Leon Sanchez, Julio v. Lopez, Rosanna et al
Filing
5
ORDER on ifp request: Plaintiff to submit Financial affidavit. Financial Affidavit due 2/4/2016. Signed by Magistrate Judge Peter A. Oppeneer on 1/13/2016. (jef),(ps)
IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF WISCONSIN
JULIO LEON SANCHEZ ,
Plaintiff,
ORDER
v.
Case No. 15-cv-795-wmc
ROSANNA LOPEZ AND CHILD SUPPORT
AGENCY,
Defendants.
In an order entered on December 16, 2015, plaintiff Julio Leon Sanchez was advised
to submit a financial affidavit in support of his request to proceed without prepayment of the
filing fee.
The affidavit that plaintiff submitted does not provide any financial information.
Without this information, it is impossible, to determine whether plaintiff qualifies for
indigent status. Therefore, I will provide plaintiff with the opportunity to supplement the
request for leave to proceed without paying the filing fee by completing the enclosed affidavit
of indigency. When completing the affidavit, plaintiff should show how basic necessities are
paid, and include actual gross monthly income from all sources for the last 12 months.
ORDER
IT IS ORDERED that plaintiff Julio Leon Sanchez, may have until February 4, 2016,
to return the enclosed affidavit of indigency, taking particular care to show how basic
necessities are paid, and include actual gross monthly income from all sources for the last 12
months. If plaintiff fails to provide this requested financial information, then I will deny the
request for leave to proceed without prepayment of the filing fee for failure to show
indigency.
Entered this 13th day of January, 2016.
BY THE COURT:
/s/
PETER OPPENEER
Magistrate Judge
UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF WISCONSIN
JULIO LEON SANCHEZ ,
ORDER
Plaintiff,
v.
Case No. 15-cv-795-wmc
ROSANNA LOPEZ AND CHILD SUPPORT
AGENCY,
Defendants.
NON-PRISONER REQUEST TO PROCEED IN DISTRICT COURT
WITHOUT PREPAYING THE FILING FEE
Answer the following questions to the best of your ability.
Note: If you do not tell the truth, the court may dismiss your lawsuit.
I.
Personal Information
1)
Are you employed?
□Yes
□ No
2)
Are you married?
If “Yes,” is your spouse employed?
□ Yes
□ Yes
□ No
□ No
3)
Do you have any dependents that you are responsible for supporting?
□ Yes
□ No
If “Yes,” list them below:
Name or initials (for
minor children only)
Relationship to You
Age
Amount of Support
Provided per Month
________________________
_________________
________
$____________
________________________
_________________
________
$____________
________________________
_________________
________
$____________
II.
Income - If you are married, your answers must include your spouse's income.
(When calculating income, include any wages, salary, rent, child support, public
assistance, unemployment compensation, disability payments, life insurance payments,
pensions, annuities, workers' compensation, stock dividends and interest, gifts and
inheritance, or other money you receive from any source.)
1)
State your total monthly wages or salary?
2)
Provide the name and address of your employer(s):
$ ______________
______________________________________________________________
3)
State your spouse's total monthly wages or salary? $ ______________
State the amount of money you have received from any other source in the last twelve months,
such as the sources listed above. Please attach an additional sheet if necessary.
Source of income
Amount
______________________________________________
$ ______________________
______________________________________________
$ ______________________
III.
Expenses - If you are married or have dependents, your expenses should also include
your household's expenses.
(When calculating household expenses, you may include groceries, clothing, medical
costs, utilities that are not included in your rental payments, transportation, and
insurance.)
1)
Identify the following amounts that you pay per month:
□ Rent or
□ Mortgage
$ __________________________________
Car payment(s)
$ __________________________________
Alimony or court-ordered child support
$ __________________________________
Credit card payment(s)
$ __________________________________
2)
Do you have any other monthly expenses that you have not already listed?
□ Yes
□ No
If “Yes,” list them below:
Expense
Amount
____________________________
$ __________________________________
____________________________
$ __________________________________
____________________________
$ __________________________________
3)
What are your total monthly expenses?
$___________________________________
IV.
Property - If you are married, your answers must include your spouse's property.
1)
Do you own a car?
□ Yes
□ No
If “Yes,” list car(s) below:
Make and Model
Year
Approximate Current
Value
_______________________________________________ __________
$________________
_______________________________________________ __________
$________________
2)
Do you own your home(s)?
□ Yes
If “Yes,” state the approximate value(s).
□ No
$ ____________________
What is the amount of equity (assessed value of residence minus outstanding
mortgage balance) in the home(s)? $ ____________________
3)
Do you have any cash or checking, savings, or other similar accounts?
□ Yes
□ No
If “Yes,” state the total of such sums.
$_____________________________
4)
Do you own any other property of value, such as real estate, stocks, bonds, trusts, or
individual retirement accounts (e.g., IRA, 401 k), artwork or jewelry?
□ Yes
□ No
If “Yes,” describe the property and the approximate value(s).
________________________________________________________________
V.
Other Circumstances - Describe any other financial circumstance(s) that you would like
the court to consider when reviewing this petition.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
I, ____________________, declare that I am the plaintiff bringing this complaint. I
declare that I am unable to prepay the fee and that I am entitled to the relief sought in the
complaint.
___________________________
Date
_________________________________________
Signature - Signed Under Penalty of Perjury
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