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And it being alleged that plaintiff is unable to pay the costs, fees and expenses to
prosecute this action, and that there is no other person beneficially interested in the action
thereof,
NOW ON MOTION OF [27. Your name]
it is
hereby
ORDERED, that plaintiff, is permitted to prosecute this action as a poor person
against [28. Insert defendant name]
,
and it is further
ORDERED, that any recovery by judgment or settlement in favor of the plaintiff shall
be paid to the Clerk of the Court to await distribution pursuant to court order, and it is further
ORDERED, that the Clerk of this Court is directed to make no charge for costs or
fees in connection with the prosecution of this case, including one certified copy of the
judgment.
ENTER
JSC

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