COURT OF APPEALS FOR THE FIRST DISTRICT OF TEXAS AT HOUSTON ORDER Appellate case name: Fred Cox, Sr v. Allen Samuels Chevrolet and Allen Samuels Appellate case number: 01-17-00973-CV Trial court case number: 2016-82605 Trial court: 215th District Court of Harris County Appellant Fred George Cox, Sr., who is self-represented, filed a notice of appeal that referenced an attached “Affidavit of Poverty.” Appellant has not made financial arrangements for the filing of the clerk’s record.

In his affidavit, appellant claimed indigence based on his unemployment, his lack of regular income, his disability, his receipt of Social Security benefits, and his lack of assets.

However, appellant’s submission does not conform to the form Statement of Inability to Afford Payment of Court Costs, nor does it otherwise completely satisfy Rule 145 of the Rules of Civil Procedure.

An appellate court may permit a party who did not file a Statement of Inability to Afford Payment of Court Costs in the trial court to proceed without payment of costs. TEX. R. APP. P. 20.1(c). Within 30 days of the date of this order, appellant is ordered to file a Statement of Inability to Afford Payment of Court Costs in form prescribed by the Supreme Court of Texas.

See id. The form Statement of Inability to Afford Payment of Court Costs is attached to this order.

It is so ORDERED.

Judge’s signature: /s/ Michael Massengale  Acting individually  Acting for the Court

Date: June 14, 2018