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CIVIL DISTRICT COURT FOR THE PARISH OF ORLEANS FIRST CITY COURT OF THE CITY OF NEW ORLEANS SECOND CITY COURT OF THE CITY OF NEW ORLEANS STATE OF LOUISIANA NO. SECTION DIVISION

versus

Date this form is completed: FORMA PAUPERIS APPLICATION
ALL QUESTIONS MUST BE ANSWERED IN FULL. COMPLETE ALL FACTS CONCERNING MOVER.
NOTE: If more than one person is seeking pauper status, each person must complete a separate form. I request a court order so that I do not have to pay court costs and fees in advance or as they accrue. PART 1: 1. My name is: first 2. My address and telephone number is: Street Address: Mailing Address: City, state and zip code: Telephone number: 3. 4. 5. My date of birth is: My social security number is: .My marital status is: (check one) married single widowed separated divorced Apt. middle last

living with another as if my spouse 6. My occupation, employer and employer's address is (if more than one, list all):

PART II: 7. (a) (b) © (d) 8. I am receiving financial assistance under one or more of the following programs: SSI or SSP (Supplemental Security Income or State Supplemental Payments Program) AFDC or TANF (Aid to Families with Dependent Children Program or Temporary Aid to Needy Families) Food Stamps (The Food Stamp Program) City or Parish Relief, General Relief or General Assistance If you checked a box in item No. 7 above, you must attach documents to verify receipt of the benefits checked. If you have checked a box in Item No. 7 above, sign on the following line and only complete the affidavits at the end of this form. I am not able to pay any of the court costs or fees in advance or as they accrue.

9.

Signature of Mover WARNING: You must immediately tell the Court if you become able to pay court costs or fees in advance or as they accrue during this action. You may be ordered to appear in Court and answer questions about your ability to pay court costs and fees. Page 1 of 4 Pages

PART III: FINANCIAL INFORMATION 10. My pay changes considerably from month to month. (If you checked this box, each amount reported in item No. 10 should be your monthly average for the past 12 months.) My monthly income: (a) (b) My gross monthly pay is: $ My payroll deductions are: (state purpose and amount) (1) $ (2) $ (3) $ (4) $ My TOTAL payroll deduction amount is: $ (c) My monthly take-home pay is: (a) minus (b): $ Other money I get each month is (Examples: workers compensation, Interest, Dividends, rent, Spousal Support, Child Support, Social Security, Retirement): (1) (2) $ $ (e) MY TOTAL MONTHLY INCOME IS: © plus (d):

11.

(f)

The number of dependents, including me, supported by this money is: My spouse's occupation and employer is:

(g)

(h)

My spouse's gross monthly income is: $

(d)

NOTE: If you answered item No. 10 and/or No. 11, attach a copy of your most recent paycheck or paystub, and if applicable, that of your spouse. 12. I am represented in this case by a volunteer attorney (examples: NOLAC, Legal Aid, ProBono Project, Law School Clinic). My monthly expenses not already listed in item No. 11 above are: (a) Rent or house payments & maintenance: $ Food & household supplies: $ Utilities & telephone: $ Clothing: $ Laundry: $ Medical Expenses: $ (l) (g) Insurance (life, health, accident, etc.): $ (m) (h) (I) School & child care: $ Child & spousal support: $ (1) (2) (3) (4) (5) (6) $ $ $ $ $ $ Amounts deducted due to garnishments, wage assign ments and earnings withholding orders: $ Other expenses (specify): (j) Transportation and/or auto expenses (insurance, gas, repair): $ Installment payments (state purpose and amount): (1) (2) (3) $ $ $

13.

(b) © (d) (e) (f)

(k)

The TOTAL amount of monthly installment payments is: $

The TOTAL amount of other monthly expenses is: $ (n) MY TOTAL MONTHLY EXPENSES ARE (add (a) through (m): $

Signature of Mover

Page 2 of 4 Pages

14.

I own or have an interest in the following property: (a) (b) Cash: $ Checking or savings accounts at any financial institution: $ (d) Real estate (list address, estimated fair market value, and equity of each property): $ (2) (3) (c) (1) (2) (3) $ $ $ $ $ $ $ $

(1)

(e)

Cars, other vehicles and boat (list make and year of each) and estimated value: (1) (2) (3) 15. $ $ $

Other property such as jewelry, furniture, furs, art, stocks, bonds, certificates of deposit, coin or stamp collections, U. S. Savings Bonds, annuities, IRA, etc.: $

I have an interest in an estate or succession which may be or is opened and or an interest in other civil litigation. (State the name, court, and case number of all such matters.):

16.

