Free Motion to Produce - District Court of Arizona - Arizona

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Name and PrisonerfBooking Number I
5-%/4/ for/.4 {~·/JA; Ina /,£7§7Féu/
Place of Confinement
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Mailing Address
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City. State. Zip Code p
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF ARIZONA
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Petitioner, ),·’€»/F No. A J; EZQQ EM
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) APPLICATION TO PROCEED
Q. , Z gd ,5 { , ) INFORMA PAUPERIS
Responclent(s). ) BY A PRISONER `
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I, Af.! Z gjg UAED , declare, in support of my request to proceed in the above
entitled case without prepayment of fees under 28 U.S.C. § 1915, that I am unable to pay the fees for these
proceedings or to give security therefor and that I believe I am entitled to relief. P .
In support of this application, I answer the following questions under penalty of perjury:
1. Are you currently employed at the institution where you are co ned? BYes [JN0
If "Yes," s te the amount of our pay and where you work. if:}/¢ 5,)
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2. Do you receive any other payments from the institution where you are confined? l:lYes B.No -
If "Yes, " state the source and amount of the payments.
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Case 2:O3—cr—OO536-FJIVI Document 21-2 Filed O8/O4/2006 Page 1 of2

E 3. Do you have any other sources of income, savings, or assets either inside or outside of the institution where
you are confined? l:lYes `R me
If "Yes," state the sources and amounts of the income, savings, or assets. `

I declare under penalty of perjury that the above information is true and correct.
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DATE SIGNATU OF APPLICANT

CERTIFICATE OF CORRECTIONAL OFFICIAL
AS TO STATUS OF APPLICANT’S TRUST ACCOUNT (
I. , certify that as of the date applicant signed thisapplication:
(Printed name of official)
The applicanfs trust account balance at this institution is: .
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_ DATE AUTHORIZED SIGNATURE TITLE/ID NUMBER INSTITUTION
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Case 2:O3—cr—OO536-FJIVI Document 21 -2 Filed O8/O4/2006 Page 2 of 2

Case 2:03-cr-00536-FJM

Document 21-2

Filed 08/04/2006

Page 1 of 2

Case 2:03-cr-00536-FJM

Document 21-2

Filed 08/04/2006

Page 2 of 2