Attachment To Motion Affidavit To Proceed In Forma Pauperis Without Prepayment Of Fees printable pdf download

Attachment To Motion Affidavit To Proceed In Forma Pauperis Without Prepayment Of Fees

UNITED STATES DISTRICT COURT

DISTRICT OF NEW HAMPSHIRE

___________________________

Case No. _______________________

___________________________

ATTACHMENT TO MOTION/AFFIDAVIT TO PROCEED

IN FORMA PAUPERIS WITHOUT PREPAYMENT OF FEES

CERTIFICATE OF CUSTODIAL INSTITUTION

Name of Inmate:

___________________________________________

Name of Institution:

___________________________________________

Address of Institution:

___________________________________________

I hereby certify that for the six-month period immediately preceding this

date the applicant has had average monthly deposits to his/her account of

$_____________.

Further, I certify that for the six-month period immediately preceding this

date the applicant has maintained an average monthly balance in his/her account of

$_____________.

I attach a certified copy of the applicant's trust account statement for the

six months preceding the submission of this certificate.

___________________________________

Authorized Officer of Institution

__________________________________

Title

___________________________________

Date

USDCNH-14 (Revised 8-00) (Previous Editions Useable)

Attachment To Motion Affidavit To Proceed In Forma Pauperis Without Prepayment Of Fees