Other facts which support this application (describe unusual medicals, needs, expenses for recent family emergencies or other unusual expenses to help the Court understand your budget-, if more space is needed, attach a page labeled attachment 16.):

WARNING: You must immediately tell the Court if you become able to pay court costs or fees in advance or as they accrue during this action. You may be ordered to appear in Court and answer questions about your ability to pay court costs and fees.

Signature of Mover STATEMENT OF ATTORNEY I, the undersigned attorney, duly admitted to practice in the State of Louisiana, do hereby declare and affirm that I have carefully reviewed the above and foregoing statement of my client and approve the client having submitted the same.

ATTORNEY'S SIGNATURE PRINT NAME BAR NUMBER: TEL. NO.: NOTE: The "supporting affidavit" required to be submitted herein above must be that of a "pecuniarily disinterested" person. This preludes the participation of the attorney, and ordinarily precludes any member of the attorney's staff, or the spouse or minor child of the indigent declarant. An appropriate reprimand for improper use of this procedure may result in a monetary sanction. AFFIDAVIT OF MOVER STATE OF LOUISIANA BEFORE ME, the undersigned authority, personally came and appeared, who after being duly sworn, deposed and said that (he) (she) is the person who furnished the information contained in the above form; that (he) (she) has signed same; and that the information contained therein is true and correct; that this information is being furnished to the Orleans Parish Civil District Court for the purpose of obtaining an order to proceed in the above captioned lawsuit pursuant to LA C.C.P. Arts. 5181 et seq., and mover is prepared to appear in Court to give any information which may be desired in addition to the above. Mover further understands that the answers herein are continuous and if Mover ever acquires any assets described herein Mover will make the fact known prior to trial of this matter. Mover agrees to be further interrogated at any stage of these proceedings to inquire into Mover's financial condition. Mover knows it is a crime to intentionally swear to a known false answer. SWORN TO AND SUBSCRIBED BEFORE ME, this day of Mover NOTARY PUBLIC Page 3 of 4 Pages PARISH OF

AFFIDAVIT OF PERSON SUPPORTING MOVER'S PAUPER STATUS

STATE OF LOUISIANA

PARISH OF

BEFORE ME, the undersigned authority, personally came and appeared, who, being duly sworn, deposed and said: That (he) (she) knows who is the mover in the above captioned matter and knows (his)(her) financial condition because:

(Basis of knowledge stated in detail.)

and (he) (she) family believes that (he) (she) is unable to pay costs in this cause in advance or as they accrue or to furnish security. (He)(She) knows that it is a crime to intentionally swear to what is known to be a false answer. I HAVE READ THE ABOVE AFFIDAVIT SWORN TO AND SUBSCRIBED BEFORE ME, this day of PARTY SWEARING

NOTARY PUBLIC

ORDER The foregoing motion, supporting affidavits and sworn facts considered, let Mover be permitted to file all pleadings, appear in, and prosecute or defend in this action without prior payment of costs or as they accrue, and without giving bond for costs, as provided by laws of the State of Louisiana and particularly Louisiana Code of Civil Procedure, Articles 5181 et seq., as amended, pending further orders of this Court. NEW ORLEANS, LOUISIANA, this day of

