Free MOTION TO PROCEED - Ohio

APPENDIX A (L.R. 2.04, fka 1.09)

IN THE COMMON PLEAS COURT, BUTLER COUNTY, OHIO

Petitioner/Plaintiff

CASE NO:

vs
Respondent/Defendant

MOTION TO PROCEED IN FORMA PAUPERIS WITH AFFIDAVIT AND SUPPORTING DOCUMENTATION

:::::::::::::::::::::::::: I declare that I am the (check appropriate status) ______ petitioner/plaintiff ______ respondent/defendant ________movant __________________ (other)

in the above-entitled proceeding. In support of my request to proceed without being required to prepay fees and costs, I state that because of my poverty, I am unable to pay the costs of said proceeding and I believe I am entitled to relief. In further support of this application, I submit the attached affidavit. I declare under penalty of perjury that the foregoing is true and correct.

Executed on:

_______________________________ (date) _______________________________ (signature of applicant)