Form J - In Forma Pauperis Form printable pdf download

Form J

IN FORMA PAUPERIS FORM

__________________________________

NO: __________________ DIV. ______

(

)

PETITIONER

THE FAMILY COURT

VERSUS

PARISH OF _______________

__________________________________

STATE OF LOUISIANA

(

)

DEFENDANT

MOTION TO PROCEED IN FORMA PAUPERIS

NOW INTO COURT comes ______________________________________________, who

respectfully represents that he/she is a citizen of the State of Louisiana and is unable to pay the costs of court

because of his/her poverty and lack of means, and therefore moves this Honorable Court for authorization to

proceed in forma pauperis.

WHEREFORE mover prays that he/she be allowed to prosecute or defend this litigation in

accordance with Louisiana Code of Civil Procedure articles 5181, et seq., without paying the costs in advance

or as they accrue, or furnishing security therefor.

PERSONAL AND FINANCIAL INFORMATION

NOTE: All questions must be answered in full. Do not leave any space empty.

1. Full Name: _________________________________________________________________________

SSN: XXX – XX - ___ ___ ___ ___ DOB: ___________________________________ Sex: _________

2. Address: ______________________________________________________________________________

________________________________________________________________________________________

3. Telephones – Home: ______________________________ Cell: _____________________________

4. Marital Status – Single: ______ Married: ______ Divorced: ______ Living with someone: ______

5. How many children live with you? ______ How many children under 18 do you support? ______

Do you have other dependents? ______ Please provide the following information for all dependents:

Name

Age

Relationship

________________________________________________ __________ ________________________

6. Are you a student? ___________ If yes, what school are you attending? ____________________________

_____________________________________ Dates of enrollment: _________________________________

_________________________________ Anticipated graduation date: _______________________________

7. What is your occupation? _______________________________________ Are you employed? ______

If yes, provide your current employment information. If no, provide your last employment information.

Employer name: ______________________________ Address: _________________________________

____________________________________________ Telephone: _______________________________

8. How long have you been currently employed or unemployed? ____________________________________

THE FAMILY COURT

FORM J, p. 1 of 4

REVISED: NOV 2013

Form J - In Forma Pauperis Form

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