UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF NEW YORK TEMURI KUPRASHVILI, Petitioner, 25 Civ. 5268 (PAE) ~against- ORDER DIRECTING PAYMENT OF FEE ‘BRYAN FLANAGAN al,, OR IFP APPLICATION Respondents. PAUL A. ENGELMAYER, United States District Judge: Petitioner, who is proceeding pro se, brings this petition for a writ of habeas corpus. To ‘proceed witha petition for a writ of habeas corpus in this court, a petitioner must either pay the $5.00 filing fee or request authorization to proceed in forma pauperis (“IFP”), submit a signed IFP application. See

, 1915. Petitioner submitted the petition without the filing fee or an IFP application. Within thirty days of the date of this order, Petitioner must either pay the $5.00 filing fee or complete and submit the attached IFP application. If Petitioner submits the IFP application, it should be labeled with docket number 25-CV-5268 (PAE). Ifthe Court grants the IFP application, Petitioner will be permitted to proceed without prepayment of fees, Sée

(ay 1). The Court certifies under

(a)(3) that any appeal from this order would -not be taken in good faith, and therefore in forma pauperis status is denied for the purpose.of an appeal. Cf Coppedge v. United States,

(1962) (holding that appellant demonstrates good faith when seeking review of a nonfrivolous issue).

The Court directs the Clerk of Court to mail a copy of this order to Petitioner at the address on record and to Bernal Peter Ojeda at 2945 Townsgate Rd. Ste. 200, Westlake Village, CA 91361-5866.

SO ORDERED. Dated: September 26, 2025 New York, New York p p A PAUL A. ENGELMAWER United States District Judge

UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF NEW YORK

{full name of the plaintiff or petitioner applying (each person must submit a separate application) VU) -against (Provide docket number, if available; if filing- this with your complaint, you will not yet have a docket number.)

{full name(s) of the defendant(s)/respondent(s} } APPLICATION TO PROCEED WITHOUT. PREPAYING FEES OR COSTS Lama plaintiff/ petitioner in this case and declare that I am unable to pay the costs of these proceedings and I believe that I am entitled to the relief requested in this action. In support of this application to- proceed uz fornia pauperis (IEP) (without prepaying fees or costs), I declare that.the responses below are true: □ 1. Are you incarcerated? LJ] Yes [1] No (lf “No,” go to Question 2.) Iam beitig held al: Do you receive any payment from this institution? [_] Yes No Monthly amount: Tflama prisoner, see

(h), Uhave attached to this document a “Prisoner Authorization” directing the facility where I am incarcerated to deduct the filing fee from my account in installments and to send to the Court certified copies of my account statements for the past six months. See 28 US.C. § 1915(a)(2), (b). l understand that this means that I will be required to pay the full filing fee. 2, Are you presently employed? L.] Yes L] ‘No “yes,” my employer's name and address are:

Gross monthly pay or wages: If “no,” what was yout last date of employment? Gross.monthly wages at the time: 3, addition to your income stated above (which you should not repeat here), have you or anyone else living at the same residence as you received more than $200 in the past 12 months from any of the following sources? Check all that apply. (a) Business, profession, or other self-employment [] Yes {] No (b) Rent payments, interest, or dividends [] Yes [] No

SDNY Rev: 8/5/2015

(c) Pension, annuity, or life insurance payments [] Yes []. No (d) Disability or worker's compensation payments Yes [|] No (e) Gifts or inheritances L] ‘Yes L] No () Any other public benefits (unemployment, social security, Yes [] No food stamps, veterain’s, etc.) (2) Any other sources [] Yes L} No ‘Tf you answered “Yes” to any question above, describe below or on separate pages each source of mowey and state the amount that you received and what you expect to receive in the future.

Tf you answered “No” to all of the questions above, explain how you are paying your expenses:

4, How much money do you have in cash or ina checking, savings, or inmate account?

5, Do you ownany automobile, real estate, stock, bond, security, trust, jewelry, art work, or other financial instrument or thing of value, including any item of value held in someone else's name? If so, describe the property and its approximate valde:

6. Do you have any housing, transportation, utilities, or loan payments, or other regular monthly -expenses? If so, describe and provide the amount of the monthly expense:

7, ‘List all people who are dependent on you for support, your relationship with each person, and how much you contiibute to their support (only provide initials for minors under 18):

8. Do you. have any debts or financial obligations not described above? If so, describe the amounts owed. and. to whom they are payable:

Declaration: 1 declare under penalty of perjiry that the above information is true. I understand that a false statement may result in a dismissal of my claims.

Dated’ Signature Name {Last, First; Ml} Prison Identification # (if incarcerated} Address City State 7ip Code

Telephone Number’ E-mail Address (if available)

IFP Application, page 2