Diaz, Jimmy

CSINIH02/CINIBQi2 TEXAS DEPARTNENT OF CRI~ln!AL JU5TICE 06/02/15
R147/ALE1031 IN-FORNA-PiU'ERIS DATA 10:24:02
TDCJfi: 0173731!11 SiiRI: 03213784 LOCATION: RANSEY I;~DIG8;T DTE: ~1/21/14
:-:Ai~E: OIAZ, JIMMY BEGINi'~ING PERIOD: 12/01/14
PREVIOUS TDCJ NUMBERS: 00475593 00721195 01201534
~RRENT BAL: 0. 00 TOT HOLD ANT: 0. e-0 ~i'1TH TOT DEP: 0. 00
6MTH DEP: 0.0ll f.[i!TH AVG BrtL: 0.00 f:lilTH AVG DEP: G.00
MONTH HIGF.EST BALAJ\'CE TOTAL DEP03ITS XONTH HIGHEST BALANCE TOTAL DEPOSITS
~~5/15 0.00 0.00 02/:5 0.00 0.Q:O
04/15 0.0~ 0.021 01/15 0.00 0.00
~3/15 0.00 0.~ 12/14 0.~0 0.00
PROCESS DATE HOLD Ai't.OU:-JT HDLD DES'CR~~TIGJ

STATE OF TEXAS COUNTY CF 8 RA L6 RJ A
Otl THIS THE~'AY OFV\4~~ ~()if I CERTIFY THAT THIS DOCUMENT IS A TRUE
COtf.PLET£ 1 Ai~D UNALTERED COPY !r~DE BY ME CF n;roRt~ATIGtl CONTAWEO IN -:-;;t:: .. (2~
COt~PUTER DATABASE REGARDit\6 THE OFFENDER'S ACCOL!!H. NP SIG: ,...ec.....~
PFl-HELP PF3-END ENTER NEXT TDCJ NUMBER: OR SID i,ul•IBER: _ __
CSINIBQJ2/CINIB~i2 TEXAS DEPhRnlHH OF CRIP1!1'\AL JU3TICE 06/~2/15
R147/ALE1031 IN-FOffi~A-PAUPERIB DATA 10:24:02
TDCJfl: 017373~1 SIDfl: \B213784 LOCATION: RAi4SEY MDIGEm DTE: llll/21114
~Ai4E: OIAZ 1 JifliJilY BEGIN;>JING PERIOD: 12/01/14
PREVI~JS TDCJ ~UMBERS: 00475593 0~72119~ 01201534
CURRENT BAL: 0. 00 TOT HOLD ANT: 0. 00 3i1TH TOT DEP: 0. 00
f.MTH DEP: 0. 0~1 £tolTH AVG BF1L: 0. 00 f.NTH AV6 DEP: G. 00
WJNTH HIGHEST BALA~CE TOTAL DEP03ITS :rlOifiH HIGHEST BALANCE TOTAL DEPOSITS
iG/15 0. 00 0. 00 02/~5 0. 00 0. fl:0
04/15 0. 0~ 0. 021 0111s e. oo 0. 00
03/15 0.00 0.00 12/14 0.00 0.00
PROCESS DATE HOLD AXOUNT HULD DESCR:~·TICJ

STATE OF TEXAS COUNTY OF 8 RA'Z6 FJ A
ON THIS THE~~AY OFJUK.~.&()ifi CERTIFY THAT THIS DOCUI4ENT !S A TRUE
COMPLETE, AND UNALTERED COPY fr~DE BY t4E CF Ir:FORMATIGt4 CONTAit~ED IN -:-i;t .. £2~
COI4PUTER DATABASE REGARDING THE OFFENDER'S ALXOUNT. NP SIG: ...ec,....~
PFl-HELP PF3-END ENTER NEXT TDCJ NUMBER: OR SID ,,Ulq!lER: _ __

: • • • • • • o I o o o o o • I • I o o o o o a •
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. J. lbm1 bHrtz J:f r?lf ~ . )/
Plaintiff's name and II} Number
I.Anl~l'Jlllnn l1o0 nfll1 ttl ..
Place of Confinemeni&shnr.:111. f:f 195~3
·.- .•.,.
·-.
·- ....... _...
CASE NO. _ _ _ _ _ _ _ _ __
(Clerk will assign the number)

APPLICATION TO PROCEED
IN FORMA PAUPERIS

f.'

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I; , declare, depose, and say I am the Plaintiff in the above entitled case. In support
of my motwn o pro eed williout being required to prepay fees, costs, or give security therefor, I state because of my
poverty, I am unable to pay in advance the filing fee for said proceedings or to give security for the filing fee. !believe I
am entitled to relief. · · ·

I, further declare the responses which! have made .to the questions.and instructions below are true.

L Have you received, within the last 12 months, any money from any of the following sources?

a. Business, profession or from self-employment? YesO No 0
b. Rent payments, interest or dividends? Yes 0 No 0
c. Pensions, annuities or life insurance payments? Yes 0 No 0
d. Gifts or inheritances? Yes 0 No 0
e. Family or friends? Yes o· No 0
f. Any other sources? Yes 0 No 0
If you answered YES to any of the questions above, describe each source of money and state
the amount received from each during the past 12 months.

2. Do you own cash, or do you have money in a checking or savings account, including any funds
in prison accounts? · '""'"'"' ·
Yes 0 No 0
/
If you answered YES to any of the questions above, stat~ total value of the items .owned.

~-...

! ~ATCIFP (REV. 9/02)
 ., \.J~

3. Do you own real estate.'stocks~··ho~ds: note, automobil;ls,
. other valuable property, excluding
ordinary household furnishings a~d clothing? . · .
.· . .
·, . . Ye~ D No [j

. If you answered YES, descri~I'Jtperty and state its approximate value.

.·-!
I unders'tand a false statement in .answer to any question in this affidavit will subject me to penalties for
·~- perjury. I declare (cettify,}'erify, or state) under . penalty of perjury that the foregoing is true and correct
(28 u.s.c. §1746).. . . . .

day of
~
udNt
·
15
,20_._.·

ID Number

YOU MUST ATTACH A CURRENT SIX (6) MONTH HISTORY OF
YOUR INMATE TRUST ACCOUNT. · YOU CAN ACQUIRE THE
APPROPRIATE INMATE ACCOUNT CERTIFICATE FROM THE
LAW LIBRARY AT YOUR PRISON UNIT.

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