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CIVIL DISTRICT COURT FOR THE PARISH OF ORLEANS
FIRST CITY COURT OF THE CITY OF NEW ORLEANS
SECOND CITY COURT OF THE CITY OF NEW ORLEANS
STATE OF LOUISIANA
NO. SECTION DIVISION
versus
Date this form is completed:
FORMA PAUPERIS APPLICATION
ALL QUESTIONS MUST BE ANSWERED IN FULL. COMPLETE ALL FACTS CONCERNING MOVER.
NOTE: If more than one person is seeking pauper status, each person must complete a separate form.
I request a court order so that I do not have to pay court costs and fees in advance or as they accrue.
PART 1:
1 . My name is: first middle last
2. My address and telephone number is:
Street Address: Apt. Mailing Address: City, state and zip code: Telephone number:
3. My date of birth is:
4. My social security number is: - -
5. .My marital status is: (check one) married single widowed separated divorced
living with another as if my spouse
6. My occupation, employer and employer’s address is (if more than one, list all):
PART II:
7. I am receiving financial assistance under one or more of the following programs:
(a) SSI or SSP (Supplemental Security Income or State Supplemental Payments Program)
(b) AFDC or TANF (Aid to Families with Dependent Children Program or Temporary Aid to Needy Families)
© Food Stamps (The Food Stamp Program)
(d) City or Parish Relief, General Relief or General Assistance
8. If you checked a box in item No. 7 above, you must attach documents to verify receipt of the benefits checked. If you havechecked a box in Item No. 7 above, sign on the following line and only complete the affidavits at the end of this form.
9. I am not able to pay any of the court costs or fees in advance or as they accrue.
Signature of Mover
WARNING: You must immediately tell the Court if you become able to pay court costs or fees in advance or as they accrue duringthis action. You may be ordered to appear in Court and answer questions about your ability to pay court costs and fees.
Page 2 of 4 Pages
PART III:
FINANCIAL INFORMATION
10. My pay changes considerably from month to month. (If you checked this box, each amount reported in item No. 10should be your monthly average for the past 12 months.)
11. My monthly income:
(a) My gross monthly pay is: $ (e) MY TOTAL MONTHLY INCOME IS: © plus (d):
(b) My payroll deductions are:(state purpose and amount) (f) The number of dependents, including me,
supported by this money is: (1) $ (2) $ (g) My spouse's occupation and employer is:(3) $ (4) $ My TOTAL payroll deduction amount (h) My spouse's gross monthly income is:is: $ $
(c) My monthly take-home pay is:(a) minus (b): $
(d) Other money I get each month is (Examples:workers compensation, Interest, Dividends,rent, Spousal Support, Child Support, SocialSecurity, Retirement):
(1) $ (2) $
NOTE: If you answered item No. 10 and/or No. 11, attach a copy of your most recent paycheck or paystub, and if applicable, that ofyour spouse.
12. I am represented in this case by a volunteer attorney (examples: NOLAC, Legal Aid, ProBono Project, LawSchool Clinic).
13. My monthly expenses not already listed in item No. 11 above are:
(a) Rent or house payments & maintenance: (j) Transportation and/or auto expenses (insurance, gas,$ repair): $
(b) Food & household supplies: $ (k) Installment payments (state purpose and amount):
© Utilities & telephone: $ (1) $ (2) $
(d) Clothing: $ (3) $
(e) Laundry: $ The TOTAL amount of monthly installment paymentsis: $
(f) Medical Expenses: $ (l) Amounts deducted due to garnishments, wage assign
(g) Insurance (life, health, accident, etc.): ments and earnings withholding orders: $ $
(m) Other expenses (specify):(h) School & child care: $
(1) $ (I) Child & spousal support: $ (2) $
(3) $ (4) $ (5) $ (6) $
The TOTAL amount of other monthly expenses is:$
(n) MY TOTAL MONTHLY EXPENSES ARE (add(a) through (m): $
Signature of Mover
Page 3 of 4 Pages
14. I own or have an interest in the following property:
(a) Cash: $ (d) Real estate (list address, estimated fair market value,and equity of each property):
(b) Checking or savings accounts atany financial institution: $ (1) $ $
(2) $ $ (3) $ $
(c) (1) $ (2) $ (3) $ (e) Other property such as jewelry, furniture, furs, art,
stocks, bonds, certificates of deposit, coin or stampCars, other vehicles and boat (list make collections, U. S. Savings Bonds, annuities, IRA,and year of each) and estimated value: etc.: $
(1) $ (2) $ (3) $
15. I have an interest in an estate or succession which may be or is opened and or an interest in other civil litigation.(State the name, court, and case number of all such matters.):
16. Other facts which support this application (describe unusual medicals, needs, expenses for recent familyemergencies or other unusual expenses to help the Court understand your budget-, if more space is needed, attach a page labeled attachment 16.):
WARNING: You must immediately tell the Court if you become able to pay court costs or fees in advance or as they accrue duringthis action. You may be ordered to appear in Court and answer questions about your ability to pay court costs and fees.
