Petition for Writ of Certiorari — Keith Carr, Petitioner v. Steve Kallis, Warden

•T-

n2 1 - 6 55 (fT)

FILED

NOV 2 2 202!

IN THE

SUPREME COURT OF THE UNITED STATES

OFFICE OF THE CLERK

SUPREME COURT. U.S

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— PETITIONER

{Your Name)

VS.

KA\US — RESPONDENTS)

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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[ ] 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;

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^Signature)

RECEIVED

DEC - 7 2021

OFFICE OF THE CLERK

SUPREME COUi'i r, U.S.

A

AFFIDAVIT OPS DECLARATION

iU SUPPORT OF MOTIONS FOR LEAVE TO PROCEED IN FORMA PAUPERIS

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, am the petitioner in the above-entitled case. In support of

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 security therefor; and I believe I am entitled to redress.

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

Spouse

You

Spouse

$ Aj tfh

a A JI

$.

$.

$.

$.

$.

$.

$.

$.

$.

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$ M fl-

Employment

Amount expected

next month

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):

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Total monthly income:

$_

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

is before taxes or other deductions.)

Employer

Address

Oates of

Employment

Gross monthly pay

$

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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.)

V

Employer

Address

Dates of

AllA-

a//a

ennm

Gross monthly pay

nt

$.

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

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

institution.

Financial institution

Typeoj^ amount

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Amoun\jja\mve

Amount^HV 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

a J //If-'

□.Motor" Vehicle #1 '

Year,■•make & model

Value Al /Zb

□.Motor Vehicle. #2>

Year, make & model

Value A1/

□ Other assets1

; Description _

Value

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

amount owed.

Amount-owed to your spouse

Amount owed to you'

Person owing you or

your spouse money

$

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

Relationship

Name

A

rjjjk

Age ;

f\J //b

S, 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.

You

Your spouse

Rent or home-mortgage payment

(include lot rented for mobile home)

Are real estate taxes included? D Yes □ No

Is property insurance included? O Yes D No

Utilities (electricity, heating fuel,

water, sewer, and telephone)

$.

Home maintenance (repairs and upkeep)

$.

Food

$.

$.

Clothing

Laundry and dry-cleaning

Medical and dental expenses

G p po

$.

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$.

■You

Your spouse

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Transportation (not including motor vehicle payments)

Recreation, entertainment,, newspapers, magazines, etc.

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

£j/fr

Homeowner’s. or renter’s

Life

$.

$.

fd/a-'

$.

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Health

Motor Vehicle

Other;

$.

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

(specify):

Aj/&-

$.

$.

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Installment payments

Motor Vehicle

$.

Credit eard(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):

$.

$.

Aj//^

Total monthly expenses:

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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

njNo

If yes, describe on an attached sheet.

10. Have you paid - or will you he paying - an attorney any money for services in connection

with this case, including the completion of this form? □ Yes Q(No

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

form?

□ Yes

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 onT Id ~<=^/

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(Signature) 7.

Page 1 of3

1/

Inmate Inquiry

Inmate Reg #:

Current Institution:

Housing Unit:

Rochester EMC

Inmate Name:

44065424

CARR, KEITH

Report Date:

10/24/2021

Living Quarters:

B03-231L

Report Time:

General Information

12:07:56 PM

I Account Balances

Commissary History

I

RCH-B-B

Commissary Restrictions

|

Comments

General Information

Administrative Hold Indicator:

No

No Power of Attorney:

No

Never Waive NSF Fee:

No

Max Allowed Deduction %:

100

PIN:

5569

PAC #:

Revalidation Date:

FRP Participation Status:

Arrived From:

306639433

16th

Completed

OKL

Transferred To:

Account Creation Date:

11/8/2011

Local Account Activation Date:

8/22/2019 3:13:24 AM

Sort Codes:

Last Account Update:

___

10/24/2021 8:00:59 AM

Account Status:

Active

Phone Balance:

$1.68

Pre-Release Plan Information

Target Pre-Release Account Balance:

Pre-Release Deduction %:

Income Categories to Deduct From:

$5,000.00

25%

0 Payroll

R71 Outside Source Funds

FRP Plan Information

FRP Plan Type

Expected Amount

Expected Rate

Account Balances

Account Balance:

$2,883.92

Pre-Release Balance:

$2,810.58

Debt Encumbrance:

$0.00

SPO Encumbrance:

$0.00

Other Encumbrances:

$0.00

Outstanding Negotiable Instruments:

$0.00

https://10.33.44.106/truweb/InmateInquiryCombined.aspx

10/24/2021

Page 2 of 3

^ ,r

■.

Administrative Hold Balance:

$0.00

Available Balance:

$73.34

National 6 Months Deposits:

$2,490.00

National 6 Months Withdrawals:

$2,435.80

Available Funds to be considered for IFRP Payments:

$2,040.00

National 6 Months Avg Daily Balance:

$2,910.23

Local Max. Balance - Prev. 30 Days:

$3,042.22

Average Balance - Prev. 30 Days:

$2,958.26

Commissary History

Purchases

Validation Period Purchases: $118.30

YTD Purchases: $232.15

Last Sales Date: 10/20/2021 8:18:36 AM

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: No

Spending Limit: $360.00

Expended Spending Limit: $ 110.95

Remaining Spending Limit: $249.05

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://10.33.44.106/truweb/InmateInquiryCombined.aspx

Active

10/24/2021