Petition To Proceed In Forma Pauperis Page 9
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11Salary/Wages
Per Month:
Type of Work:
Contributions
From Children:
Contributions
From Parents:
Other Contributions:
e.
PROPERTY OWNED (state as dollar amounts)
Cash:
Checking Account:
Savings Account:
Certificates of Deposit:
Real Estate
(Including Home):
Motor Vehicle: Make:
Year:
Cost: $
Amount Owed: $
Stocks & Bonds:
Other:
f.
DEBTS AND OBLIGATIONS (state as dollar amounts)
Mortgage:
Rent:
Loans:
Other:
g. PERSONS DEPENDENT UPON YOU FOR SUPPORT
(Wife) (Husband) Name:
Children, if any:
Age
Age
Age
Age
Page 6 of 8
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Parent category: Legal