HE SUPREME COURT OF THE UNITED STATES tichaelEMeKinay Sr — PETITIONER (Your Name) Vs. Carletha R.Gaston — RESPONDENT(S) MOTION FOR LEAVE TO PROCEED IN FORMA PAUPERIS. The petitioner asks leave to file the attached petition for a writ of certiorari Without prepayment of eosts and to proceed in forma pauperis. ‘Please check the appropriate boxes: UuPettioner has previously been granted leave to proceed in forma pauperis in the following courts): Petitioner has not previously been granted leave to proceed in forma _peniperis in any other court. Petitioner's affidavit or declaration in support of this motion is attached hereto. O Petitioner's affidavit or declaration is not attached because the court below appointed counsel in the current proceeding, and: The appointment was made under the following provision of law: or Ca copy of the order of appointment is appended. Midd) €birgy a o/s (aor (Signature)AFFIDAVIT OR DECLARATION IN SUPPORT OF MOTION FOR LEAVE TO PROCEED IN FORMA PAUPERIS 1 MichoelB.Mekin2y,S1._, am tn petitioner inthe soveantited cae i eupat of ‘my muon to proceed i fra powers T state that becase of my poverty Tam nae ve an the costs of his caso orto give seamity therefor; and I believe Tain elledtosednens 1. For both you and your spouse estimate the average amount of money reccived from each of the following soufees during the past 12 months. Adjust any amount. that was received ‘wookly, biweekly, quarterly, semiannually, or annually to show the monthly rate. Use gross ‘amounts, that is, amounts before any deductions for taxes or otherwise, iiepomanee 1 asttoenttoal Oded acs cl rae any Aunt vu Sum Yas Ena AGI 51000" 541945 Loo” Settemployment sM/A SAA SNA s a Income tom reat propery — §_M/fk gM ss NA g A (uch as rental income) Interest and dvdends stk og NL s Nh WA its sWite s AVA s_pi «We Alimony si s WIAs WA s_DiA Child Support sMA ss WA os NA sD Retirement such as socal § MA sg N/A s WA og ‘security, pensions, annuities, insurance) Disabtty (such as cocitt = S WA gs Ns WA og aoauTy,ourares panera) Unemployment payments s. Wg WIAs Wi DA Pie esstance sWA spi sis Wi (euch ao welfare) Other peciy: ss WA ss bir gs WIA g WIA Tota onthy income: «4945 ¢ 1000" .Ha9e «Loos? a82, List your employment history for the past two years, most recent first. (Gross monthly pay is before taxes or other deductions.) employer Areas bates tes mony a a , ecnbils Tn, AUBSfodo “BTM : ee 8, List your spouse's employment history for the past two years, most recent employer frst (Gross monthly pay is before taxes or other deduetions.) Employer Address Dates of Gross monthly pay Sheol 200 Tet re TS gitooe® ll e-tdetedtelallae ee fee 4. How much cash do you snd your spouse have? Below, state any money you or your spouse have in bank accounts oF in any other finansial institution. Typo geppunt (ea, checking or savings) Ameung.you have Amount your spouse hes et ry adnan atl Siting 7 pepe es 5. List the assets, and their values, which you own or your spouse owns. Do not list clothing ‘and ordinary household furnishings. OHome (Other real estate Value M/A Value Ueffotr Veniao nA ATGMGSe ArT. ~CAMftoe Venice M2 9005; Dadgo Veer Lee ee sa rm pa ie ‘other assets) Dexeription A) on vane