Free IndigentAppeal.PDF - North Carolina

State of North Carolina North Carolina Industrial Commission

PETITION TO APPEAL AS AN INDIGENT PERSON
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AFFIDAVIT As the individual plaintiff in the above-entitled action, I affirm that I am financially unable to advance the required costs for the prosecution of this action before the North Carolina Court of Appeals. Therefore, I now petition the Industrial Commission for an order allowing me to bring suit in this action as an indigent.
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I am presently a recipient of Food Stamps Aid to Families With Dependent Children (AFDC). Supplemental Security Income (SSI) I am a prison inmate. A Department of Corrections report is attached showing deposits, withdrawals, and balances in my prison trust account during the last six months. Although I am not a recipient of food stamps, AFDC, or SSI, I am financially unable to advance the costs of filing this action or appeal.

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ORDER Based upon the Affidavit appearing above, it is ORDERED that: The applicant is authorized to bring suit as an indigent The petition is denied. Commissioner Signature Date Executive Secretary Deputy Commissioner