pro se guide - united states district court...3ur 6h *xlgh wr )lolqj
TRANSCRIPT
![Page 1: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/1.jpg)
![Page 2: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/2.jpg)
![Page 3: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/3.jpg)
![Page 4: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/4.jpg)
![Page 5: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/5.jpg)
![Page 6: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/6.jpg)
![Page 7: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/7.jpg)
![Page 8: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/8.jpg)
![Page 9: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/9.jpg)
![Page 10: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/10.jpg)
![Page 11: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/11.jpg)
![Page 12: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/12.jpg)
![Page 13: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/13.jpg)
![Page 14: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/14.jpg)
![Page 15: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/15.jpg)
![Page 16: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/16.jpg)
![Page 17: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/17.jpg)
![Page 18: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/18.jpg)
![Page 19: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/19.jpg)
![Page 20: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/20.jpg)
![Page 21: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/21.jpg)
![Page 22: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/22.jpg)
![Page 23: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/23.jpg)
![Page 24: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/24.jpg)
![Page 25: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/25.jpg)
![Page 26: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/26.jpg)
![Page 27: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/27.jpg)
![Page 28: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/28.jpg)
![Page 29: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/29.jpg)
![Page 30: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/30.jpg)
![Page 31: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/31.jpg)
![Page 32: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/32.jpg)
![Page 33: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/33.jpg)
![Page 34: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/34.jpg)
![Page 35: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/35.jpg)
![Page 36: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/36.jpg)
![Page 37: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/37.jpg)
Page of
WAWD (Rev. 2/ ) IFP and Written Consent
UNITED STATES DISTRICT COURT Western District of Washington
Case Number:
Plaintiff
vs. DECLARATION AND APPLICATION
TO PROCEED IN FORMA PAUPERIS
AND WRITTEN CONSENT FOR
PAYMENT OF COSTS
Defendant(s)
DECLARATION AND APPLICATION TO PROCEED IN FORMA PAUPERIS
I (print your name) declare I am the plaintiff in this case; I believe I am entitled to relief; and I am unable to pay the costs of this proceeding or give security therefor. The nature of my action is briefly stated as follows:
In support of this application, I answer all of the following questions:
1. Are you presently employed?
Yes Total amount of net monthly salary (take home pay) $
Name and address of employer
No Date of last employment Total amount of last net monthly salary $
2. If married, is your spouse presently employed? Not married
Yes Total amount of spouse's net monthly salary (take home pay) $
Name and address of employer
No Date of spouse's last employment Total amount of last net monthly salary $
3. For the past twelve months, list the amount of money you and/or your spouse have received from any ofthe following sources.
a. Business, profession or other self-employment $ b. Income from rent, interest or dividends $ c. Pensions, annuities or life insurance payments $ d. Disability, unemployment, workers compensation or public assistance $e. Gifts or inheritances $ f. Money received from child support or alimony $ g. Describe any other source of income $
![Page 38: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/38.jpg)
Page of
4. List the amount for each of the following for you and/or your spouse:
Cash on hand $ Checking Account $ Savings Account $
5. Do you and/or your spouse own or have any interest in any real estate, stocks, bonds, notes, retirementplans, automobiles, or other valuable property (excluding ordinary household furnishings and clothing)? If Yes, describe the property and state its approximate value:
Yes $
No
6. Are any persons dependent upon you or your spouse for support? If Yes, state their relationship to youor your spouse, and indicate how much is contributed toward their support each month. (Do not include names of minor children. )
Yes $
No
7. Describe the types of monthly expenses you incur, such as housing, transportation, utilities, loanpayments, or other regular monthly expenses and the amount spent each month.
$
8. Provide any other information that will help explain why you cannot pay court fees and costs.
I declare under penalty of perjury that the foregoing is true and correct.
Executed on: (Date) Signature of Plaintiff
WRITTEN CONSENT FOR PAYMENT OF COSTS UNDER LOCAL RULE CR3( )
I, (print your name)
hereby consent that any recovery in damages that I may receive in the above-captioned cause may be reduced, if so directed by the court, in such an amount as is necessary for payment of the unpaid fees and costs which are taxed against me in the course of this litigation.
Executed on: (Date) Signature of Plaintiff
![Page 39: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/39.jpg)
(SEE INSTRUCTIONS ON NEXT PAGE OF THIS FORM.)
(EXCEPT IN U.S. PLAINTIFF CASES) (IN U.S. PLAINTIFF CASES ONLY)
(Firm Name, Address, and Telephone Number) (If Known)
(Place an “X” in One Box Only) (Place an “X” in One Box for Plaintiff(For Diversity Cases Only) and One Box for Defendant)
(U.S. Government Not a Party) or
and(Indicate Citizenship of Parties in Item III)
(Place an “X” in One Box Only)
(Place an “X” in One Box Only)
(specify)(Do not cite jurisdictional statutes unless diversity)
(See instructions):
![Page 40: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/40.jpg)
![Page 41: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/41.jpg)
Plaintiff(s)
Defendant(s)
(Defendant’s name and address)
CLERK OF COURT
Signature of Clerk or Deputy Clerk
![Page 42: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/42.jpg)
(This section should not be filed with the court unless required by Fed. R. Civ. P. 4 (l))
(name of individual and title, if any)
(date)
(place)
(date)
(name)
(date)
(name of individual)
(name of organization)
(date)
(specify):
Server’s signature
Printed name and title
Server’s address
![Page 43: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/43.jpg)
![Page 44: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/44.jpg)
![Page 45: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/45.jpg)
![Page 46: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/46.jpg)
![Page 47: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/47.jpg)
![Page 48: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/48.jpg)
![Page 49: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/49.jpg)
each case All fields are required.
not
![Page 50: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/50.jpg)
FEDERAL CIVIL RIGHTS LEGAL CLINIC
30 Minutes of Free Legal Advice
The Legal Clinic handles federal legal issues involving discrimination,prisoner rights, Fourth Amendment search and seizure, excessive force,
free speech, voting rights, the Second Amendment and religious freedom.
Volunteer attorneys will not provide legal representation but canrefer you to other community resources.
Clinic Sessions Are By Appointment OnlyFour Thursdays Per Month
12:00-2:00 pm
U.S. Courthouse 700 Stewart Street, Suite 2310 (Ground Floor)
Seattle, WA 98101
The Legal Clinic is located directly across from the Clerk's Office.
Photo identification is required for entry into the courthouse.
For Appointments Please Call 206-267-7070Phone Lines Open Tuesday - Thursday from 9:00 am - 12:00 pm
![Page 51: Pro Se Guide - United States district court...3ur 6h *xlgh wr )lolqj](https://reader033.vdocuments.site/reader033/viewer/2022053012/5f0f7c4b7e708231d44465fc/html5/thumbnails/51.jpg)
FEDERAL CIVIL RIGHTS LEGAL CLINIC
30 Minutes of Free Legal Advice
The Legal Clinic handles federal legal issues involving discrimination,prisoner rights, Fourth Amendment search and seizure, excessive force,
free speech, voting rights, the Second Amendment and religious freedom.
Volunteer attorneys will not provide legal representation but canrefer you to other community resources.
Clinic Sessions Are By Appointment OnlyThe First Thursday of Every Month
12:00-2:00 pm
U.S. Courthouse 1717 Pacific Avenue, Room 3230
Tacoma, WA 98402
The Legal Clinic is located a few doors down from the Clerk's Office.
Photo identification is required for entry into the courthouse.
For Appointments Please Call 253-572-5134Phone Lines Open Monday - Thursday 9:00 am - 12:00 pm & 1:15 pm - 4:00 pm