Free Microsoft Word - IFP103 - Minnesota

State of Minnesota
County
Select County

District Court
Judicial District: Court File Number: Case Type: General

Petitioner

vs.

Supplemental Affidavit for Proceeding In Forma Pauperis (Minn. Stat. § 563.01)

Respondent

STATE OF MINNESOTA

) ) SS COUNTY OF ) (County where Affidavit signed) 1. 2. I am a party in this action and make this request in good faith. (Check one of the following:) An order allowing me to proceed in forma pauperis without paying filing fees, service and publication fees, and copy fees has previously been issued in this case. Or I have completed and attached an "Affidavit for Proceeding In Forma Pauperis." 3. I am asking for an order directing the payment of the following costs by the state courts: a. Witness/expert witness for: Trial Deposition Name and address of witness:

I expect this witness to provide the following evidence or testimony (please give a general description):

I estimate the costs for this witness to be: Subpoena $ Service Fee $ Mileage $ Attendance Fee $ Other $
IFP103 State ENG Rev 8/08 www.mncourts.gov/forms Page 1 of 2

b.

Transcript expenses: Date of hearing, trial or deposition: I need a copy of this transcript for the following reasons:

I estimate the costs of obtaining this transcript to be: Court reporter fees $ Copy fees $ $ Other; c. Other expenses:

These expenses are necessary because:

Estimated costs:

$

Dated:
Signature (Sign only in front of notary public or court administrator.)

Name: Subscribed and sworn to before me this day of
Notary Public \ Deputy Court Administrator

Address: . City/State/Zip: Telephone:

,

IFP103

State

ENG

Rev 8/08

www.mncourts.gov/forms

Page 2 of 2