MCFADYEN et al v. DUKE UNIVERSITY et al

Filing 198

MOTION for Leave to Proceed In Forma Pauperis by LINWOOD WILSON. (Attachments: #1 Affidavit Declaration In Support)(WILSON, LINWOOD)

IFP/Civ.
Rev. 9/01

IN THE UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF NORTH CAROLINA

Plaintiff,
APPLICATION FOR LEAVE TO PROCEED
IN FORMA PAUPERIS
AND AFFIDAVIT/DECLARATION IN SUPPORT

v.

THE CITY OF DURHAM, et al

(52

, '. ()fJ CV!=>
/P /

Defendant(s)

I, ');N ·'1tJr.A \ 1; \:,ij!I\ ID-z' "Y\~r,:..,t: request leave of Court to proceed in the aboveentitled action without prepa
ent of fees and costs or giving security therefor.
In
support of this request, I state that I am unable to pay such costs or give security
therefor and that I believe that I am entitled to redress.
The nature of this action
is case 1:07cvq!~42
V.S.C. § 1983, 42 V.S.C. § 1985, 42 V.S.C. § 1986,
42 V.S.C. § 1988(b), and the common law of the State of North Carolina

I understand
that any false statement or answer
application may subject me to the penalties for perjury.

to

any

question

in

this

1. Are you presently employed?
Yes
No ><
a. 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
salary and wages per month which you received.
State of NC AGC 6/25/2007
$39,900.00

and the amount of the

2. Is your spouse presently employed?
Yes
No
No spouse ><
a. If the answer if yes, state the amount of spouse's salary or wages per month,
and give the name and address of spouse's employer.

b. If the answer is no, state the date of last employment
salary and wages per month which your spouse received.

and the amount

of

3. Have you received within the past twelve months any money from any of the following
sources:
Yes

NOX

Yes X

No

Yes

NOX

d. Social Security, SSI or disability?

Yes X

No__

e. Workers'

Yes

NOX

f. Child support?

Yes

NOX

g. AFDC, WIC or Food Stamps?

Yes

NOX

h. Gifts or inheritances?

Yes

NOX

i. Any other sources?

Yes X No

a. Business, profession,
b. Rent payments,

or form of self-employment?

interest, or dividends?

c. Pensions, annuities,

or insurance?

Compensation

or Unemployment?

-- --

If the answer to any of the above is yes, describe each source of money and state
the amount received from each during the past twelve months.
Richard Porter,
divorce

friend, loans me $250.00 per week until my lawsuits and

settles. Sale of stock $920.00, Borrowed

$19,000.00

from my

retirement to pay legal fees - all gone none left. Social Security
$699.00 per month.

4. Has your spouse received within the past twelve months
sources listed in question No.3?
Yes

No

any money

check

from any of the

No spouse ~

If the answer to any of the above is yes, describe each source of money and state
the amount received from each during the past twelve months.

5. Do you and your spouse, if any, own any cash, or have money in a checking,
or any other financial account?
Yes

X

No

If the answer is yes, state the total value of the items owned.
$130.00 as of today for bills that are due.

-2-

savings,

6. Do you and your spouse, if any, own
automobiles, or other valuable property
and clothing)?

X

Yes

any real estate, stocks, bonds, notes,
(excluding ordinary household furnishings

No

If the answer is yes, describe

the property

Primary residence

Linwood Wilson,

of Defendant

and state its approximate
$160,000.00

value.

todays market.

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

to

8. List your debts, obligations, and creditors, including banks, loan companies, charge
accounts, and monthly bills.
Creditor

Total Debt

New York Community Bank
Progress

126,900.00

Payment

893.98
212.00

Energy

Cobra/Health

Monthlv

388.00

Ins.

Time Warner Cable,Broadbanqb

206.00

Capital One

25.00

groceries

200.00

car rental, Richard Porter

300.00

I declare under penalty

of perjury

that the fareg?jng~ue
Executed

on

and correct.

I!m~~

05/02/2011
(Date)

/

-3-

(Signatu~e of Plaintiff)