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Affidavit In Support Of Application To Proceed In Forma Pauperis 257P - Delaware
| Affidavit In Support Of Application To Proceed In Forma Pauperis Form. This is a Delaware form and can be used in Family Court Statewide . |
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Form 257p (Rev. 10/07) Family Court For the State of Delaware AFFIDAVIT IN SUPPORT OF APPLICATION TO PROCEED IN FORMA PAUPERIS http://courts.delaware.gov/Courts/Family%20Court/ 1 of 7 American LegalNet, Inc. www.FormsWorkflow.com Form 257p (Rev. 10/07) PROCEEDINGS IN FORMA PAUPERIS · · Please complete all portions of the attached application All requests for information must be supplied, if possible. Failure to supply information may result in a denial of your Application to Proceed In Forma Pauperis. Approval of this application will result in the waiver of fees for filing and notice/publication only. · 2 of 7 American LegalNet, Inc. www.FormsWorkflow.com Form 257p (Rev. 10/07) The Family Court of the State of Delaware In and For New Castle Kent Sussex County AFFIDAVIT IN SUPPORT OF APPLICATION TO PROCEED IN FORMA PAUPERIS Petitioner Name Street Address v. Respondent Name File Number Street Address Apt. or P.O. Box Number City State Zip Code Apt. or P.O. Box Number Petition Number City State Zip Code Attorney Name and Phone Number Attorney Name and Phone Number I, the Petitioner Respondent in the matter of , being first duly sworn, depose and say that I am . In support of my application to proceed without paying Court fees and costs, or give security, I state: My date of birth is: My current address is: Because of my financial situation, I am unable to pay the costs of this proceeding or give security. In support of that statement, I supply the following information: 1. Are you presently employed? Yes No (If your answer is no, please skip to question 4) 2. If Yes, state: a. The name and address of your employer: 3 of 7 American LegalNet, Inc. www.FormsWorkflow.com Form 257p (Rev. 10/07) b. State how often you are paid: c. State the amount of your take home pay per pay period: * If employed, you must attach a recent pay-stub or other documentation of income. 3. If you are not employed, state: a. Name and address of last employer: b. Location and date of last employment: 4. If you are not employed, please state the reason why: 5. If you are not employed, please list any government benefits that you currently receive (SSDI, food stamps, TANF, etc.): Type of Benefit (SSDI, TANF, etc.) Monthly Amount Received 6. State whether you have received any income (dividends, rent, savings, interest, etc.), gifts, such as stocks, bonds or cash, from any source in the last the last 12 months: Yes 7. If yes, state: Amount of income or value of gift Date Received No From Whom Received 4 of 7 American LegalNet, Inc. www.FormsWorkflow.com Form 257p (Rev. 10/07) 8. List all property owned, whether held in your name alone or jointly with anyone else: a. Real estate: b. Property (stocks, bonds, bank accounts, vehicles): c. Name and address of any joint owner, designating which property is jointly owned and name and relationship to joint owner: 9. If you have a spouse, state: a. Amount of income received: b. Source: c. Frequency income is received: 10. Itemize debts and regular monthly expenses: 5 of 7 American LegalNet, Inc. www.FormsWorkflow.com Form 257p (Rev. 10/07) Debt/Expense Monthly Amount 11. List names, ages and addresses of any dependents: Name Age Address I, swear or affirm that the above information is true and correct and is made under penalty of perjury. DATE SIGNATURE SWORN TO AND SUBSCRIBED before me this , . day of Deputy Clerk of Court/Notary Public 6 of 7 American LegalNet, Inc. www.FormsWorkflow.com Form 257p (Rev. 10/07) The Family Court of the State of Delaware In and For New Castle Kent Sussex County IN RE: Petitioner File Number: vs. Petition Number: Respondent ORDER TO PROCEED IN FORMA PAUPERIS The Court has reviewed the Petitioner's application and, if necessary, has questioned the Petitioner under oath. Petitioner's application is hereby: Granted. The Court waives all fees and costs associated with the filing and notice of this action. This does not include waiver of transcript fees. Granted in part. ________________________________________________________ ________________________________________________________ Denied. ________________________________________________________ ________________________________________________________ Petitioner must pay all fees and costs associated with the filing and notice of this action. Please remit payment to the cashier's office. If the above provisions are not completed within 30 days of the date of this Order, the underlying petition is dismissed pursuant to this Order. IT IS SO ORDERED, this day of , . CC: Petitioner Remit payment to: _____________________________ JUDGE/COMMISSIONER Cashier's Office, 500 N. King Street, Wilmington, DE 19801 400 Court Street, Dover, DE 19901 22 The Circle, Georgetown, DE 19947 7 of 7 American LegalNet, Inc. www.FormsWorkflow.com
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