Signature of Mover
STATEMENT OF ATTORNEY
I, the undersigned attorney, duly admitted to practice in the State of Louisiana, do hereby declare and affirm that I have carefullyreviewed the above and foregoing statement of my client and approve the client having submitted the same.
ATTORNEY'S SIGNATURE PRINT NAMEBAR NUMBER: TEL. NO.:
NOTE: The "supporting affidavit" required to be submitted herein above must be that of a "pecuniarily disinterested" person. Thispreludes the participation of the attorney, and ordinarily precludes any member of the attorney's staff, or the spouse or minor child ofthe indigent declarant. An appropriate reprimand for improper use of this procedure may result in a monetary sanction.
AFFIDAVIT OF MOVER
STATE OF LOUISIANA PARISH OF
BEFORE ME, the undersigned authority, personally came and appeared, who after being duly sworn, deposed and said that (he) (she) is the person who furnished the information contained in the aboveform; that (he) (she) has signed same; and that the information contained therein is true and correct; that this information is beingfurnished to the Orleans Parish Civil District Court for the purpose of obtaining an order to proceed in the above captioned lawsuitpursuant to LA C.C.P. Arts. 5181 et seq., and mover is prepared to appear in Court to give any information which may be desired inaddition to the above. Mover further understands that the answers herein are continuous and if Mover ever acquires any assetsdescribed herein Mover will make the fact known prior to trial of this matter. Mover agrees to be further interrogated at any stage ofthese proceedings to inquire into Mover’s financial condition. Mover knows it is a crime to intentionally swear to a known falseanswer.
SWORN TO AND SUBSCRIBED BEFORE ME,this day of
Mover
NOTARY PUBLIC
Page 4 of 4 Pages
AFFIDAVIT OF PERSON SUPPORTING MOVER'S PAUPER STATUS
STATE OF LOUISIANA PARISH OF
BEFORE ME, the undersigned authority, personally came and appeared, who, being duly sworn, deposed and said:That (he) (she) knows who is the mover in the above captioned matter and knows (his)(her) financial condition because:
(Basis of knowledge stated in detail.)
and (he) (she) family believes that (he) (she) is unable to pay costs in this cause in advance or as they accrue or to furnish security.(He)(She) knows that it is a crime to intentionally swear to what is known to be a false answer.
I HAVE READ THE ABOVE AFFIDAVITSWORN TO AND SUBSCRIBED BEFORE ME,
this day of PARTY SWEARING
NOTARY PUBLIC
ORDER
The foregoing motion, supporting affidavits and sworn facts considered, let Mover
be permitted to file all pleadings, appear in, and prosecute or defend in this action without prior payment of costs or as they accrue,and without giving bond for costs, as provided by laws of the State of Louisiana and particularly Louisiana Code of Civil Procedure,Articles 5181 et seq., as amended, pending further orders of this Court.
NEW ORLEANS, LOUISIANA, this day of
JUDGE
PROCEDURES IN FORMA PAUPERIS
Section 1. Before any judicial proceedings are permitted to be prosecuted or defended pursuant to Louisiana Code of Civil Procedure,Articles 5 18 1, et seq. (Waiver of Costs for Indigent Party), the applicant and the affiant attesting to the applicant's inability to pay thecosts of court, may be required to appear before the Judge assigned the case so that the Court may properly comply with C.C.P. art.5183(2) by inquiring into the facts and satisfying itself that the applicant is entitled to the privilege.
