Motion And Affidavit To Proceed In Forma Pauperis
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1STATE OF SOUTH CAROLINA
)
IN THE FAMILY COURT
)
_____JUDICIAL CIRCUIT
COUNTY OF
)
___________________________
)
)
)
MOTION AND AFFIDAVIT
Plaintiff, )
TO PROCEED IN FORMA PAUPERIS
vs.
)
)
)
Defendant. )
Docket No. ___________________________
I,___________________________________, being duly sworn, state that I am the
Plaintiff and that I do not have the funds available to pay the costs of filing and service in this
case. I request that the complaint be filed and service made without cost to me.
Sworn to before me this
______day of _________________,20_____
___________________________________
_____________________________________
Notary Public of South Carolina
Plaintiff
My Commission expires: _________________
ORDER
Leave is granted to proceed in forma pauperis.
Leave is denied to proceed in forma pauperis. This case will be dismissed without further
order of the court if the filing fee and associated costs are not paid on or before
_______________________,20____. (Family Court Only)
Date: _________________, 20____
Family Court Judge
__________________________,S.C.
NOTICE TO PLAINTIFF:
The Court may assess costs against either party at hearing.
Custodial Parent (if applicable): ___________________________________________________
SCCA 405F (12/2009)
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