Roberts, Darrell

Court of Appeals of Texas·Decided September 26, 2016·No. WR-66,147-05·Published

Opinion

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_ IN-THE QNITED STATES DISTRICT COURT ` 1 l FoR THE w nISTRICT oF TEXAS

A:l gates ‘¥ DIVISION @mc),éu. &>a.¢;n_<§ l”_)~'l'§l}‘g

Plaintiff’ s name and ID Number

wmata » Place of Confinement l _ ,

_Yu_»,a:\'l

CASE NO.

(Clerk will assign the number)

4‘§(“::)§ 7 12 fm ~ l Al¥PLICATIoN To PRoCEED 43 £D\ n,o.< ar on/ ' ` ` = IN FoRMA PAUPERIS 90 - \Q)o)< QQ umw ma ’F)<

Defendant’ s name and address ‘

I,WMIQDM, declare, depose, and say I am the Plaintiff m 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. 7

" I, furtherdeclare the responses which `l'izave made z".`€')"tli'e 'qs;.et~'.~;;=lo:t'm"~(,.;1.,»,'.!.?_1.;,";?:-'.=.t=.<";,lor_is,=t.<;?lt;-uz 2.:.';.,:::;-.`".._ 1. Have you received, within the last 12 months, any money from any of the following sources? ‘ va. ` Busine`ss, profession or from self-employment? ' _ , Yes \:\ _No § b. Rent payments, interest or dividends? » Yes § , ' _ c. Pensions, annuities or life insurance payments? _ ' ‘ Yes \:] No o@( d. Gifts or inheritances? , _ j Yes [] No IQ/ .e. ` Family or friends? _ `~ - " »Yes [\ ' No d ' f. Any other sources? ~ ' .. ,_ . . Yes [] No VQ"_

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

_2. Do you own cash, or do you have money in a checking or savings account, including any funds _ ~ in prison accounts? . ‘

yYes [:!4_ iv No

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

q‘_\¢vATClFP (REV. 9/02)

z _ 3. Do you own real estate, stocks, bonds, note, automobiles, or other valuable property, excluding e,,~: _ l ordinary household furnishings and clothing?

Yes [:| No 131

If you answered YES, describe the property and state its approximate 'va_lue.`

I’ understand a false statement in answer to any question in this affidavit will subject me to penalties for

b 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 10 q /C¢ day of ge P¢(._ ",20 ( Q

@

Signature of Plaintiff\/ 4 v ID Number

YOU MUST A'I'I`ACH A CURRENT SIX (6) MON.TH HISTORY OF » YOUR INMATE TRUST ACCOUNT. YOU CAN ACQUIRE THE

f APPROPRLATE INMATE ACCOUNT CERTIFICATE FROM THE LAW LIBRARY AT YOUR PRISUN UNi'T"

1 2 ' .' ~ j ' l -~¢rATCIFP(REv. 9/02)

(C) tchln_GO - PASSPORT . ~~"` Wednesolay, _August__lV, 2016, 8:58:37 AM

CSINIBOZ/CINIBOZ‘ TEXAS DEPARTMENT OF CRIMINAL JUSTICE 08/17/16

1N60/SRA6141 IN-FORMA-PAUPERIS DATA 08:58:15 TDCJ#: 01273928 SID#: 06630035 LOCATION: JAMES LYNAUGH INDIGENT DTE: 11/07/14 NAME: ROBERTS,DARRELL ' BEGINNING PERIOD: 02/01/16

PREVIOUS TDCJ NUMBERS:

CURRENT BAL: 8.84 TOT HOLD AMT: 50.00 3MTH TOT DEP: 3.00 6MTH DEP: 5.42 6MTH AVG BAL: 5.92 GMTH AVG DEP: 0.90 MONTH HIGHEST BALANCE TOTAL DEPOSITS MONTH HIGHEST BALANCE TOTAL DEPOSITS 07/16 8.84 0.00 04/16 5.84 0.00

06/16 8.84 3.00 03/16 5.84 2.42

05/16 5.84 0.00 02/16 3.42 0.00

PROCESS DATE HOLD AMOUNT HOLD DESCRIPTION

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Roberts, Darrell, (Tex. Ct. App. 2016).

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