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Claim $3 Supporting FACTS (tell your. story briefly withort oiting cases or law): E. State what relies’ you seek from the Court. Make no legal arguments . do not cite cases or statuteon: “6 ; Pay 2 theo ae, So apis OXESA Pauperia ALPGavat . . é . Atlhies perl, iL hexeby apply for 1eorra to procecd with thie complaint withowt pre~ payment of fees or carts or giving security therefor. In support of my. application, X atate unier oath thet the following facts ere true: {1) I om ths plaintice is this complaint, and £ believes that. I em entitied to redrera. {2) = om unible to “propay the costs of wala exth on, or give security ‘therefor, becauee: dea &... es (3) I nave no asseta or. funds which could be used to prepay the fees . or costa except [2 OL Uirite “none™ above if you have nothing; otherwise » t12% your es5ecn ) signature of utvirr "l declare ‘under penalty of perjury that the foregoing is true and correct. {Signaturg) — j IT IS NO LONGER NECESSARY TO HAVE YOUR PETITION NOTARIZED. Executed on _Plpv. 70, £9 : . ate