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CAUSE NUMBER: JE _ /3~0;.::__\---.:q:__q~6::::..___L U 4 2[113
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Residence of Dependants Address, City, State, Zip Code
CC-13-06190-C
Justice of the Peace 4-2 841 West Irving Boulevard Irving, TX 75060 ;:~~DAVI
P. (214) 589-7000 F. (214) 589-7048 2601a 4 T INABILITY To PAY
1111111/lllll//ll/111
INCOME OF TENANT & SPOUSE
'- ...)
___ Se I~ em pt~e
Tenant's Employer
-An1
Tenant's Job iTle and/or Dut1es
___ 0~--- Co n._( 0 'Q s-\ Gwl\ cl QIG\ .\ ~ ,e_ T " -=tSos.L------------ --- -------
Tenant s Employer Address, City, State, Zip Code
---·---- ·----,----------
'J'en(~~~~sur,e:f\~2 Na-·m_e_ __ Tenant's Supervisor's Phone
Tenant's Monthly Salary/Income Tenant's Other Income
-~ --0
Spouse's Employer Spouse's Job Title and/or Duties
-------,--------------------,----------------
Spouse's Employer Address. City, State, Zip Code
Spouse's Supervisor ·s Name Spouse 's Supervisor's Phone
---·---------------
Spouse's 111onrhly Salary/Income Spouse's Orher Income
GOVERNMENT ENTITLEMENT INCOME
--------------
Unemployment Benefits AFDCITANF
_,___ __________ ------ ----··--·- --· -- ·-·----
Social Security Disability
Veteran's Benefits Child Support
------- -- · - - - - -
Other Amounts- Describe
ALL OTHER INCOME
----------- · · - - - - - - - - - - - - - - -
List all other sources of income and amounts. Cash on hand
--------------- ------- -----·- ---····------· ...... -··--· -----
Financial lnst irution olChecking Account Balance Amount
-····----------------
Financial Ins! itut ion o_fSavings Account Balance Amount
REAL PROPERTY (residential, commercial, or land owned)
----------·---------- - - - - - - - - - - -
Address (~(Real Property Ovmed Value of Properly
- ------ - - - - - - -··-------------·-·--
Address o(Real Property Owned Value o(Property
Ju.~tice of the Peace 4-2 841 West Irving Boulevard Irving, TX 75060
P. (214) 589-7000 F. (214) 589-7048
PERSONAL PROPER~ (other than ltouseholdfurnishings,~thes,
tools of tt trade,
or personal effects. This includes vehicles tmd other sources of transportation)
····--.. - - - · - - - - - - - - - - - - - - - - - - - - : - - - - : : - = - - - - - - - - - - -
Descriplion a./Property Owned Value ofProperty
---·-·-------··-------------
Descriplion £dProperty Owned Value ofProperty
MONTHLY EXPENSES
---- g3C) _ _ _ _ _ __ ·---------'~"""--,------------------
Rent and/or !~'for/gage Amount Vehicle/Car Payment Amount
....e.-
··--·--- __ _3_gQ
Insurance Amount Ulility Amount
·---~ ~
Child Care Amount Child Support Amount
___'faa~ ..e-
F'ood and/or Incidental Amount Medical and/or Dental Amoun/
--~2~~-a-~----------------------------
Other AmoumGf\S Describe Other A mount
-(hher ;{,~;;~t ~cce.s(t··~ Describe Other Amount
Signed this the { G --day of _____:A:....cu>!..§~·L.L..ir....l-J--+-·---- 70 L22 d
-~4--t?.arr( 'o f(or(f 4'a~Y~d _.fib __
Signa/ure oj'Af/iant Printed Name ojAjjianl
THE STATE OF TEXAS §
COUNTY OF DALLAS §
BEFORE ME. the undersigned authority, on this day personally appeared the above
named aftiant who upon oath, stated that he/she is the Tenant making this Pauper's
Aftidavit and that the information provided is true and correct.
0 AND SUBSCRIBE~ before me on the /~-day of
......!...llAtk:f44fU---=-- , 20_{_ _ .
CERTIFICATE OF DELIVERY: I the Defendant in the above and entitled to·rcible
detainer I torcible entry and detainer certify that I have sent the torgoing document to the
opposing party on this the day of_____ , 20 ________ _
--·--··---- ·-----
Signature ufDefendant Printed Name ofAffianl
Justice of tile Peace 4-2 841 West Irving Boulevard Irving, TX 75060
P. (214) 589-7000 F. (214) 589-7048