Civil Action No. CA 1108-86
JURY TRIAL DEMANDED
personally, and representing,
PEACE PARK (WHITE HOUSE)
WASHINGTON TIMES Inc.
by and through resident agents:
BO HI PAK,
3600 New York venue, N.E,
DECLARATION IN SUPPORT OF REQUEST TO PROCEED
IN FORMA PAUPERIS
I, WILLIAM Thomas declare that I am the movant in the above entitled case, that in support of my motion to proceed without being required to prepay fees, costs or give security therefor, I state that because of my poverty, I am unable to pay the costs of said proceeding or to give security therefor; that I believe I am entitled to relief.
1. Are you presently employed?
Yes__ No _X
If the answer is "yes," state the amount of your salary or wages per month; and give the name and address of your employer. I preform socially benificial actions for which no finiancial renumeration. I have no income.
b. If the answer is "no," state the date of last employrnent and the amount of the salary and wages per month which you receuved.
2. Have you received within the past twelve months any money from any of the following sources?
a. Business, profession or form of self-employment? Yes __ No _X
Rent payments, interest or dividends? Yes __ No _X.
Pensions, annuities or life insurance payments? Yes __ No _X
d. Gifts or inheritances? Yes __ No _X
e. Any other sources? Yes __ No _X
If the answer to any of the above is "yes," describe-each source of money and state the amount received from each during the past twelve months.
3. Do you own any cash, or do you have money in a checking or savings account?
Yes __ No _X (include any funds in prison accounts)
If the answer is "yes," state the total value of the items owned.
4. Do you own real estate, stocks, bonds, notes, automobiles, or other valuable property (excluding ordinary household furnishings and clothing)?
Yes __ No _X
If the answer is "yes," describe the property and state its approximate value.
5. List the persons who are dependent upon you for support, state your relationship to these persons, and indicate how much you contribute toward their support:
I declare (or certify, verify, or state) under penalty of perjury that the foregoing is true correct Executed on February 6 , 1986 (date)
(Signature of Movant)
Subscribed and sworn to before me this 6th day of Feb. 1986