Section 2. Should counsel for any litigant who has been permitted to prosecute or defend in forma pauperis desire to take action in thecause which would increase the expense over and above those normally attendant to trial and appeal, such as, but not limited to, thetaking of depositions to be used in lieu of a witness' testimony or otherwise, counsel shall first present to the judge presiding over theDivision to which the case was allotted, a motion which shall be tried contradictorily with the adverse party(ies) to the end that theactual necessity for same may be determined. The purpose of this section is to minimize the cost to the public or to the party who mayultimately be cast for cost but without in any way prejudicing such litigant's cause or rights accorded the litigant by Louisiana Code ofCivil Procedure, Article 518 1, et seq. If the purpose of the motion is to secure reporting services outside the courtroom, the Court, inits discretion, may furnish same utilizing a reporter on its staff.
Section 3. In the event a judicial proceeding is filed and sought to be prosecuted in forma pauperis and the court refuses to permit theapplicant to so proceed, the court shall order that the applicant be allowed fifteen (15) days within which to advance the necessarycosts and in default of same may dismiss, without prejudice, the proceeding. In the further event that an applicant does not withinfifteen (15) days from date of denial seek a hearing thereof, the proceeding may be dismissed without prejudice upon ex parte motionof any party at interest.
Section 4. Any part or all of these procedures may be waived by the court when the applicant is in the custody of the Department ofCorrections or is otherwise incarcerated. Such other or additional requirements for proceeding in forma pauperis may be
Section 5. This form shall be used in all paper proceedings filed after April 30, 1998. Prior to April 30, 1998, the previous formapauperis affidavit provided by the Clerk of Court may be used in lieu of this form.
I certify that I have read the foregoing procedures, Sections 1 through 5.
SIGNATURE OF PARTY OR LAWYER
FIRST CITY COURT OF THE CITY OF NEW ORLEANS
STATE OF LOUISIANA
CIVIL COURTS BUILDING
421 LOYOLA AVE., ROOM 201
NEW ORLEANS, LA.
Case #
versus
Section
CERTIFICATION OF ATTORNEY
On information and belief, the undersigned attorney for plaintiff in the above
captioned matter, and pursuant to the Code of Civil Procedure Article 1702:1, certifies
that:
(a) Defendant was served personally
domiciliary on .
(b) Plaintiff's claim is a suit on open account
promissory note , revolving charge contract
installment contract .
(c) Attached hereto are invoices , statement of account ,
promissory note , contract , and plaintiff's affidavit of
correctness (and non-military service) are required.
(d) Plaintiff makes a claim for attorney's fees pursuant to LSA -R.S. 9:2781. A
copy of the demand letter and return receipt are attached indicating fifteen
(15 days having elapsed after defendant's receipt of plaintiff's demand and
prior to suit being filed.
DATE ATTORNEY FOR PLAINTIFF
C E R T I F I C A T I O N O F C L E R K
I certify that I have examined the record in the above captioned matter and as of this
date no answer, exception or opposition has been filed by any other party hereto.
DATE CLERK OF COURT
Form 1038
FIRST CITY COURT OF THE CITY OF NEW ORLEANS
STATE Of LOUISIANA
No. Section “ ” Docket #
VS
AFFIDAVIT OF CORRECTNESS OF ACCOUNT AND/OR NOTE AND NON-MILITARY SERVICE
Before me, the undersigned authority, duly qualified and commissioned in and for
the Parish of Orleans and therein residing, personally came and appeared
who, being first duly sworn by me, Notary, deposed:
That he is the
plaintiff in the above entitled and numbered cause; that he is familiar and well acquainted
with the debt of
defendant(s) in the above captioned cause; that the true and correct amount owed to
plaintiff by the above named defendant(s) is $ plus interest
and attorney's fees as prayed for; all subject to a credit of $ .
That the defendant (s) is (are) not in the military services of the United States of
America nor in that of any of its allies.
Affiant
Sworn to and subscribed before me
this day of
19 ..
NOTARY PUBLIC
FORM #1036A
FIRST CITY COURT OF THE CITY OF NEW ORLEANSSTATE OF LOUISIANA
CIVIL COURTS BUILDING421 LOYOLA AVE. ROOM 201
NEW ORLEANS, LA.
No. Section
versus
MOTION TO SET FOR TRIAL ON THE MERITS
Now comes , representing who certifies that the case is ready for trial in accordance with Rule 10, Section 4(c)reprinted at the bottom of this form, moves the Court to set this case for trial.
Mover further certifies that the Constablehas been paid for the service of thisnotice to all parties.
Signature of Mover Address City, State, Zip Code Telephone
IT IS ORDERED by the Court that this case be set for trial on the merits at 10:00 a.m. onthe day of ,19 . Before Section .
