Nebraska > Local County > 3rd District
Affidavit And Application To Proceed In Forma Pauperis - Nebraska
| Affidavit And Application To Proceed In Forma Pauperis Form. This is a Nebraska form and can be used in 3rd District Local County . |
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IN THE DISTRICT COURT OF _____________ COUNTY, NEBRASKA __________________________, Plaintiff, vs. ________________________, Defendant. STATE OF NEBRASKA COUNTY OF __________ ) ) ss: ) ) Case No. __________________ ) ) ) AFFIDAVIT AND APPLICATION TO ) PROCEED IN FORMA PAUPERIS ) (Request to Proceed Without Payment of Fees) ) ) ) The undersigned, being first duly sworn on oath, deposes and says that: 1. 2. 3. I am the Plaintiff in an action for Dissolution of Marriage, and I am of lawful age. I bring this action in good faith, and I am entitled to redress. I am unable to pay the cost of litigation, including the cost of publication, and am unable to provide security. 4. I have a net income of only $ _____________________ per month, derived from ____________________________________, and I support a household of ___ people. (i.e., employment, public benefits, Social Security, etc.) 5. liquidated. My living expenses wholly absorb my income, and I have no assets that can be WHEREFORE, pursuant to Neb. Rev. Stat. ยงยง 25-2301 to 25-2310, I request that the Court authorize me to proceed in forma pauperis and direct ______________________ County, (name of county where filing) Nebraska, to pay my costs, including fees and other expenses related to this action and waive provision of security. __________________________ Plaintiff (print name) __________________________ Signature SUBSCRIBED AND SWORN TO before me this ____ day of _____________, 20___. ______________________________ Notary Public 11/04/04 rev. American LegalNet, Inc. www.FormsWorkflow.com
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