Application To Sue As A Poor Person
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STATE OF ILLINOIS
IN THE CIRCUIT COURT OF THE ______________ JUDICIAL CIRCUIT
_______________________COUNTY
)
______________________
)
_____ Application granted
)
_____ Application denied
Plaintiff,
)
)
vs.
)
No. _______
)
______________________
)
__________________, 20__
)
Defendant.
)
________________________
JUDGE
APPLICATION TO SUE AS A POOR PERSON
I, __________________________, on my own behalf, on oath state:
1. My current address is _________________________________________________
____________________________________________________________________.
2. My occupation, source of income, amount of public benefits is __________________
____________________________________________________________________.
3. My other sources of income or support are ________________________________.
4. My income for the preceding year was approximately ________________________.
5. The sources and amounts of income I expect to receive in the future are:
_____________________________________________________________________.
6. Person(s) who are dependent on me for support are: ________________________
_____________________________________________________________________
_____________________________________________________________________.
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