Deputy Clerk of Court
SERVICE INFORMATION: Have Notice of Trial served on the following counsel (or litigant).
Counsel for
Address
Counsel for
Address
Counsel for
Address
Counsel for
Address
RULE 10, SECTION 4(c)
The request to set the matter for trial can only be made after issued is joined, and allexceptions, motion for summary judgment, and any other preliminary matters have beendisposed.
Form 1014-A
FIRST CITY COURT OF THE CITY OF NEW ORLEANS
STATE OF LOUISIANA
CIVIL COURTS BUILDING
421 LOYOLA AVE., ROOM 201
NEW ORLEANS, LA.
NO. SECTION
VS
FILED: DY CLERK
REQUEST TO WITHDRAW GARNISHMENT DEPOSIT
ON MOTION OF attorney
for (garnishee/plaintiff)
herein, and suggesting to the Court that, in response to the garnishment interrogatories
served on the garnishee:
(Please check one) an answer has been filed
no answer has been filed
Mover desires to withdraw the $15.00 fee deposited with the Clerk of First City Court
of the City of New Orleans, as per ACT 359 of 1976.
SUBMITTED BY:
NAME:
ADDRESS:
CITY/STATE/ZIP:
PHONE:
******************************************************************************
LET IT BE noted that the sum of $15.00 on deposit with the Clerk was issued
to
Attorney for
Check no.
On this day
FORM 1018-IM
BOND FOR COSTS
STATE OF LOUISIANAFIRST CITY COURT FOR THE CITY OF NEW ORLEANS
No Division
vs.
I am security for costs herein in the sum of
as per order rendered 19
AFFIDAVIT OF SURETY
being duly sworn, says that he is worth over and above
all his debts and obligations the sum of Dollars
in assets that can be subjected to levy under execution, and that he resides in the Parish of Orleans.
Sworn to and subscribed before me this
day of 19 A. D.
AFFIDAVIT OF PRINCIPAL
being duly sworn, says that he is informed and
believes that
the surety on this bond, is worth over and above his debts and obligations in assets that can be subjected
to levy under execution, the amount for which he has bound himself in this bond.
Sworn to and subscribed before me this
day of 19 A.D.
Form 1016
STATE OF LOUISIANAFIRST CITY COURT FOR THE CITY OF NEW ORLEANS
No. SECTION
vs.
KNOW ALL MEN BY THESE PRESENTS, That we
as principal,
and
as suret
are held and firmly bound unto
executors, administrators and assigns in the sum of
Dollars
for the payment whereof we bind ourselves, our heirs, executors and administrators, firmly by these
presents, dated in the City of New Orleans, on this day of
in the year of our Lord one thousand nine hundred and
WHEREAS the above bounden
have this day filed of appeal from a final judgment rendered against
in the suit of
No. of the FIRST CITY COURT for the City of New Orleans, on the
day of 19 and signed on the
day of 19 .
NOW THE CONDITION OF THE ABOVE OBLIGATION IS SUCH
That the above bound
shall prosecute
appeal, and shall satisfy whatever judgment may be rendered against
or that the same shall be satisfied by the proceeds of estate,
real or personal, if be cast in the appeal; otherwise that the said
shall be liable in place.
Signed, Sealed and Delivered
in the Presence of
(SEAL)
(SEAL)
No.
FIR
ST C
ITY
CO
UR
TFo
r the
City
of N
ew O
rlean
s
vs.
APP
EA
L B
ON
D
File
d
,
19
Dep
uty
Cle
rk.
AFFIDAVIT OF SURETY
being duly sworn, says that is worth over
and above all debts and obligations
Dollars in assets that can be subjected to levy under execution, and that resides in the
City of New Orleans.
Sworn to and subscribed before me this
day of 19 A. D.
AFFIDAVIT OF PRINCIPAL
being duly sworn, says that is informed and
believes that
the surety on this bond, is worth over and above debts and obligations in assets that can be
subjected to levy under execution, the amount for which has bound in this bond.
Sworn to and subscribed before me this
day of 19 A. D
FIRST CITY COURT
of
THE CITY OF NEW ORLEANSSECTION “ ”
FORM 1012
JUDGMENT
No.
Versus
STATE OF LOUISIANA
First City Court of the City of New Orleans
No. Section Docket No
EXHIBIT LIST
EXHIBITS OFFERED, INTRODUCED AND FILED INTO EVIDENCE ON BEHALF OF
,
BY , ATTORNEY FOR ,
MARK FOR IDENTIFICATION DESCRIPTION
FIRST CITY COURT
of
THE CITY OF NEW ORLEANSSECTION “ ”
FORM 1007
JUDGMENT
No.
