Petition for Writ of Certiorari — Clyde Pontefract, Petitioner v. United States, et al.

7127

supreme Court, U.S.

filed

JAN 2 2 2021

IN THE

OFFICE OF THE CLRW

SUPREME COURT OF THE UNITED STATES

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— PETITIONER

(Your Name)

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VS.

— 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 costs and to proceed in forma pauperis.

[&] Petitioner has previously been granted leave to proceed in forma pauperis

in the following court(s):

.

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CpcrQ

ILL

[ ] Petitioner has not previously been granted leave to proceed in forma

pauperis in any other court.

Petitioner’s affidavit or declaration in support of this motion is attached hereto.

(Signature)

AFFIDAVIT OR DECLARATION

IN SUPPORT OF MOTION FOR LEAVE TO PROCEED IN FORMA PAUPERIS

A-^To.c.V t am the petitioner in the above-entitled case. In support of

I,

my motion to proceed in forma pauperis, I state that because of my poverty I am unable to pay

the costs of this case or to give.secmdty therefor; and I believe I am entitled to redress. TL<' 3

^tcaol< -l^e-PRop^ art.

to precesiac«oj-v-V a n-b

1. For both you and your spouse estimate the average amount of money received from each of

the following sources during the past 12 months. Adjust any amount that was received

weekly, biweekly, quarterly, semiannually, or annually to show the monthly rate. Use gross

amounts, that is, amounts before any deductions for taxes or otherwise.

Income source

Average monthly amount during

the past 12 months

You

Employment

Self-employment

Income from real property

(such as rental income)

Spouse

You

$.

$.

m

$_J^4

$.

$ /v>A

$ a)A

Amount expected

next month

$.

$_ht£

$_tlA

$.

s

$.

Alimony

Child Support

$ aja

$

Gifts

rvlf)

$___

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:

a$_iM

$ t\)fi

$ b>F\

$.

MA

$ rO'R

$ )JJ\

$.

Nf\

$.

$ A1 h

$ (Oh

$ jOfl

$_j^A

$.

$.

$.

$.

$.

$_fJ£

$.

$.

m

$.

M/)

$.

aJ/)

Ei

$_NA

s MB

$__AIK

$.

$ ts)h

$ POA

$ hJft

Interest and dividends

m

Spouse

$.

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PONTEFRACT, CLYDE 13955035

2. List your employment history for the past two years, most recent first. (Gross monthly pay

is before taxes or other deductions.)

Employer

Address

Dates of

Employment

Am

Gross monthly pay

$

$

$.

AM

3. List your spouse’s employment history for the past two years, most recent employer first.

(Gross monthly pay is before taxes or other deductions.)

Employer

Address

Dates of ,

Employment

am

Gross monthly pay

$.

$.

$.

AM

4. How much cash do you and your spouse have? $

____

iQi

Below, state any money you or your spouse have in bank accounts or in any other financial

institution.

Financial institution

Type of account

Am punt you have

Amount your spouse has

$.

$.

$.

$.

$.

5. List the assets, and their values, which you own or your spouse owns. Do not list clothing

and ordinary household furnishings.

□ Home

Value

□ Other real estate

Value

hJn

MR

□ Motor Vehicle #1

Year, make & model

Value___________

□ Other assets

Description _

Value_____

rJh

□ Motor Vehicle #2

Year, make & model

Value___________

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PONTEFRACT, CLYDE 13955035

6. State every person, business, or organization owing you or your spouse money, and the

amount owed.

Person owing you or

your spouse money

Amount owed to you

Amount owed to your spouse

Owr\r<A

$ gpp-t

$.

$.

$.

$.

$.

tzoA 4or

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7. State the persons who rely on you or your spouse for support.

Name

Relationship

Age

f\h/\

pjP\

8. Estimate the average monthly expenses of you and your family. Show separately the amounts

paid by your spouse. Adjust any payments that are made weekly, biweekly, quarterly, or

annually to show the monthly rate.

Your spouse

You

\

Rent or home-mortgage payment

(include lot rented for mobile home)

Are real estate taxes included? □ Yes □ No

Is property insurance included? □ Yes □ No

$.

m

$.

Utilities (electricity, heating fuel,

water, sewer, and telephone)

$.

$.

Home maintenance (repairs and upkeep)

$.

$.

Food

$.

Clothing

$.

A)f\

$.

Laundry and dry-cleaning

$.

03^

$.

Medical and dental expenses

$.

NR

$.

NA

NA

$.

ilB.

PONTEFRACT, CLYDE 13S55035

You

Your spouse

Transportation (not including motor vehicle payments)

ft

pJf\

Recreation, entertainment, newspapers, magazines, etc.

$

/\tf\

$.

$.