JUDGE PROCEDURES IN FORMA PAUPERIS Section 1. Before any judicial proceedings are permitted to be prosecuted or defended pursuant to Louisiana Code of Civil Procedure, Articles 5 18 1, et seq. (Waiver of Costs for Indigent Party), the applicant and the affiant attesting to the applicant's inability to pay the costs of court, may be required to appear before the Judge assigned the case so that the Court may properly comply with C.C.P. art. 5183(2) by inquiring into the facts and satisfying itself that the applicant is entitled to the privilege. Section 2. Should counsel for any litigant who has been permitted to prosecute or defend in forma pauperis desire to take action in the cause which would increase the expense over and above those normally attendant to trial and appeal, such as, but not limited to, the taking of depositions to be used in lieu of a witness' testimony or otherwise, counsel shall first present to the judge presiding over the Division to which the case was allotted, a motion which shall be tried contradictorily with the adverse party(ies) to the end that the actual necessity for same may be determined. The purpose of this section is to minimize the cost to the public or to the party who may ultimately be cast for cost but without in any way prejudicing such litigant's cause or rights accorded the litigant by Louisiana Code of Civil Procedure, Article 518 1, et seq. If the purpose of the motion is to secure reporting services outside the courtroom, the Court, in its discretion, may furnish same utilizing a reporter on its staff. Section 3. In the event a judicial proceeding is filed and sought to be prosecuted in forma pauperis and the court refuses to permit the applicant to so proceed, the court shall order that the applicant be allowed fifteen (15) days within which to advance the necessary costs and in default of same may dismiss, without prejudice, the proceeding. In the further event that an applicant does not within fifteen (15) days from date of denial seek a hearing thereof, the proceeding may be dismissed without prejudice upon ex parte motion of any party at interest. Section 4. Any part or all of these procedures may be waived by the court when the applicant is in the custody of the Department of Corrections or is otherwise incarcerated. Such other or additional requirements for proceeding in forma pauperis may be Section 5. This form shall be used in all paper proceedings filed after April 30, 1998. Prior to April 30, 1998, the previous forma pauperis affidavit provided by the Clerk of Court may be used in lieu of this form. I certify that I have read the foregoing procedures, Sections 1 through 5.

SIGNATURE OF PARTY OR LAWYER

Page 4 of 4 Pages

FIRST CITY COURT OF THE CITY OF NEW ORLEANS
STATE OF LOUISIANA CIVIL COURTS BUILDING 421 LOYOLA AVE., ROOM 201 NEW ORLEANS, LA.

Case # versus Section

CERTIFICATION OF ATTORNEY

On information and belief, the undersigned attorney for plaintiff in the above captioned matter, and pursuant to the Code of Civil Procedure Article 1702:1, certifies that: (a) Defendant was served personally domiciliary (b) on .

Plaintiff's claim is a suit on open account promissory note installment contract , revolving charge contract . , statement of account ,

(c)

Attached hereto are invoices promissory note , contract

, and plaintiff's affidavit of

correctness (and non-military service) are required. (d) Plaintiff makes a claim for attorney's fees pursuant to LSA -R.S. 9:2781. A copy of the demand letter and return receipt are attached indicating fifteen (15 days having elapsed after defendant's receipt of plaintiff's demand and prior to suit being filed.

DATE ATTORNEY FOR PLAINTIFF

CERTIFICATION

OF

CLERK

I certify that I have examined the record in the above captioned matter and as of this date no answer, exception or opposition has been filed by any other party hereto.

DATE CLERK OF COURT

Form 1038

FIRST CITY COURT OF THE CITY OF NEW ORLEANS
STATE Of LOUISIANA

No.

Section " "

Docket #

VS

AFFIDAVIT OF CORRECTNESS OF ACCOUNT AND/OR NOTE AND NON-MILITARY SERVICE Before me, the undersigned authority, duly qualified and commissioned in and for the Parish of Orleans and therein residing, personally came and appeared who, being first duly sworn by me, Notary, deposed: That he is the plaintiff in the above entitled and numbered cause; that he is familiar and well acquainted with the debt of defendant(s) in the above captioned cause; that the true and correct amount owed to plaintiff by the above named defendant(s) is $ and attorney's fees as prayed for; all subject to a credit of $ plus interest .

That the defendant (s) is (are) not in the military services of the United States of America nor in that of any of its allies.

Affiant Sworn to and subscribed before me this day of 19 NOTARY PUBLIC ..

FORM #1036A

FIRST CITY COURT OF THE CITY OF NEW ORLEANS
STATE OF LOUISIANA CIVIL COURTS BUILDING 421 LOYOLA AVE. ROOM 201 NEW ORLEANS, LA. No. Section

versus

MOTION TO SET FOR TRIAL ON THE MERITS
Now comes , representing who certifies that the case is ready for trial in accordance with Rule 10, Section 4(c) reprinted at the bottom of this form, moves the Court to set this case for trial. Mover further certifies that the Constable has been paid for the service of this notice to all parties.

Signature of Mover Address City, State, Zip Code Telephone IT IS ORDERED by the Court that this case be set for trial on the merits at 10:00 a.m. on the day of ,19 . Before Section .

