Anderson, Chamel Nicole

• Court: Court of Appeals of Texas
• Decided: February 2, 2015
• Docket: WR-82,572-01
• Status: Published

Opinion

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U P5 •y .— .*! IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF TEXAS DIVISION

Plaintiff's name and ID Number

Place of Confinement I

CASE NO. (Clerk will assign the number) V.

/ APPLICATION TO PROCEED IN FORMA PAUPERIS

Mils n fiotj 3ls iba oci^^> c\oA&m&' *h/ ~7u^o? Defendant's name and address J ' J

I, C-vtH-JqI -r%~lUt*?Z>C$£zhavQ, depose, and say I am the Plaintiff in the above entitled case. In support of my motion to proceed without being required to prepay fees, costs, or give security therefor, I state because of my poverty, I am unable to pay in advance the filing fee for said proceedings or to give security for the filing fee. I believe I am entitled to relief.

I, further declare the responses which I have made to the questions and instructions below are true.

1. Have you received, within the last 12 months, any money from any of the following sources?

a. Business, profession or from self-employment? Yes • b. Rent payments, interest or dividends? Yes • c. Pensions, annuities or life insurance payments? Yes • d. Gifts or inheritances? Yes n, e. Family or friends? Yes j&j f. Any other sources? YesO

If you answered YES to any of the questions above, describe each source of money and state amount received from each during the past 12 months.

-tzuvuM hir/ \^V\wt tix-in-i: £0* i tip* a Do you own cash, or do you have money in a checking or savings account, including any funds in prison accounts? Yes • No

If you answered YES to any of the questions above, state the total value of the items owned.

&ATCIFP (REV. 9/02) 3. Do you own real estate, stocks, bonds, note, automobiles, or other valuable property, excluding ordinary household furnishings and clothing?

Yes • No

If you answered YES, describe the property and state its approximate value.

I understand a false statement in answer to any question in this affidavit will subject me to penalties for perjury. I declare (certify, verify, or state) under penalty of perjury that the foregoing is true and correct (28 U.S.C. §1746).

Signed this the

ID Number

YOU MUST ATTACH A CURRENT SIX (6) MONTH HISTORY OF YOUR INMATE TRUST ACCOUNT. YOU CAN ACQUIRE THE APPROPRIATE INMATE ACCOUNT CERTIFICATE FROM THE LAW LIBRARY AT YOUR PRISON UNIT.

&ATC1FP (REV. 9/02) CSINIB0S/CINIB02 TEXAS DEPARTMENT OF• CRIMINAL JUSTICE 01/£S/I 5 LM34/AvI85££ IN--FORMA-PAUP ERIS DATA 09 ; Ah9;5|0 TDCJ#: 01811941 3ID#; 03401307 LOCATIONIs MURRAY INDIGENT DTE: NAME; ANDERSON,CHAMEL NICOLE BEGINNING PERIOD; 07/01./14 PREvIOUS TDCJ NUMBERS: 01630537 CURRENT BAL; IS.01 TOT HOLD AMT; . 00 ;3MTH TOT DEP; 90. 00 6MTH DEP; £70.00 6MTH AVG BAL: 53.06 «EvMTH AVG DEP: 45. 00 MONTH HIGHEST BALANCE TOTAL DEPOSITS MONTH HIGHEST BALANCE TOTAL DEPOS ITS 1£/14 31. 71 70.00 09/14 143,a \i / 40. 00 11/14 13. 98 0. 00 08/14 1£7., 37 80. 00 10/14 47. 18 £0.00 07/14 73,. 94 60. 00 PROCESS DATE HOLD AMOUNT HOLD DESCRIPTION

STATE OF TEXAS COUNTY OF_ Qonji\\ ON THIS " HE 2g#)DAY OF C5^jaUQCy_ ?2QiS I CERTIFY THAT THIS DOCUMENT TRUE COMPLETE, AND UNALTERED COPY WRDE BY ME OF INFORMATION CONTftJUMED^JN COMPUTER DATABASE REGARDING THE OFFENDER'S ACCOUNT. NP SIG o? PF1-HELP PF3-END ENTER NEXT TDCJ NUMBER; OR SID NUMBER;

ANGELA S.VINCENT Notary Public STATE OF TEXAS My Comm. Exp. 02/24/2015 Notary without Bond