/

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F or 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.
Income amount expected
next month

Average monthly income
amount during the past 12
months
Spouse
You

Income source

Employment
Self-employment
Income from real property (st,clt as ,‘ental income,,)
Interest and dividends

$
$

$

$

$

$

$

$

$

$

$

$

s

$

$

$

$

$

$

$

$

$

$

Gifts
Alimony
Child support

Spouse

You

Page 2 ol 5

AO 239 (Rev. 0Cl5) Application to Proceed in District Court Without Prepaving Fees or Costs (Long Form)
Retirement

(sticli as social securitt, pensions, annuities,

s

s

$

$

$

$

$

$

$

$

$

$

S

S

$

S-7i0zO S

0.oo $

0.00 S

instuance,

Disability (such as social security, insurance payments)
Unemployment payments

Public-assistance

Other

(spec,ji’):

/

.

$

(such as ttelfare)

-T

/JH’_F-

1-

.3 7.

.
.

fotal monthly income:

List your employment history for the past two years, most recent employer first.

2.

0.00

(Gross monthly pay is before tcLves or

other deductions.)

Gross
monthly pay

Dates of employment

Address

Employer

S

S
List

3.

your spouse’s employment history for

the

past two years, most recent employer first.

(Gross monthly pay is before

taxes or other deductions.)

/Vi9
Address

Employer

Gross
monthly pay

Dates of employment

S
S
S

How much cash

4.

do

you and your spouse have?

$

Below, state any money you or your spouse have in

Financial institution

7
1/

bank

accounts or in any other financial institution.

C’

At.

Ic i.

.

2

Amount your
spouse_has

Amount you have

Type of account
.

c3jf/.’ 7.

0/

S

S

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.

If you

are a prisoner, you

Page 3 of 5
AO 239 (Rev. 01/15) Application to Proceed in District Court Without Prepaying Fees or Costs (Long Forni)
5.

List the assets, and their values, which you own or your spouse owns. Do not list clothing and ordinary
household furnishings.

Assets owned by you or your spouse
Home

(

(Va/tie)

Other real estate

A/tv)

$

(Va/tie)
$

Motor vehicle

#1 (Va/tie)

$

Make and year:

Model:

Registration #:

Motor vehicle

#2 (Va/tie,)

$

Make and year:

Model:

Registration #:

Other assets

(Va/tied

$

Other assets

(Va/tie)

$

6.

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

Person owing you or your spouse
money

Amount owed to you

Amount owed to your spouse

$
$

State

the

$

persons who rely on you or your spouse for support.

Name (or, if under 1$,

1_ndt

$

$
7.

$

(?

initials onl

)

Relationshi

Age

Page 4 of 5
A0 239 (Rev. 01/15) Application to Proceed in District Court Without Prepaying Fees or Costs (Long Forn)

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 rate.
Your spouse

You

Rent or home-mortgage payment (inchiding lot rented for mobile home,)
Are real estate taxes included?
Yes
No
Is property insurance included?
Yes
No /V
Utilities electricitv, heatingfuel, water, sewer, and telepltone
Home maintenance (repairs and upkeep)

krs

4/4

$
i

/ it

7%_ 7 o

O

$

$

$

$

$

food

$ ,?COOOf $

Clothing

$

Laundry and dry-cleaning

S

/

Medical and dental expenses

$

/)t.

Transportation not including motor vehicle payments,)

$

Recreation, entertainment, newspapers, magazines, etc.

$

$
ô

‘

c

£ t.tz

$
Y

$

t’ O)

$

d.

/O

$

Insurance (‘not deductedfrom wages or included in mortgage payments)

Homeowner’s or renter’s:

$

$

Life:

$

$

$

$

Motor vehicle:

$

$

Other:

$

$

$

$

Motor vehicle:

$

$

Credit card (name,):

$

$

Department store (name,):

$

$

Other:

$

$

$

$

Health:

tJ

Taxes (not deductedfront wages or included in nuortgage payments) ‘spec(fu):

Installment payments

Alimony, maintenance, and support paid to others

Page 5 of 5
AO 239 (Rev. 01/15) Application to Proceed in District Court Without Prepaying Fees or Costs (Long Forni)

Regular expenses for operation of business, profession, or farm (attach detailed

statement)
Other

(spec(/’):

$
$

$

0.00 $

0.00

Do you expect any major changes to your monthly income or expenses or in your assets or liabilities during the
next 12 months’?
Yes

10.

4/4

$
Total monthly expenses:

9.

$

If yes, describe on an attached sheet.

or will you be spending—any money for expenses or attorney fees in conjunction with this
Have you spent
lawsuit?
Yes J-No
If yes, how much?

$

11.

Provide any other information that will help explain why you cannot pay the costs of these proceedings.

12.

Identify the city and state of your legal residence.

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Your daytime phone number:
Your age:

/v%

-

Your years of schooling:

-

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4.