• Rule 29 (Filing and service on opposing party or counsel)
• Rule 30 (Computation and extension of time)
• Rules 33.2 and 34 (Preparing pleadings on 8½ x 11 inch paper)
• Rule 39 (Proceedings in forma pauperis)
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| Appendix A - | Decision of State Court of Appeals |
| Appendix B - | Decision of State Trial Court |
| Appendix C - | Decision of State Supreme Court Denying Review |
| Appendix D - | Order of State Supreme Court Denying Rehearing |
(Signature)
| Income Source | Average monthly amount during the past 12 months | Amount expected next month | ||
|---|---|---|---|---|
| You | Spouse | You | Spouse | |
| Employment | $ | $ | $ | $ |
| Self-Employment | $ | $ | $ | $ |
| Income from real property (such as rental income) | $ | $ | $ | $ |
| Interest and Dividends | $ | $ | $ | $ |
| Gifts | $ | $ | $ | $ |
| Alimony | $ | $ | $ | $ |
| Child Support | $ | $ | $ | $ |
| Retirement (such as social security, pensions, annuities, insurance) | $ | $ | $ | $ |
| Disability (such as social security, insurance payments) | $ | $ | $ | $ |
| Unemployment payments | $ | $ | $ | $ |
| Public-assistance (such as welfare) | $ | $ | $ | $ |
| Other (specify): _______________________ | $ | $ | $ | $ |
| Total monthly income: | $ | $ | $ | $ |
| Employer | Address | Dates of Employment | Gross Monthly Pay |
|---|---|---|---|
| Employer | Address | Dates of Employment | Gross Monthly Pay |
|---|---|---|---|
| Financial Institution | Type of Account | Amount you have | Amount your spouse has |
|---|---|---|---|
| ☐ Home | ☐ Other real estate |
| Value ___________________ | Value ___________________ |
| ☐ Motor Vehicle #1 | ☐ Motor Vehicle # 2 |
| Year, Make, Model _______ | Year, Make, Model _______ |
| Value ___________________ | Value ___________________ |
| ☐ Other assets | |
| Description | |
| Value | |
| Person owing you or your spouse money | Amount owed to you | Amount owed to your spouse | |
|---|---|---|---|
| Name | Relationship | Age | |
|---|---|---|---|
| You | Your Spouse | ||
|---|---|---|---|
| Rent or home-mortgage payment (include lot rented for mobile home) | |||
| Are real estate taxes included? ☐ Yes ☐ No | |||
| Is property insurance included? ☐ Yes ☐ No | |||
| Utilities (electricity, heating fuel, Water, sewer, and telephone) | |||
| Home Maintenance (repairs and upkeep) | |||
| Food | |||
| Clothing | |||
| Laundry and Dry-Cleaning | |||
| Medical and Dental Expenses | |||
| Transportation (not including motor vehicle payments) | |||
| Recreation, entertainment, newspapers, magazines, etc. | |||
| Insurance (not deducted from wages or included in mortgage payments) | |||
| Homeowner’s or renter’s | |||
| Life | |||
| Health | |||
| Motor Vehicle | |||
| Other: | |||
| Taxes (not deducted from wages or included in mortgage payments) (specify): _______________________ | |||
| Installment payments | |||
| Motor Vehicles | |||
| Credit card(s) | |||
| Department store(s) | |||
| Other: _______________________ | |||
| Alimony, maintenance, and support paid to others | |||
| Regular expenses for operation of business, profession, or farm (attach detailed statement) | |||
| Other (specify): | |||
| Total monthly expenses: | |||
(Signature)
___________________________________
(Your Name)
___________________________________
(Address)
___________________________________
(City, State, Zip Code)
___________________________________
(Phone Number)
| OPINIONS BELOW | 1 |
| JURISDICTION | # |
| CONSTITUTIONAL AND STATUTORY PROVISIONS INVOLVED | # |
| STATEMENT OF THE CASE | # |
| REASONS FOR GRANTING THE WRIT | # |
| CONCLUSION | # |
| APPENDIX A | |
| APPENDIX B | |
| APPENDIX C | |
| APPENDIX D | |
| APPENDIX E | |
| APPENDIX F |
| CASES | PAGE NUMBER |
| [Case name and citation | 5] |
| [ | ] |
| [ | ] |
| [ | ] |
| STATUTES AND RULES | |
| [Statute number or Rule number and citation | 4] |
| [ | ] |
| [ | ] |
| [ | ] |
| [ | ] |
| OTHER | |
| [ | ] |
| [ | ] |
| [ | ] |
(Signature)
