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                                                                   T0C3 No. W7370S

                                                                    3^lSouH»Bmi;lyir
                                                                    B^^r(k|TK7SriW
                                                                    0*W U/H//6
                                    IN THE UNITED STATES DISTRICT COURT
                                   FOR THE     yd 1    DISTRICT OF TEXAS
                                            \Jbto       DIVISION


ViWhAL.?* Coam iMvoi
Plaintiff's name and ID Number


W,Q,M<:/W// 0/,1-r-
Place of Confinement



                                                                              case no. flV/6-Oo730-6l/
                                                                                           (Clerk will assign the number)


                                                                              APPLICATION TO PROCEED
                                                                                 IN FORMA PAUPERIS

^0/iKy< L/ll/yt/^ \Jvu*Ia
Defendant's name and address*'/



         I, vl/lM/n MutrtQ (.yrfovi           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?                         Yes   •     No 0"
                 b.      Rent payments, interest or dividends?                                 Yes   n     No H"
                 c.      Pensions, annuities or life insurance payments?                       Yes   H     No Bf
                 d.      Gifts or inheritances?                                                Yes   [J    No U
                 e.      Family or friends?                                                    Yes   «     No •
                 f.      Any other sources?                                                    Yes   •     No H'

                 If you answered YES to any of the questions above, describe each source of money and state
                 the amount received from each during the past 12 months.

                 iLf^iVwA IhJk l.e,<-r 1% \>„>nUf 6{>fx SQ^ 4rTon, fr..                           mom     f6/A
                                                                                                               P

                 Do you own cash, or do you have money in a checking or savings account, including any funds
                 in prison accounts?                                          ^
                                                      Yes T |          No •

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




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

                                                  Yes •          No a^
               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    0<C,             day of Uov-en> \>^f               ,20 /U.

                                  KV^k?^ j&^                       i°miros
                                 Signature of Plaintiff                    ID Number



       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 LD3RARY AT YOUR PRISON UNIT.




                                                                                                  •&ATCIFP (REV. 9/02)
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                                                r^RECEIVEDN                   300lioerriEHrlydr
                                                       NOV 1 5 2016           KWl(*,Tx 7WM
                                                 \
                                                     THIRD COURT OF APPEALS
                                                        JEFFREY a KYLE/        O.WlU^/16
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