Application To Proceed Without Prepayment Of Fees And Affidavit Page 3

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UNITED STATES DISTRICT COURT
Clear Form
DISTRICT OF MINNESOTA
REFERENCE LIST
FILED UNDER SEAL
_______________________________
Plaintiff,
vs.
Civil Action Number ____cv________/____
________________________________
________________________________
________________________________
________________________________
Defendant(s)
- - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
MINOR CHILDREN’S INITIALS
MINOR CHILDREN’S NAME
DATED: ______________
Signature of Plaintiff
K:\XFR\forms\External forms\newforms\IFP appl - AO240.WPD
Page 3 of 3
Form Modified 06/06/05

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