This document conta· · pag th ms some . /~ '~ ~c? J-e_ -(> /tz_ '/It_ ,"J {Jr/- 0 r-- ,/W ~ A.~)mdlm{i o •maging. · y) es . at a~ of poor quality

Lu ~~ ~ Ce; w ,f C9l d ;2 w tJ u to!. ~ l.e__o J-e I/ fee -fo (/lov -J4 S--k-'J-0J o-r fk· FolloC.Jr'vr_y fe/!J,~/ 0~/ &hyJcfY~ (.) Co Hc_#-( F7ci~OcJ y; ~ f3 I (A) efe# c f '7roofj : 3

Abet Acosta, Cterk ~X fc:'/·1-<L~ :j'5;1! 7f/f /fofltJ/qJ/e Oa·-k- ~-G(- !_£ ~V'.oJe_ ·. fk-fl J-l~~e~ f' &:x</'+ or . . fqj'e ~ GiJ(>'j ~-OF. { 0 .

f C,-:_#r:Oa! ..AtJ;eal !f r _Aur +'-'~r 7eJ(a.!' ~~#!J~/A~S 1- MOTION FOR LEAVE TO PROCEED IN FORMA PAUPERIS

I, . .-zlaze. 'I Pr6J~f-. f-tfZ> I s-rrt do hereby request leave to proceed in forma pauperis ~d state unaer oath that I am unable to pay the costs for commencement of this _ _ _ _ _ _ _ _ _ action, or to give security therefor, and that I believe I am entitled to redress.

I further state the foll<?w~ng: ·/ I am not employed ( i~· Imnemployedh;: ~ ~~(e/ Jkrr0-{;pWiJfb-,// and my salary is $ _ _ _ _ _ _ _ _ _ _ per---'---~-----· I have no other sources of income except the following (include public assistance, social security disability, or any other income not included above employment and state the amount):

I have $_ _ _ _ _ (§ ___,. _,______ IN CASH.

I have the following funds in the bank:

NAME OF THE BANK TYPE OF ACCOUNT AMOUNT - J //}I j_f ,..--- $ \'?\ .,-_ ....... /'""' $ ~ $

I own the following valuable property (include real estate, stocks, bonds, notes, automobiles, and other valuable property, but exclude ordinary household furnishings and clothing):

VALUE $ $ $

I have the following debts: