Motion to Proceed In Forma Pauperis — Christopher J. Barnett, Petitioner v. Oklahoma

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<i-648§

IN THE

SUPREME COURT OF THE UNITED STATES

CMrh-ki^X 'J •

Supreme Court, U.S.

FILED

-ft— PETITIONER

(Your Name)

DEC 2 0 2023

vs.

OFFICE OF THE CLERK

QMibhom coUf of cr/tyvtWL, ^-^^RESPONDENTCS)

ftfP<LSlS

TUtye, Dftuib

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.

%

Please check the appropriate boxes:

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

the following eourt(s):

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Ok C-b of Cri/hf/uflL QpPefl/S, Sufft/yjp

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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.

□ Petitioner’s affidavit or declaration is not attached because the court below

appointed counsel in the current proceeding, and:

□ The appointment was made under the following provision of law:

, or

□hareopy-of-the-ordemf-appoirttment-is-appendedr

RECEIVED

DEC 2 9 2023

(Signature)

A

—

—AmaAVPiaRzDECi-^RaLTraKr-

IN SUPPORT OF MOTION FOR LEAVE TO PROCEED IN FORMA PAUPERIS

i. (Lbrti frflrfoen

*

petitioner in the above-entitled, ease. In support of

Tixy 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

o'

Amount expected

next month

Spouse

You

Spouse

$.

$.

$.

Employment

$.

Self-employment

$_0

$.

$.

$.

Income from real property

(such as rental income)

$__ 0

$.

$.

$.

Interest and dividends

$.

i.

i

$.

$.

$.

Alimony

$0

$_0

$_Cl

$.

$.

$.

Child Support

$___ $

$.

$.

$.

Retirement (such as social

security, pensions,

annuities, insurance)

$_0_

$.

$.

$.

Disability (such as social

security, insurance payments)

$_6_

$.

$.

$.

Unemployment payments

$_cl

$.

$.

$.

Public-assistance

(such as welfare)

$.

o

$.

$.

$.

Gifts

Other (specify!:

O

Total monthly income:

&

$.

&

D

$.

$.

$.

2zzList=yrai^emp1^3™ea1^Mstory-f§E=tbe-pas€=two-yeaf&,-iB©&i-Fe€eKfe--aFsfe—CGrbss-mentS^pai

is before taxes or other deductions.)

Employer

Address

Dates of

Employment

Gross monthly pay

$.

$.

$.

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

Gross monthly pay

$.

$.

$.

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

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

institution.

Type of account (e.g., checking or savings)

Amount 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 ^)Qb\o

IaJ frfe&Id5vr£

□ Motor Vehicle #1

Year, make & model

Value____________

□ Other assets

Description _

Value_____

□ Other real estate

Value_________

□ Motor Vehicle #2

Year, make & model

Value____________

-67^State—every—person^—businessy-or—organization—owing^your-or-your~spouse—money, and—theamount owed.

Person owing you or

your spouse money

AjOAi<L.

Amount owed to you

Amount owed to your spouse

$.

$.

$.

$.

$.

$.

7. State the persons who rely on you or your spouse for support. For minor children, list initials

instead of names (e.g. “J.S.” instead of “John Smith”).

Name

Relationship

Age

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.

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

$.

Utilities (electricity, heating fuel,

water, sewer, and telephone)

$.

Home maintenance (repairs and upkeep)

$.

Food

$.

Clothing

$.

Laundry and dry-cleaning

Medical and dental expenses

Your spouse

&

$.

6

6

6

$.

$.

$.

$.

£)

0

$.

$.

t

$.

$.

You

Your-spotise

Transportation (not including motor vehicle payments)

$.

-6

$.

Recreation, entertainment, newspapers, magazines, etc.

$.

6

$.

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

0

Homeowner’s or renter’s

%.

Life

$.

Health

$.

0

b

Motor Vehicle

$.

6

0

Other;

$.

$.

$__£

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

(specify):

O

$.

S

$.

-Installment-payments

0

Motor Vehicle

$.

Credit eard(s)

$.

0

Department store(s)

$.

0

Other;

$.

0

$.

0

$.

S

$.

o

$.

Alimony, maintenance, and support paid to others

Regular expenses for operation of business, profession,

or farm (attach detailed statement)

Other (specify):

Total monthly expenses:

0

$.

i

0

$.

$.

i

9—B o^oxcexjieet=aa3a3i^^changes4;o-your-montMy4SlGme-o^expenses-€>F-Hiryoiir-assets-&r

liabilities during the next 12 months?

□ Yes

®No

If yes, describe on an attached sheet.

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

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

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:

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:

l~L-llg/zoz3

,

,2o23

(Signature)

STATEMENT OF INSTITUTIONAL ACCOUNTS

I hereby state that on /z./{%/c? day of &£g c,/u

C

in his/her few account and $

in his/her savings' account

Z 7-/&1

,20 Ajj

this piis oner had. $

...... ..

0

-

A ledger sheet for this prisoner's trust account (or institutional equivalent) for the preceding six month

period, or for the entire period of confinement if less than six months, is attached.

•A

Date

Authorized. Prison Official

i/ryu?n.

/}aa#

Title

Motion to Proceed IFP

3

AO-240 Modified (04/05)

JCCC

UNIT 2-LOWER

[Transaction I ?gr

Transaction Date

Transaction Type

06/01/2023

06/30/2023

06/30/2023

07/31/2023

MAILFOSTAGE

legal copay

COPCES.NOTARY

($4.17)

08/31/2023

COPIESJIOTARY

LEGAL COPAY

COPIESJWML

POSTAGE

($1.83)

PLRA

09/18/2023

PLRA

09/30/2023

GANG PAY

10/01/2023

PLRA

$14.45

CS£23-CV-0300-TCK-

($1.45)

JF

($zas)

23-CV-0232-TCK-JKJ

PLRA

10/01/2023

10/01/2023

PLRA

PLRA

10/24/2023

PLRA

10/24/2023

PLRA

10/31/2023

GANG PAY

10/31/2023

11/01/2023

PLRA

$14.45

5S®?iC\A03ooLrcx-

$14.00

-528.45

($2.89)

CSS23-CV-0300-TCKJF

23-CV-0232-TCK-JKJ

525.56

($2.89)

$22.67

13713084

23-CV-0232-TCK-JFJ

($2.89)

23-CV-0232-TCK-JFJ

(S2.S9J

$2.89

$30.00

$14.45

COPY COURTS

FILINGS

($2.89)

$19.73

$19.78

$49.78

$64/23

$61.34

CSS23-CV-0300-TCK-

PLRA

11/01/2023

PLRA

23-CV-0232-TCK-JKJ

LEGAL COPAY

MAIL,FOSTAGE

($2.89)

S58.45

CSS23-CV-0300-TCK-

JF

11/20/2023

LEGAL COPAY

r»30/2023-

■gang-pay-

12/01/2Q23

PLRA

(32.89)

13713084

($289)

($18.91)

COPIESJMAIL,

POSTAGE

(31298)

12101/2023

PLRA

12/01/2023

PLRA

23-CV-0232-TCK-JKJ

12/01/2023

PLRA

23-CV-0299-CVE-JFJ

$55.56

$5267

$33.76

$19.78

-$14-45------

-"S34t23

($289)

$31.34

43289).

-528:45-

($289)

$25.56

($2.33)

$22.67

CSS23-CV-0300-TCK-

JF

CSjS23-C\A030CLTCK-

JF

|Siimrnarv Balances

|

5

$44.00

($30.00)

11/01/2023

Available Balance

$74.00

($30.00)

23-CV-0232-TCK-JFJ

JF

11/03/2023

$106.89

$104.00

($30.00)

23-CV-0232-TCK-JFJ

INSTITUTIONAL DEBT

$108.34

13713084

JF

10/01/2023

$115.56

($7.22)

CSS23-CV-0300-TCKJF

PLRA

09/21/2023

$103.62

$101.11

03058557

PLRA

09/08/2023

$112.67 ’

$105.45

($2.51)

COPY COURTS

HUNGS

MEDICAL COPAY

09/01/2023

$98.33

S93.22

($7/22)

LEGAL COPAY

INSTITUTIONAL DEBT

08/31/2023

.

$14.45

COPY COURTS

GANG PAY

08/31/2023

510256

($0.17)

HUNGS

07/31/2023

5109.78

($7-22)

LEGAL COPAY

INSTITUTIONAL debt

07/31/2023

i

Account Balance

614.45

COPY COURTS

HUNGS

gang PAY

07/31/2023

f

Amount

$95.33

INSTITUTIONAL DEBT

06/30/2023

f

RecapfcgChecfc? Sender Name

SANG PAY

06/30/2023

t

Source Document#

BEGINNING BALANCE

BED 42 (L)

Savings Balance

Debt Encumbrance

Other Ene*::7»*—27ice

Outstanding

Insffuments

Administrative Holds

Account Balance

2

.

. —J—

Numbers for Paupers Affidavit appear in

-bofcCbejow.

Deposit

Balance

$14.45

$109.78

$115.56

$115.56

$14.45

august

$14.45

oct

nov

20%

Months

$14.45

$28.45

$14.45

$14.45

$64.23

$34.23

$

14.45

$

77.97

$

2.89

$

15.59

6