Versus
Defendant failing to appear and answer, and the legal delay in which to answer having
elapsed and plaintiff making due proof of claim herein, it is ordered, adjudged and decreed that
Plaintiff
have Judgment and recover of Defendant
Judgment read, rendered and signed in open Court this
day of 19 .
Judge.
STATE OF LOUISIANA
First City Court of the City of New Orleans
No. Section “ ”
NOTICE OF SIGNING OF DEFAULT JUDGMENT
VERSUS
To:
In accordance with C.C.P. Article 1913 (B), you are hereby notified that judgment by
default in the above numbered and entitled cause was confirmed on the day of
, 2000 , at New Orleans, Louisiana.
Counsel for Plaintiff:
Name:
Address:
Telephone #:
Current Statement: Principal.....................$ Interest........................ Atty. Fee...................... Ct. Costs...................... Shrff. Comm................ Total......................$ Payment................BALANCE TO DATE $
Form 1011A
STATE OF LOUISIANAFIRST CITY COURT OF THE CITY OF NEW ORLEANS
No. SECTION DOCKET
Filed Deputy Clerk.
VS.
To the Honorable First City Court for the Parish of Orleans:
GARNISHMENT INTERROGATORIES AND ORDER
The Supplemental petition of represents:this Court issued a writ of fieri facias ordering the Constable of The First City Court of this Parish the seizure
and possession of all property rights and credits of defendant by the of this Court and to cause to be made in the manner prescribed by law, an amount sufficient to pay and satisfythe same in the sum of: and having good reason to believe that third person, is indebtedto said defendant or has property or effects in its possession or control belonging to said defendant.
THEREFORE, petitioner prays that be made garnisheeherein, and ordered to answer under oath, to accompanying interrogatories and after all due and legal proceedings, be condemned to pay the amount of said Writ and costs, along with additional costs, interest, and feesas they may accrue as per judgment.
Attorney for Petitioner
ORDER
LET THIS SUPPLEMENTAL PETITION BE FILED, AND LET be made garnishee herein, and ordered to answer the accompanying interrogatories, under oath, writing, within 15 days, from service, andas the law directs, as herein prayed for, and let the sum of $15.00 be deposited with the Clerk of Court as per R.S. 13:3927.
New Orleans, Louisiana, this day of 19
Deputy Clerk, FCC
INTERROGATORIES
TO BE ANSWERED CATEGORICALLY UNDER OATH, IN WRITING 15 DAYS FROM SERVICE. RETURN TO ROOM 201, 421 LOYOLAAVE., NEW ORLEANS, LA.
1. Are you indebted to the defendant herein in a sum sufficient to satisfy the full amount of said writ?
2. Is the defendant garnished herein in your employ?
a) If yea - state what are his wages and how paid, and if there is any money due him for services rendered, not exempt by law from seizure.
b) If nay - state where and by whom the defendant garnished is presently employed and residing, if known to you.
3. Have you not in your hands, on deposit or under your control, not exempt by law from seizure, any money, rights, credits,commissions, property, or effects of any description belonging to defendant herein? If yea, state what it consists of and howmuch.
4. Have you not since the service of these interrogatories, paid or transferred to the defendant herein money, property, credits. oreffects of any description whatever or caused the same to be done, or had any transaction whatever with defendant? If yea, statein what it consisted.
5. State whether or not there are other judgments or garnishments affecting such wage, salary or compensation and if so, the statusthereof ?
Serve:
Sworn to and subscribed before me, this day of 19
Form 1080 Rev. 2-88
WRIT OF ARREST
STATE OF LOUISIANAFirst City Court of the City of New Orleans
No. SECTION: DOCKET:
Vs.
The State of Louisiana to the Constable of the First City Court of the City of New Orleans:
GREETINGS:--
YOU ARE HEREBY COMMANDED, in the name of the State of Louisiana, and of
the First City Court of the City of New Orleans, to arrest the body of the defendant,
and him confine till he shall have given
bond in the amount of that he shall not depart from this State for the term of
three months, without the leave of this said Court.
WITNESS THE HONORABLE Judge
of this said Court, this day of in the year of our Lord
One thousand nine hundred and and in the year of the
Independence of the United States of America.
Judge.
Seal.