Deputy Clerk of Court
SERVICE INFORMATION: Have Notice of Trial served on the following counsel (or litigant).

Counsel for Address Counsel for Address Counsel for Address Counsel for Address

RULE 10, SECTION 4(c)
The request to set the matter for trial can only be made after issued is joined, and all exceptions, motion for summary judgment, and any other preliminary matters have been disposed.

Form 1014-A

FIRST CITY COURT OF THE CITY OF NEW ORLEANS
STATE OF LOUISIANA CIVIL COURTS BUILDING 421 LOYOLA AVE., ROOM 201 NEW ORLEANS, LA.

NO.

SECTION

VS

FILED:

DY CLERK

REQUEST TO WITHDRAW GARNISHMENT DEPOSIT

ON MOTION OF for

attorney (garnishee/plaintiff)

herein, and suggesting to the Court that, in response to the garnishment interrogatories served on the garnishee: (Please check one) an answer has been filed no answer has been filed Mover desires to withdraw the $15.00 fee deposited with the Clerk of First City Court of the City of New Orleans, as per ACT 359 of 1976.

SUBMITTED BY: NAME: ADDRESS: CITY/STATE/ZIP: PHONE: ****************************************************************************** LET IT BE noted that the sum of $15.00 on deposit with the Clerk was issued to Attorney for Check no. On this day

FORM 1018-IM

BOND FOR COSTS

STATE OF LOUISIANA
FIRST CITY COURT FOR THE CITY OF NEW ORLEANS
No vs. I am security for costs herein in the sum of as per order rendered 19 Division

AFFIDAVIT OF SURETY
being duly sworn, says that he is worth over and above all his debts and obligations the sum of Dollars

in assets that can be subjected to levy under execution, and that he resides in the Parish of Orleans. Sworn to and subscribed before me this day of 19 A. D.

AFFIDAVIT OF PRINCIPAL being duly sworn, says that he is informed and believes that the surety on this bond, is worth over and above his debts and obligations in assets that can be subjected to levy under execution, the amount for which he has bound himself in this bond. Sworn to and subscribed before me this day of 19 A.D.

Form 1016

STATE OF LOUISIANA
FIRST CITY COURT FOR THE CITY OF NEW ORLEANS
No. SECTION

vs.

KNOW ALL MEN BY THESE PRESENTS, That we as principal, and as suret are held and firmly bound unto executors, administrators and assigns in the sum of Dollars for the payment whereof we bind ourselves, our heirs, executors and administrators, firmly by these presents, dated in the City of New Orleans, on this in the year of our Lord one thousand nine hundred and WHEREAS the above bounden day of

have this day filed

of appeal from a final judgment rendered against in the suit of

No. day of day of

of the FIRST CITY COURT for the City of New Orleans, on the 19 19 . and signed on the

NOW THE CONDITION OF THE ABOVE OBLIGATION IS SUCH That the above bound shall prosecute appeal, and shall satisfy whatever judgment may be rendered against or that the same shall be satisfied by the proceeds of real or personal, if be cast in the appeal; otherwise that the said estate,

shall be liable in Signed, Sealed and Delivered in the Presence of

place.

(SEAL) (SEAL)

AFFIDAVIT OF SURETY being duly sworn, says that and above all debts and obligations resides in the is worth over

Dollars in assets that can be subjected to levy under execution, and that City of New Orleans. Sworn to and subscribed before me this day of 19 A. D.

AFFIDAVIT OF PRINCIPAL

being duly sworn, says that believes that the surety on this bond, is worth over and above subjected to levy under execution, the amount for which

is informed and

debts and obligations in assets that can be has bound in this bond.

Sworn to and subscribed before me this day of 19 A. D

FIRST CITY COURT

For the City of New Orleans

No.

APPEAL BOND

vs.

Filed

Deputy Clerk.

, 19

FORM 1012

JUDGMENT
No.

FIRST CITY COURT
Versus of THE CITY OF NEW ORLEANS SECTION " "

STATE OF LOUISIANA
First City Court of the City of New Orleans

No.

Section

Docket No

EXHIBIT LIST

EXHIBITS OFFERED, INTRODUCED AND FILED INTO EVIDENCE ON BEHALF OF

, BY , ATTORNEY FOR ,

MARK FOR IDENTIFICATION

DESCRIPTION

FORM 1007

JUDGMENT
No.

