IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF KANSAS
_________________________________ Plaintiff(s), v. ________________________________ ________________________________ Defendant(s).
) ) ) ) ) ) ) ) ) )
Case No. _________________________
MOTION TO PROCEED WITHOUT PREPAYMENT OF FEES I, _________________________________, ask the court for permission to continue with this case without the payment of fees and costs. In support of my request, I state, under penalty of perjury, that the following facts are true: (1) (2) I am the plaintiff in this case and I believe that I am entitled to relief. This case is about:
. (3) (4) Because of my financial status, I am unable to pay the fees and costs of this case. I have completed and am filing an Affidavit of Financial Status with this motion.
Executed this _____ day of ___________, 20___.
Signature of Plaintiff