Davis-Rascoe v. Commissioner of Social Security Administration

Filing 7

ORDER re 3 MOTION for Leave to Proceed in forma pauperis (Restricted Access) filed by Makesha Davis-Rascoe. Case to be brought into proper form by 1/25/2017. (Add an additional 3 days only if served by mail or otherwise allowed under Fed. R. Civ. P. 6.) Signed by Magistrate Judge Jacquelyn D Austin on 1/4/2017. (Attachments: # 1 Plaintiff's Answers to Court's Special Interrogatories)(abuc)

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IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF SOUTH CAROLINA MAKESHA DAVIS-RASCOE, ) ) PLAINTIFF, ) ) vs. ) ) COMMISSIONER OF SOCIAL SECURITY ) ADMINISTRATION, ) ) DEFENDANT. ) ______________________________________ ) C/A No. 8:17-3-RBH-JDA PLAINTIFF’S ANSWERS TO COURT’S SPECIAL INTERROGATORIES Plaintiff is directed to answer the following questions as completely as possible in the space provided. If you need additional space, attach a separate sheet of paper and indicate which answer(s) are continued on the separate sheet. BE AWARE THAT YOUR ANSWERS MUST BE COMPLETELY TRUTHFUL AND ARE GIVEN UNDER PENALTY OF PERJURY. 1. In your motion for leave to proceed in forma pauperis, you appear to indicate that you receive disability and medical retirement benefits of approximately $4253.00 each month. And, you state that you have approximately $2794.00 in expenses each month. Please explain below more details about why you cannot pay the $400 filing fee. ______________________________________________________________________ ______________________________________________________________________ ________________________________________ ______________________________ ____________________________________________________________ __________ ______________________________________________________________________ ______________________________ ________________________________________ __________________________________________________ ____________________ ______________________________________________________________________ ______________________________________________________________________ Page 1 of 2 2. Provide a list of your regular monthly income. ______________________________________________________ ________________ ______________________________________________________________________ ______________________________________________________________________ ____________________________________________ __________________________ 3. List below any debts or financial obligations you have and describe the amounts owed (both the total outstanding balance and the required monthly payments) and to whom they are payable. ______________________________________________________________________ _____________________________ _________________________________________ _________________________________________________ _____________________ _____________________________________________________________________ _ ______________________________________________________________________ _______________________________________ _______________________________ ___________________________________________________________ ___________ ______________________________________________________________________ I declare under penalty of perjury that the foregoing is true and correct. Signed this ______ day of___________________, 2017 _____________________________________ Signature of Plaintiff Page 2 of 2

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