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Motion For Leave To Proceed On Appeal Without Prepayment Of Costs Or Fees And Appellant-Petitioners Opening Brief A-11 - Official Federal Forms
| Motion For Leave To Proceed On Appeal Without Prepayment Of Costs Or Fees And Appellant-Petitioners Opening Brief Form. This is a national form and can be used in 10th Circuit Court Of Appeals Circuit Court Of Appeals . |
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UNITED STATES COURT OF APPEALS FOR THE TENTH CIRCUIT Case No. __________________ Plaintiff/Petitioner - Appellant, v. 9 Motion for Leave to Proceed on Appeal Without Prepayment of Costs or Fees (Part A) and 9 Defendant/Respondent - Appellee. Appellant/Petitioner's Opening Brief (Part B) PART A NOTICE AND INSTRUCTIONS Your motion for leave to proceed on appeal without prepayment of costs or fees a will be evaluated by the court using these standards: Leave to Proceed Without Prepayment of Costs or Fees. You must meet all of the requirements of the Prisoner Litigation Reform Act (PLRA), Pub. L. No. 104-134, 110 Stat. 1321 (Apr. 26, 1996); 28 U.S.C. ยง 1915. This includes submitting the certified statement of trust account and authorization to deduct funds attached to this form. The forms will not be considered unless they are complete. American LegalNet, Inc. www.USCourtForms.com FAILURE TO SET FORTH FACTS AND ARGUMENTS SHOWING THAT YOU MEET THE APPROPRIATE STANDARD WILL SUBJECT YOUR APPEAL TO DISMISSAL WITHOUT FURTHER NOTICE. You may use Part A of this form to furnish a statement of the case, the issues you intend to raise on appeal, and the reasons your appeal meets the applicable standards. The form is intended to guide you in meeting the above standards. If you need more space to answer, additional pages may be attached. The information you furnish, together with the full record of the proceedings in the district court, will be the basis for this court's decision. You should bear in mind that an appeal is not a retrial, but rather a review of the district court's judgment and record of proceedings. APPLICATION AND/OR MOTION 1. Statement of the Case. (This should be a brief summary of the proceedings in the district court.) 2. Issues to be Raised on Appeal. (New issues raised for the first time on appeal generally will not be considered.) 3. Summary of Your Argument Showing that Your Appeal Meets the Appropriate Standards. A-11 Motion for Leave to Proceed on Appeal without Prepayment of Costs or Fees (Part A), Appellant/Petitioner's Opening Brief (Part B) PLRA- 1/04 Page 2 American LegalNet, Inc. www.USCourtForms.com 4. Do you think the district court applied the wrong law? If so, what law do you want applied? 5. Did the district court incorrectly decide the facts? If so, what facts? 6. Did the district court fail to consider important grounds for relief? If so, what grounds? 7. Do you feel that there are any other reasons why the district court's judgment was wrong? If so, what? 8. What action do you want this court to take in your case? A-11 Motion for Leave to Proceed on Appeal without Prepayment of Costs or Fees (Part A), Appellant/Petitioner's Opening Brief (Part B) PLRA- 1/04 Page 3 American LegalNet, Inc. www.USCourtForms.com 9. Were you required to seek and exhaust administrative remedies prior to filing your claim in district court? If yes, what steps did you take to exhaust those remedies? _________________________ Date ___________________________________ Signature A-11 Motion for Leave to Proceed on Appeal without Prepayment of Costs or Fees (Part A), Appellant/Petitioner's Opening Brief (Part B) PLRA- 1/04 Page 4 American LegalNet, Inc. www.USCourtForms.com FINANCIAL DECLARATION Affidavit in Support of Motion to Proceed on Appeal in Forma Pauperis I swear or affirm under penalty of perjury that because of my poverty I am unable to pay the docket fees of my appeal or to post a bond for them. I believe I am entitled to a different result than that reached in the district court. I further swear or affirm under penalty of perjury that the responses which I have made to the questions and instructions below relating to my ability to pay the fees for my appeal are true. Instructions. Please complete all questions in this application and then sign it on the last page. If the answer to any question is "0" or "none," or the question is "not applicable", so indicate by writing "0", "none", or "not applicable (N/A)". If additional space is needed to answer any question or to explain your answer to any question, please use and attach a separate sheet of paper identified with your name, the docket number of your case and the number of the question. 1. Are you or your spouse currently employed? Yes _____ No _____ 2. If you or your spouse are currently employed, state the name and address of your employer, the length of your employment with that employer, and your monthly gross pay. Gross pay is pay before any taxes or other deductions are taken. If you have more than one employer, please provide the information requested below about the other employer(s) on a separate sheet of paper and attach it to this application. A-11 Motion for Leave to Proceed on Appeal without Prepayment of Costs or Fees (Part A), Appellant/Petitioner's Opening Brief (Part B) PLRA- 1/04 Page 5 American LegalNet, Inc. www.USCourtForms.com Yourself: Name and Address of Employer _________________________________ _________________________________ _________________________________ Length of Employment _____ ______ Years Months Monthly Gross Pay $____________ Your Spouse: Name and Address of Employer _________________________________ _________________________________ _________________________________ Length of Employment _____ ______ Years Months Monthly Gross Pay $____________ 3. If you are currently unemployed, state the date of your last employment and your monthly gross pay during your last month of employment. Gross pay is pay before any taxes or other deductions are taken. Date of last employment (Month/Year) for yourself _______________; spouse _____________ Monthly gross pay during last month of employment $____________ 4. State whether you or your spouse have received money from any of the following sources during the past twelve months, and, if so, the average monthly amount from that source. Adjust any money that was received weekly, bi-weekly, quarterly, semi-annually, or annually to show the monthly rate. Did you receive money from any of the following sources during the past 12 months? Average monthly amount during past 12 months for you and your spouse if applicable. You Self-employment Income from real property (such as rental income) Interest and dividends Y/N ___ Y/N ___ Y/N ___ $ _______ $ _______ $ _______ Spouse $ _______ $ _______ $ _______ Amount expected next month You $ _______ $ _______ $ _______ Spouse $ _______ $ _______ $ _______ Gifts Y/N ___ $ _______ $ _______ $ _______ $ ____
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