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                                IN THE UNITED STATES DISTRICT COURT
                               FOR THE             DISTRICT OF TEXAS
                                                    DIVISION

mrdt?;J t?oboJ ff/Ylcyo/                                        RECEIVED
Plaintiff's name and ID Number

                                                                 FEB 0 4 2015
Place of Confinement                                         COURT OF APPEALS
                                                          SECOND DISTRICT OF TEXAS
                                                            DEBRA SP!SA!{, CLERK
                                                                           CASE NO.-,-;:;,-;--.,.,.-----,--:.,----:-..,-
                                                                                    (Clerk will assign the number)


                                                                           APPLICATION TO PROCEED
                                                                              IN FORMA PAUPERIS




         I,   $&q]W£fc~                  declare, depose, and say I am the Plaintiff in the above entitled case. In support
of my motion to proceed without being required to prepay fees, costs, or give security therefor, I state because of my
poverty, I am unable to pay in advance the filing fee for said proceedings or to give security for the filing fee. I believe I
am entitled to relief.

        I, further declare the responses which I have made to the questions and instructions below are true.

         1.      Have you received, within the last 12 months, any money from any of the following sources?

                 a.   Business, profession or from self-employment?
                      Rent payments, interest or dividends?
                                                                                             Yes   D      No~
                 b.                                                                          Yes   D      No
                 c.   Pensions, annuities or life insurance payments?                        Yes          Noi.5"
                 ~
                 u.   Gifts or inheritances?                                                 Yes   D      No  G--
                 e.   Family or friends?                                                     Yes   [§/    NoD
                 f.   Any other sources?                                                     Yes   D      No c:Y




         2.      Do you own cash, or do you have money in a checking or savings account, including any funds
                 in prison accounts?
                                                Yes D          No~-

                  If you answered YES to any of the questions above, state the total value of the items owned.
                                                                ~

                                                                1
                                                                                                          1\-ATCIFP (REV. 9/02)
       3.      Do you own real estate, stocks, bonds, note, automobiles, or other valuable property, excluding
               ordinary household furnishings and clothing?

                                               Yes 0             No~
               If you answered YES, describe the property and state its approximate value.




I understand a false statement in answer to any question in this affidavit will subject me to penalties for
perjury. I declare (certify, verify, or state) under penalty of perjury that the foregoing is true and correct
(28 u.s.c. §1746).



                                   ..,?
       Signed this the __· _..:.,J_··___ day of




       YOU MUST ATTACH A CURRENT SIX (6) MONTH HISTORY OF
       YOUR INMATE TRUST ACCOUNT. YOU CAN ACQUIRE THE
       APPROPRIATE INMATE ACCOUNT CERTIFICATE FROM THE
       LAW LIBRARY AT YOUR PRISON UNIT.




      --    ..•~-------------------




                                                             2                                       -A-ATCIFP (REV. 9/02)
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                                                                                                                                                        11-20-2018

                                                                                                              ~,:,.,,         Notary WithOut Bond




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                                                                                                                                                                                            •
                                                                                                         ,.,_,.. ,,.    Notary Without Bond




                                                                                                                                                                                        )
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                                              Office of Presiding Judge
                                          5th Floor, Tarrant County Justice Center
                                                 Fort Worth, Texas 76196
Counties                                                                                              DAVID L. EVANS
                                                                                                      Presiding Judge
ARCHER                                                                                                Telephone (817) 884-1558
CLAY                                              December 10,2014
COOKE                                                                                                 OUIDA STEVENS
DENTON                                                                                                Administrative Assistant
EASTLAND
ERATH                                                                                                 TRACY KEMP
HOOD         Mr. Theodis Dodson                                                                       Assistam
JACK
JOHNSON      #1490901                                                                                 Telephone (817) 884"!558
MONTAGUE                                                                                              FAX       (817) 884-1560
PALO PINTO   Connally Unit
PARKER                                                                                                E-Mail:
SOMERVELL    899 FM 632                                                                               SthAdmin @8thJudicia!Region.com
STEPHENS
TARRANT
             Kenedy, Tx, 78119
WICHITA
WISE
YOUNG        Dear Mr. Dodson
                                                     Re:      1072134
                                                              Theodis Dodson
                                                              V,
                                                              The State


                    I have received your request I don't have jurisdiction to rule on your request I
             copying the triai judge with this letter and sending her the original of your request,
                    Thank you,




             cc:    Judge Elizabeth Beach
                    Mr. Robert Ford
                    Mr. William Ray
                    Mr. Sean Colston
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      FEB 0 4 2015
    COURT OF APPEALS
 SECOND DISTRICT OF TEXAS
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   DEBRA SPISAK, CLERK                                c?/J)

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