Insurance (not deducted from wages or included in mortgage payments)

Homeowner’s or renter’s

$.

$.

Life

$.

$.

Health

$.

Ah

hlh

mA

$.

Motor Vehicle

$.

fOA

$.

Other:

$.

tlA

AA

$.

Taxes (not deducted from wages or included in mortgage payments)

(specify):

$.

$.

Installment payments

Motor Vehicle

$.

MA

Credit card(s)

$.

jOA

$.

NA

hi A

Department store(s)

$.

MA

$.

Hh

Other:

$.

$.

/\3A

$.

UA

$.

aJA

Alimony, maintenance, and support paid to others

$.

h) A

aJ A

Regular expenses for operation of business, profession,

or farm (attach detailed statement)

$.

AA

Other (specify):

$.

Total monthly expenses:

$.

A»A

Apt

$.

$.

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PONTEFRACT, CLYDE 13955035

9. Do you expect any major changes to your monthly income or expenses or in your assets or

liabilities during the next 12 months?

□ Yes

If yes, describe on an attached sheet.

10. Have you paid - or will you be paying - an attorney any money forservices in connection

with this case, including the completion of this form? □ Yes yQfNo

If yes, how much?_____ _________________

If yes, state the attorney’s name, address, and telephone number;

11. Have you paid—or will you be paying—anyone other than an attorney (such as a paralegal or

a typist) any money for services in connection with this case, including the completion of this

□ No

-jy £)/•

\ k^C),

If yes, how much?

If yes, state the person’s name, address, and telephone number:

£_\

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12. Provide any other information that will help explain why you cannot pay the costs of this case.

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I declare under penalty of perjury that the foregoing is true and correct.

Executed on:

,20__

FOiMTEFRACT, CL

be im&mm

AC'

Page 1 of3

IMPRINTn

Inmate Inquiry

Inmate Reg #:

13955035

Current Institution:

Fort Dix FCI

Inmate Name:

PONTEFRACT, CLYDE

Housing Unit:

Report Date:

01/07/2021

Living Quarters:

FTD-C-C

C03-162L

Report Time:

General Information

3:32:00 PM

I Account Balances

|

Commissary History

I

Commissary Restrictions

|

Comments

General Information

Administrative Hold Indicator:

No

No Power of Attorney:

No

Never Waive NSF Fee:

No

Max Allowed Deduction %:

100

PIN

PAC#

Revalidation Date:

FRP Participation Status:

Arrived From:

16th

No Obligation

ELK

Transferred To:

Account Creation Date

2/17/2012

Local Account Activation Date:

10/7/2020 3:16:39 AM

Sort Codes:

Last Account Update:

___

1/7/2021 1:14:14 PM

Account Status:

Active

Phone Balance:

S25.00

Pre-Release Plan Information

Target Pre-Release Account Balance:

Pre-Release Deduction %:

Income Categories to Deduct From:

$3,000.00

25%

Payroll

[7| Outside Source Funds

FRP Plan Information

FRP Plan Type

Expected Amount

Expected Rate

Account Balances

Account Balance:

$2,582.84

Pre-Release Balance:

$1,400.98

Debt Encumbrance:

$0.00

SPO Encumbrance:

$0.00

Other Encumbrances:

$0.00

Outstanding Negotiable Instruments:

$0.00

https://10.33.101.106/truweb/InmateInquiryCombined.aspx

1/7/2021

Page 2 of 3

Administrative Hold Balance:

$0.00

Available Balance:

$1,181.86

National 6 Months Deposits:

$2,467.35

National 6 Months Withdrawals:

$2,614.65

Available Funds to be considered for IFRP Payments:

$2,017.35

National 6 Months Avg Daily Balance:

$2,729.66

Local Max. Balance - Prev. 30 Days:

$2,777.99

Average Balance - Prev. 30 Days:

$2,503.58

Commissary History

Purchases

Validation Period Purchases: $144.70

YTD Purchases: $608.80

Last Sales Date: 1/6/2021 3:14:08 PM

SPO Information

SPO's this Month: 0

SPO $ this Quarter: $0.00

Spending Limit Info

Spending Limit Override: No

Weekly Revalidation: No

Bi-Weekly Revalidation: Yes

Spending Limit: $205.00

Expended Spending Limit: $44.15

Remaining Spending Limit: $ 160.85

Commissary Restrictions

Spending Limit Restrictions

Restricted Spending Limit: $0.00

Restricted Expended Amount: $0.00

Restricted Remaining Spending Limit: $0.00

Restriction Start Date: N/A

Restriction End Date: N/A

Item Restrictions

List Name

List Type

Start Date

End Date

https://10.33.101.106/truweb/InmateInquiryCombined.aspx

Active

1/7/2021