                           "" Cc~ 31) 51 tj{)-G ~
              CAUSE NUMBER: JE _ /3~0;.::__\---.:q:__q~6::::..___L      U 4 2[113
Te:d~~o,\
        t-Jo.-\\ono.\ M o        §  t~<j9~
                                        IN THE JUSTICE COURT                                  ~-s/i.r 1 ,'\TZ
 PLAINTIFF                       §§                                CL~. ElfAV DlSTf!l(!
                                                                                               ~       .-     <-
   vs.                                                                                         c::     > ~m
                              §                           PRECINCT 4, PLACE 2                  en      '''<~,
                              §                                                                (..)    '.. ::::.:-np
                                                                                               o       s-<::s::f"''
                              §                                                                ~       ~p~s
                              §                                                                 :X     ::'- 1"'1 ;;D
                                                                                                        _,;:or<l
 DEFENDANT(S) & ALL OCCUPANTS §                           DALLAS COUNTY, TEXAS                  <i!     ~~:z:
                                                                                                c.n     ,..
                                                                                                ~       (J)

               AFFIDVAIT OF INABILITY TO PAY COSTS (TRCP 749a)
 IIWE the named Defendant(s) in the above styled and number forcible detainer and /or
 forcible entry and detainer, are/am unable to pay the court costs of appeal therein. 1/we
 verify that the statements made in this affidavit are true and correct, and contain complete
 infonnation as to the my identity, the nature and amount of governmental entitlement
 income, the nature and amount of employment income, other income, (interest,
 dividends, etc.), spouse's income if available to me, property owned (other than
 homestead), cash or checking account, dependents, debts, and monthly expenses (Texas
 Property Code §24.0052).

 TENANT'S IDENTITY                   \
      fV\C\CCJf,~D              T O'((CS

 Tenant's Street_.4.ddress, City, State, Zip (:'ode
  LIGC-\ S-t-G090~                                        L(G9         S}6 (Jqo3
 Tenant's Primary Phone                                   Tenant's Secondary Phone

 Tenant's Date of Birth


 SPOUSE'S IDENTITY

 Spouse 's Full Name



 Spouse's Primary Phon                                   Spouse's Secondary Phone

 Spouse's Date of irth


 DEPENDANTS
          ~                                              I q yrs A      IS \j'fs.
 Number of Dependants                                    Ages of Dependants
 Go3cc~f'\C'>n            sA    G'f9.b 9ro.if,·e           \x 3.505\
 Residence of Dependants Address, City, State, Zip Code

                                                                                       CC-13-06190-C
              Justice of the Peace 4-2 841 West Irving Boulevard Irving, TX 75060 ;:~~DAVI
                               P. (214) 589-7000 F. (214) 589-7048                2601a 4 T INABILITY To PAY



                                                                                      1111111/lllll//ll/111
 INCOME OF TENANT & SPOUSE
                                   '-                                              ...)
___   Se I~ em pt~e
 Tenant's Employer
                                                                               -An1
                                                                     Tenant's Job iTle and/or Dut1es
___ 0~--- Co         n._( 0 'Q          s-\   Gwl\ cl     QIG\ .\   ~ ,e_ T " -=tSos.L------------ --- -------
 Tenant s Employer Address, City, State, Zip Code
---·---- ·----,----------
 'J'en(~~~~sur,e:f\~2 Na-·m_e_ __                                    Tenant's Supervisor's Phone

 Tenant's Monthly Salary/Income                                       Tenant's Other Income
           -~                                                                 --0
 Spouse's Employer                                                    Spouse's Job Title and/or Duties
-------,--------------------,----------------
 Spouse's Employer Address. City, State, Zip Code

 Spouse's Supervisor ·s Name                                          Spouse 's Supervisor's Phone
---·---------------
 Spouse's 111onrhly Salary/Income                                     Spouse's Orher Income


  GOVERNMENT ENTITLEMENT INCOME
 --------------
  Unemployment Benefits                                               AFDCITANF
                                                _,___   __________ ------                  ----··--·- --·   --     ·-·----
  Social Security                                                     Disability

  Veteran's Benefits                                                   Child Support
    -------        -- · - - - - -
  Other Amounts- Describe


  ALL OTHER INCOME
 ----------- · · - - - - - - - - - - - - - - -
  List all other sources of income and amounts.                        Cash on hand
 ---------------                                              -------                     -----·- ---····------·   ......   -··--·   -----
  Financial lnst irution olChecking Account                            Balance Amount
 -····----------------
      Financial Ins! itut ion o_fSavings Account                       Balance Amount


      REAL PROPERTY (residential, commercial, or land owned)
  ----------·---------- - - - - - - - - - - -
   Address (~(Real Property Ovmed      Value of Properly
                               -              ------                - - - - - - -··-------------·-·--
      Address o(Real Property Owned                                     Value o(Property




                   Ju.~tice   of the Peace 4-2 841 West Irving Boulevard Irving, TX 75060
                                       P. (214) 589-7000 F. (214) 589-7048
PERSONAL            PROPER~ (other than                  ltouseholdfurnishings,~thes,
                                                                        tools of tt trade,
or personal effects. This includes vehicles tmd other sources of transportation)
····--.. - - - · - - - - - - - - - - - - - - - - - - - - : - - - - : : - = - - - - - - - - - - -
Descriplion a./Property Owned                              Value ofProperty
---·-·-------··-------------
Descriplion £dProperty Owned                                           Value ofProperty


MONTHLY EXPENSES
---- g3C) _ _ _ _ _ __ ·---------'~"""--,------------------
Rent and/or       !~'for/gage Amount                                   Vehicle/Car Payment Amount
       ....e.-
··--·---                                                              __ _3_gQ
 Insurance Amount                                                      Ulility Amount
·---~                                                                       ~
Child Care Amount                                                      Child Support Amount
___'faa~                                                                      ..e-
F'ood and/or Incidental Amount                                         Medical and/or Dental Amoun/
  --~2~~-a-~----------------------------­
 Other AmoumGf\S                                                        Describe Other A mount

-(hher    ;{,~;;~t ~cce.s(t··~                                          Describe Other Amount

 Signed this the          { G --day of _____:A:....cu>!..§~·L.L..ir....l-J--+-·---- 70   L22     d
-~4--t?.arr( 'o                    f(or(f                           4'a~Y~d _.fib                     __
 Signa/ure oj'Af/iant                                             Printed Name ojAjjianl

 THE STATE OF TEXAS                                  §
 COUNTY OF DALLAS                                    §

 BEFORE ME. the undersigned authority, on this day personally appeared the above
 named aftiant who upon oath, stated that he/she is the Tenant making this Pauper's
 Aftidavit and that the information provided is true and correct.

                   0 AND        SUBSCRIBE~ before me on the /~-day of
  ......!...llAtk:f44fU---=--           ,   20_{_ _ .




  CERTIFICATE OF DELIVERY: I the Defendant in the above and entitled to·rcible
  detainer I torcible entry and detainer certify that I have sent the torgoing document to the
  opposing party on this the            day of_____                          , 20 ________ _


 --·--··---- ·-----
  Signature ufDefendant                                             Printed Name ofAffianl

                     Justice of tile Peace 4-2 841 West Irving Boulevard Irving, TX 75060
                                       P. (214) 589-7000 F. (214) 589-7048