FIRST CITY COURT
Versus of THE CITY OF NEW ORLEANS SECTION " "

Defendant failing to appear and answer, and the legal delay in which to answer having elapsed and plaintiff making due proof of claim herein, it is ordered, adjudged and decreed that Plaintiff

have Judgment and recover of Defendant

Judgment read, rendered and signed in open Court this day of 19 . Judge.

STATE OF LOUISIANA
First City Court of the City of New Orleans No. Section " "

NOTICE OF SIGNING OF DEFAULT JUDGMENT

VERSUS

To:

In accordance with C.C.P. Article 1913 (B), you are hereby notified that judgment by default in the above numbered and entitled cause was confirmed on the , 2000 , at New Orleans, Louisiana. day of

Counsel for Plaintiff: Name: Address:

Telephone #:

Form 1011A

STATE OF LOUISIANA FIRST CITY COURT OF THE CITY OF NEW ORLEANS
No. Filed VS. To the Honorable First City Court for the Parish of Orleans: GARNISHMENT INTERROGATORIES AND ORDER The Supplemental petition of represents: this Court issued a writ of fieri facias ordering the Constable of The First City Court of this Parish the seizure and possession of all property rights and credits of defendant by the of this Court and to cause to be made in the manner prescribed by law, an amount sufficient to pay and satisfy the same in the sum of: and having good reason to believe that third person, is indebted to said defendant or has property or effects in its possession or control belonging to said defendant. THEREFORE, petitioner prays that be made garnishee herein, and ordered to answer under oath, to accompanying interrogatories and after all due and legal proceed ings, be condemned to pay the amount of said Writ and costs, along with additional costs, interest, and fees as they may accrue as per judgment. Attorney for Petitioner ORDER LET THIS SUPPLEMENTAL PETITION BE FILED, AND LET be made garnishee herein, and ordered to answer the accompanying interrogatories, under oath, writing, within 15 days, from service, and as the law directs, as herein prayed for, and let the sum of $15.00 be deposited with the Clerk of Court as per R.S. 13:3927. New Orleans, Louisiana, this day of Deputy Clerk, FCC INTERROGATORIES TO BE ANSWERED CATEGORICALLY UNDER OATH, IN WRITING 15 DAYS FROM SERVICE. RETURN TO ROOM 201, 421 LOYOLA AVE., NEW ORLEANS, LA. 1. 2. Are you indebted to the defendant herein in a sum sufficient to satisfy the full amount of said writ? Is the defendant garnished herein in your employ? a) If yea - state what are his wages and how paid, and if there is any money due him for services rendered, not exempt by law from seizure. b) If nay - state where and by whom the defendant garnished is presently employed and residing, if known to you. 3. Have you not in your hands, on deposit or under your control, not exempt by law from seizure, any money, rights, credits, commissions, property, or effects of any description belonging to defendant herein? If yea, state what it consists of and how much. Have you not since the service of these interrogatories, paid or transferred to the defendant herein money, property, credits. or effects of any description whatever or caused the same to be done, or had any transaction whatever with defendant? If yea, state in what it consisted. 19 SECTION Deputy Clerk. DOCKET

4.

5.

State whether or not there are other judgments or garnishments affecting such wage, salary or compensation and if so, the status thereof ? Serve: Current Statement: Principal.....................$ Interest........................ Atty. Fee...................... Ct. Costs...................... Sworn to and subscribed before me, this Shrff. Comm................ day of 19 Total......................$ Payment................ BALANCE TO DATE $

Form 1080 Rev. 2-88

WRIT OF ARREST

STATE OF LOUISIANA First City Court of the City of New Orleans
No. SECTION: DOCKET:

Vs.

The State of Louisiana to the Constable of the First City Court of the City of New Orleans: GREETINGS:-YOU ARE HEREBY COMMANDED, in the name of the State of Louisiana, and of the First City Court of the City of New Orleans, to arrest the body of the defendant, and him confine till he shall have given bond in the amount of that he shall not depart from this State for the term of

three months, without the leave of this said Court. WITNESS THE HONORABLE of this said Court, this One thousand nine hundred and Independence of the United States of America. day of and in the Judge in the year of our Lord year of the

Judge. Seal.