Forma Pauperis Application Form - Louisiana Court Page 4
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4AFFIDAVIT OF PERSON SUPPORTING MOVER’S PAUPER STATUS
The “supporting affidavit” required to be submitted herein must be that of a “pecuniarily disinterested” person. This precludes the
participation of the attorney, and ordinarily precludes any member of the attorney’s staff, or the spouse or minor child of the
indigent declarant. An appropriate reprimand for improper use of this procedure may result in monetary sanctions.
STATE OF LOUISIANA
PARISH OF _________________________
BEFORE ME, the undersigned authority, personally came and appeared, ________________________________________,
Who, being duly sworn, deposed and said: That (he) (she) knows ______________________________________________,
who is the mover in the above captioned matter, and knows (his) (her) financial condition because:
___________________________________________________________________________________________________
(Basis of knowledge stated in detail)
___________________________________________________________________________________________________
SWORN TO AND SUBSCRIBED BEFORE ME,
I HAVE READ THE ABOVE AFFIDAVIT
this ______ day of _________________, _______
_______________________________________________
AFFIANT’S SIGNATURE
_________________________________________
NOTARY PUBLIC
PRINT NAME: _____________________________
NOTARY/BAR NO.: _________________________
ORDER
The foregoing motion, supporting affidavits and sworn facts considered, let Mover, _______________________________
_____________________,be permitted to file all pleadings, appeal in, and prosecute or defend in this action without prior
payment of costs or as they accrue, and without giving bond for costs, as provided by the laws of the State of Louisiana
and particularly Louisiana Code of Civil Procedure Article 5181 et seq., as amended, pending further orders of this court.
New Orleans, Louisiana this ___________ day of ______________________________________, ____________.
_________________________________________
JUDGE
PROCEDURES IN FORMA PAUPERIS
Section 1.
Before any judicial proceedings are permitted to be prosecuted or defended pursuant to Louisiana Code
of Civil Procedure, Articles 5181, et seq. (Waiver of Costs for Indigent Party), the applicant and the
affiant attesting to the applicant’s inability to pay the costs of court, may be required to appear before
the Judge assigned the case so that the Court may properly comply with C.C.P. art. 5183(2) by inquiring
into the facts and satisfying itself that the applicant is entitled to the privilege.
Section 2.
Should counsel for any litigant who has been permitted to prosecute or defend in forma pauperis desire
to take action in the cause which would increase the expense over and above those normally attendant
to trial and appeal, such as, but not limited to, the taking of depositions to be used in lieu of a witness’s
testimony or otherwise, counsel shall first present to the judge presiding over the Division/Section to
which the case was allotted, a motion which shall be tried contradictorily with the adverse party(ies) to
the end that the actual necessity for same may be determined. The purpose of this section is to
minimize the cost to the public or to the party who may ultimately be cast for costs, but without, in any
way, prejudicing such litigant’s cause or rights accorded the litigant by Louisiana Code of Civil Procedure,
Article 5181, et seq. If the purpose of the motion is to secure court reporting services outside the
courtroom, the Court, in its discretion, may furnish same.
Section 3.
In the event a judicial proceeding is filed and sought to be prosecuted in forma pauperis and the Court
refuses to permit the applicant to so proceed, the Court shall order that the applicant be allowed fifteen
(15) days within which to advance the necessary costs and in default of same may dismiss, without
prejudice, the proceeding. In the further event that an applicant does not, within fifteen (15) days from
date of denial, seek a hearing thereof, the proceeding may be dismissed without prejudice upon ex
parte motion of any party at interest.
Section 4.
Any part or all of these procedures may be waived by the Court when the applicant is in the custody of
the Department of Corrections or is otherwise incarcerated. Such other or additional requirements for
proceeding in forma pauperis may be imposed as are deemed appropriate and in accordance with the
law.
Section 5.
This form shall be used in all pauper proceedings filed after January 1, 2015.
I certify that I have read the foregoing procedures, Section 1 through 5.
_______________________________________________
SIGNATURE OF MOVER OR MOVER’S LAWYER
Page 4 of 4
Civil – Forma Pauperis Application (01-01-2015)
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