Form Gc5 - Pauper'S Oath Application Form - Galveston County, Texas printable pdf download

_______JUDICIAL DISTRICT COURT

COUNTY COURT AT LAW #_______

JUSTICE OF THE PEACE COURT #_______

GALVESTON COUNTY, TEXAS

THE STATE OF TEXAS

CAUSE NO.

vs.

______________________________________

SPN. NO.

PAUPER’S OATH APPLICATION

Name: ________________________________________________

Phone No. (_____)_____-_________

Address:_______________________________________________

D.O.B.: _______________________

City, State:_____________________________________________

Zip Code:______________________________________________

I am a Defendant in the above entitled action. I am not represented by counsel in this proceeding. I have no

assets, except for the following:

Earnings = $______________ per

week

month

year.

Employer Name: ___________________________________________________

Address: __________________________________________________________

Phone Number: (_____) _____-_________

If unemployed, list the last job you had and efforts to gain employment:

_____________________________________________________________________________

I have other income in the amount of (state source of income and amount).

_____________________________________________________________________________

I am

married

not married and support _______ children under 18 years of age and or other

dependents who are (name and relationship):

_____________________________________________________________________________

Earnings of my spouse and/or minor children are (name of employer and amount of weekly/monthly

earnings): ____________________________________________________________________

I have the following money:

At home

$___________________

Checking Account

$_________________

Savings Acct. $___________________

Safety Deposit Box

$_________________

Due/Owed to me $_________________

Other

$_________________

I have the following debts and expenses (groceries, child care, etc.) per month:

_____________________________________________________________________________

{Form #GC-5}

Form Gc5 - Pauper'S Oath Application Form - Galveston County, Texas

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