"" Cc~ 31) 51 tj{)-G ~ CAUSE NUMBER: JE _ /3~0;.::__\---.:q:__q~6::::..___L U 4 2[113 Te:d~~o,\ t-Jo.-\\ono.\ M o § t~<j9~ IN THE JUSTICE COURT ~-s/i.r 1 ,'\TZ PLAINTIFF §§ CL~. ElfAV DlSTf!l(! ~ .- <- vs. c:: > ~m § PRECINCT 4, PLACE 2 en '''<~, § (..) '.. ::::.:-np o s-<::s::f"'' § ~ ~p~s § :X ::'- 1"'1 ;;D _,;:or<l DEFENDANT(S) & ALL OCCUPANTS § DALLAS COUNTY, TEXAS <i! ~~:z: c.n ,.. ~ (J) AFFIDVAIT OF INABILITY TO PAY COSTS (TRCP 749a) IIWE the named Defendant(s) in the above styled and number forcible detainer and /or forcible entry and detainer, are/am unable to pay the court costs of appeal therein. 1/we verify that the statements made in this affidavit are true and correct, and contain complete infonnation as to the my identity, the nature and amount of governmental entitlement income, the nature and amount of employment income, other income, (interest, dividends, etc.), spouse's income if available to me, property owned (other than homestead), cash or checking account, dependents, debts, and monthly expenses (Texas Property Code §24. 0052).

TENANT'S IDENTITY \ fV\C\CCJf,~D T O'((CS Tenant's Street_.4.ddress, City, State, Zip (:'ode LIGC-\ S-t-G090~ L(G9 S}6 (Jqo3 Tenant's Primary Phone Tenant's Secondary Phone Tenant's Date of Birth

SPOUSE'S IDENTITY Spouse 's Full Name

Spouse's Primary Phon Spouse's Secondary Phone Spouse's Date of irth

DEPENDANTS ~ I q yrs A IS \j'fs.

Number of Dependants Ages of Dependants Go3cc~f'\C'>n sA G'f9.b 9ro.if,·e \x 3.505\ Residence of Dependants Address, City, State, Zip Code CC-13-06190-C Justice of the Peace 4-2 841 West Irving Boulevard Irving, TX 75060 ;:~~DAVI P. (214) 589-7000 F. (214) 589-7048 2601a 4 T INABILITY To PAY

1111111/lllll//ll/111 INCOME OF TENANT & SPOUSE '- ...) ___ Se I~ em pt~e Tenant's Employer -An1 Tenant's Job iTle and/or Dut1es ___ 0~--- Co n._( 0 'Q s-\ Gwl\ cl QIG\ .\ ~ ,e_ T " -=tSos.L------------ --- ------- Tenant s Employer Address, City, State, Zip Code ---·---- ·----,---------- 'J'en(~~~~sur,e:f\~2 Na-·m_e_ __ Tenant's Supervisor's Phone Tenant's Monthly Salary/Income Tenant's Other Income -~ --0 Spouse's Employer Spouse's Job Title and/or Duties -------,--------------------,---------------- Spouse's Employer Address. City, State, Zip Code Spouse's Supervisor ·s Name Spouse 's Supervisor's Phone ---·--------------- Spouse's 111onrhly Salary/Income Spouse's Orher Income

GOVERNMENT ENTITLEMENT INCOME -------------- Unemployment Benefits AFDCITANF _,___ __________ ------ ----··--·- --· -- ·-·---- Social Security Disability Veteran's Benefits Child Support ------- -- · - - - - - Other Amounts- Describe

ALL OTHER INCOME ----------- · · - - - - - - - - - - - - - - - List all other sources of income and amounts. Cash on hand --------------- ------- -----·- ---····------· ...... -··--· ----- Financial lnst irution olChecking Account Balance Amount -····---------------- Financial Ins! itut ion o_fSavings Account Balance Amount

REAL PROPERTY (residential, commercial, or land owned) ----------·---------- - - - - - - - - - - - Address (~(Real Property Ovmed Value of Properly - ------ - - - - - - -··-------------·-·-- Address o(Real Property Owned Value o(Property

Ju.~tice of the Peace 4-2 841 West Irving Boulevard Irving, TX 75060 P. (214) 589-7000 F. (214) 589-7048 PERSONAL PROPER~ (other than ltouseholdfurnishings,~thes, tools of tt trade, or personal effects. This includes vehicles tmd other sources of transportation) ····--.. - - - · - - - - - - - - - - - - - - - - - - - - : - - - - : : - = - - - - - - - - - - - Descriplion a./Property Owned Value ofProperty ---·-·-------··------------- Descriplion £dProperty Owned Value ofProperty

MONTHLY EXPENSES ---- g3C) _ _ _ _ _ __ ·---------'~"""--,------------------ Rent and/or !~'for/gage Amount Vehicle/Car Payment Amount ....e.- ··--·--- __ _3_gQ Insurance Amount Ulility Amount ·---~ ~ Child Care Amount Child Support Amount ___'faa~ ..e- F'ood and/or Incidental Amount Medical and/or Dental Amoun/ --~2~~-a-~----------------------------­ Other AmoumGf\S Describe Other A mount -(hher ;{,~;;~t ~cce.s(t··~ Describe Other Amount Signed this the { G --day of _____:A:....cu>!..§~·L.L..ir....l-J--+-·---- 70 L22 d -~4--t?.arr( 'o f(or(f 4'a~Y~d _.fib __ Signa/ure oj'Af/iant Printed Name ojAjjianl THE STATE OF TEXAS § COUNTY OF DALLAS § BEFORE ME. the undersigned authority, on this day personally appeared the above named aftiant who upon oath, stated that he/she is the Tenant making this Pauper's Aftidavit and that the information provided is true and correct.

0 AND SUBSCRIBE~ before me on the /~-day of ......!...llAtk:f44fU---=-- , 20_{_ _ .

CERTIFICATE OF DELIVERY: I the Defendant in the above and entitled to·rcible detainer I torcible entry and detainer certify that I have sent the torgoing document to the opposing party on this the day of_____ , 20 ________ _

--·--··---- ·----- Signature ufDefendant Printed Name ofAffianl Justice of tile Peace 4-2 841 West Irving Boulevard Irving, TX 75060 P. (214) 589-7000 F. (214) 589-7048