WPC<  :M|:4 ||?6? {{r XefQkZ:`y 30!nc:Fm]/ tq_3'NM'4,=!oBRB V8 @|D99O*/ZUƔx@SY[4$aί_?3EXkΕ.~%UBmSm;~!E:yKŎv9CyO{ywP3[Iתq>R3{Z@+ziR~K.vщ^ʵ.=cp/-(ݜz$L_%*Ѕo ~T";c^*T\dKX*&LB$⧌s9)#P~dׂ+p;WLP׿ cwb?U`>v5,P6ڸQH,#^}{o8ȉj [W# % 0: ` ^+ w UN UN U @) 0i 4 b   f a ^  m N                                                         B Monique & Lily's printer0X($USUS.,i:\corel\wp11\TEMPLA~1\LAWCLE~1\wfdORDER.wpti:\corel\wp11\Templates\Law Clerk\wfdORDER.wpt(uH Z6Times New Roman Regular6Times New Roman Regular(9 Z(Times New Roman  PAUPERISmovantVgo3:i+00- -3|x1TABLE Al4 U23H  d !USUS.,  _% $ 8XXdd8     @   6XUnitedStatesDistrictCourt    DistrictofWyoming#XX| 6#  XXXX 2 :   .,,(#(#.%  %򀀀, l t    `  Plaintiff(s), D L   vs. $ %  %򀀀#XXX Xi#,     `  Defendant(s).   ) l t  ) X `  ) D L  ) 0 8  ) $ )  )  )  )-    p CaseNo.%  %򀀀 $ .,,.        MOTIONTOPROCEED   INFORMAPAUPERISANDSUPPORTINGAFFIDAVIT    P&%XXI,򀀀declarethatIamthe(checkappropriatebox) @H   &petitioner/plaintiff/movant0 h 0h(#h(#&other(#(# intheaboveentitledproceeding;thatinsupportofmyrequesttoproceedwithoutprepaymentoffeesorcosts &%%&  #&%% &c#&%%&under28U.S.C.1915IdeclarethatIamunabletopaythecostsoftheseproceedingsandthat#&%%&#Iamentitled x  tothereliefsoughtinthecomplaint/petition/motion. PX! Insupportofthisapplication,Ianswerthefollowingquestionsunderpenaltyofperjury: # 1.8  Areyoucurrentlyincarcerated? h &Yes  &No(If No,completequestions26ONLY. % If Yes,completeallquestionsandpages3and4.) &     If Yes,statetheplaceofyourincarceration.򀀀 8"@(   Areyouemployedattheinstitution?򀀀#XX%&#&%XXԀDoyoureceiveanypaymentfromtheinstitution?򀀀#XX%&B #&%XXԀ #) 0  Attachastatementfromtheinstitution(s)ofyourincarcerationshowingatleastthepast six months $+ ofyourtrustaccount.%,(#(# 2.  Areyoucurrentlyemployed?0 h &Yes  &NoL'T.h(#h(#   a.0 ` Iftheansweris Yes,statetheamountofyourtakehomesalaryorwagesandpayperiod (!0 andgivethenameandaddressofyouremployer.򀀀)!1` (#` (#    `  *"2    `  +#3    `  \,d$4 _ 4-<%5  Ї#XX%& #&%XX  b.0 ` Iftheansweris No,statethedateofyourlastemployment,theamountofyourtakehome  salaryorwagesandpayperiodandthenameandaddressofyourlastemployer.򀀀` (#` (#    `    #XX%&#&%XX3.  Inthepast12monthshaveyoureceivedanymoneyfromanyofthefollowingsources? X `   a. ` Business,professionorotherselfemployment p &Yes  0  &No  (# (#   b. ` Rentpayments,interestordividends  0 p &Yes  0 p(#p(#&No  (# (#   c. ` Pensions,annuitiesorlifeinsurancepayments p &Yes  0  &No (# (#   d. ` Disabilityorworkerscompensationpayments p &Yes  0  &No  (# (#   e. ` Giftsorinheritances h 0  0(#(#0p(#(#&Yes0p(#p(#  &Nohp (#(#   f. ` Anyothersources h 0  0(#(#0p(#(#&Yes  0 p(#p(#&No@H  (# (# 0  Iftheanswertoanyoftheaboveis Yes,describeeachsourceofmoneyandstatetheamount   receivedandwhatyouexpectyouwillcontinuetoreceive.Ifnecessary,youmayaddaseparate   sheetofpaper.򀀀 (#(#    x  4.  Doyouhave any cashorcheckingorsavingsaccounts? p &Yes  0  &No(0 (# (#   If Yes,statethetotalamount. h 򀀀    5.0  Doyouownanyrealestate,stocks,bonds,securities,otherfinancialinstruments,automobilesorany  otherthingofvalue?   h      p &Yes    &Nodl(#(#   If Yes,describethepropertyandstateitsvalue.򀀀        #XX%&#&%XX  6.0  Listthepersonswhoaredependentonyouforsupport,stateyourrelationshiptoeachpersonand t | indicatehowmuchyoucontributetotheirsupport.򀀀L!T(#(#    $",   #XX%&h#&%XX "  #XX%&N!#&%XX&%%&#XX%&!#IherebyauthorizetheUnitedStatesDistrictCourt,DistrictofWyoming,oritsrepresentative,to $" investigatemyfinancialstatus,andauthorizeanyindividual,corporation,orgovernmentalentityto %# releaseanysuchinformationtotheCourtoritsrepresentative. &$ Ideclareunderpenaltyofperjurythattheaboveinformationistrueandcorrect. \(d & *Vddd Xdd Xdd X(#(#,Sdd ,%dd +  H)P!'H)P!   ̀ *") Date 0&!+#*  0$򀀀 *",   SignatureofApplicant1'%+#-   1 &%XX    PRISONERFILINGFEEINFORMATION   #XX%&&#G&&%XX   ` (1)0 Thefilingfeesare:  (# (#    `  #XX%&&#&%XXMotiontoVacateSentence(28U.S.C.2255)$0.00 X `    `  PetitionforWritofHabeasCorpus(28U.S.C.2254)$5.00 0 8    `  CivilRightsComplaint$350.00      `  AllAppealstoTenthCircuit$455.00#XX%&'#&%XX     0   ` (2) Ifyouarefilingapetitionforwritofhabeascorpus,orareappealingadenialofa   petitionforwritofhabeascorpusora2255motion,youmustpaytheentirefilingfeeunlessyou hp  aregrantedleavetoproceedwithoutprepaymentoffeesorsecurityunder28U.S.C.1915(a)(1).@H (#(# \)  0   ` (3) Ifyouarefilingacivilrightscomplaintorappeal,youarerequiredtopaytheentire   filingfee,evenifyouaregrantedleavetoproceedinformapauperis.Ifyoudonothavesufficient   fundsinyourtrustaccounttopaytheentirefeeatthistime,youwillberequiredtomakeaninitial   partialpaymentofthefilingfeeandsubsequentmonthlypaymentsuntilyouhavepaidtheentire x  filingfee.PX(#(#  +  0  0` (#(# (A)  Yourinitialpartialpaymentwillbe20%ofyouraveragemonthlybalance  ortheaveragemonthlydepositstoyouraccount,whicheverisgreater.Thereafter,youmust  payinstallmentsof20%oftheprecedingmonth'sincome,includingalldepositstoyour  account;` (#` (# W-  0  0` (#(# (B)  #&%%&!#&%%&#XX%&')#&%XXYoumustcontinuetomakeinstallmentpaymentsuntilthefilingfeeisfully 8@ paid,withoutregardtowhetheryouractionisclosedoryouarereleasedfromconfinement.` (#` (# /   #XX%&/#&%XXPRISONERFILINGFEEAUTHORIZATION   #XX%&0#&%XX0   IrequestandauthorizemycustodiantosendtotheClerkoftheUnitedStatesDistrictCourtfortheDistrict p x ofWyomingacertifiedcopyofthestatementforthepastsixmonthsofmytrustfundaccount(or H!P institutionalequivalent).Ifurtherrequestandauthorizemycustodiantoremittheentirefilingfeetothe  "( ClerkifIhavesufficientfundsinmytrustaccounttopaythefullfee.IfIdonothavesufficientfundstopay "  thefullfilingfee,Irequestandauthorizethecustodiantocalculateanddisbursefundsfrommytrustaccount #! (orinstitutionalequivalent)intheamountsspecifiedby28U.S.C.1915(b).Thisauthorizationisfurnished $" inconnectionwithacivilactionorappeal,andIunderstandthatthetotalamountofthefilingfeeis$350.00 %# foracivilrightscomplaintand_$455.00_ԀforanappealtotheTenthCircuitCourtofAppeals.Ialso X&`$ understandthatthesefeeswillbewithdrawnfrommyaccount regardlessoftheoutcomeofmyactionor 0'8% appeal .ThisauthorizationshallapplytoanyotherinstitutiontowhichImaybetransferred.  ( & #&%%&y/#1 &%%&  Dated:򀀀,20___#&%% &7# &%%&# XX% &s1# &%X X. )!(    `     h     򀀀 p+x#*    `     h     SignatureofPrisoner  H,P$+ _   # XX% &7#CERTIFICATEOFPENALINSTITUTION &%X X   Z9  Iherebycertifythaton_______________,20___,theprisonerhereinhadthefollowingamount   inhis/herprisoner'strustfundaccount: l t @TT ____________________  $ ̀__________________    h 0  0(#(#_______________________________________ @#  (#(# Date# XX% &9# &%X X#&%% &7# &%%&0  0` (#(#    h     Signatureofauthorizedtrustfundofficer| ` (#` (# 0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#_______________________________________,4 (#(#    `     h     Printedortypednameofauthorizedofficer   0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#_______________________________________ (#(#    `     h     Titleofauthorizedofficer   0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#_______________________________________<D(#(#    `     h     Nameofinstitution  # XX% &;##XXX X;#