COURT OF APPEALS FOR THE FIRST DISTRICT OF TEXAS AT HOUSTON ORDER Appellate case name: Rachael Braud v. Nathan Lane Robert Appellate case number: 01-19-00163-CV Trial court case number: 2017-64891 Trial court: 245th District Court of Harris County After the court reporter advised this Court that appellant had not made financial arrangements for the preparation and filing of the reporter’s record, appellant filed an affidavit of indigence in this Court stating that she could afford to pay the appellate filing fee of $175, but she did not state that she could not afford to pay other court costs. Rule 145 of the Texas Rules of Civil Procedure applies when the issue is ability to afford costs of the appellate record. See TEX. R. CIV. P. 145(c). Because appellant’s affidavit did not meet the requirements of the rule, the Court issued an order directing appellant to file a Statement of Inability in the trial court. A supplemental clerk’s record filed in April 2020 revealed that appellant filed the affidavit of indigence but not a statement of inability in the trial court. The Court subsequently issued another order, attaching a form Statement of Inability, and directed appellant to complete the form and file it in the trial court. A supplemental clerk’s record filed on July 20, 2020, indicated that appellant had not filed the statement of inability in the trial court. Absent a statement of inability or other document stating under oath that appellant cannot afford to pay court costs, including the appellate record, appellant has not met the requirements to avoid payment of the clerk’s record or the reporter’s record. A notice issued in July 2019 that the appeal might be dismissed unless appellant made financial arrangements for the filing of the clerk’s record or established her inability to afford the costs. Unless appellant establishes her inability to afford to pay the costs of the appellate record by filing in the trial court either the statement of inability attached to this order or an amended affidavit of indigence that states she is unable to afford the costs of the appellate record or costs on appeal other than the filing fee, the threat of dismissal continues to exist. Accordingly, this Court ORDERS appellant to file a Statement of Inability (form attached) in the trial court or file an amended affidavit of indigence in the trial court stating her inability to afford payment of courts costs other than the filing fee. Additionally, appellant must also provide to this Court proof of filing of this document in the trial court by requesting a supplemental clerk’s record to be filed in this Court containing the Statement of Inability or amended affidavit of indigence within 20 days of the date of this order. If appellant fails to file this supplemental clerk’s record, the Court may dismiss the appeal. See TEX. R. APP. P. 42.3; Manley v. Love’s Travel Stop, No. 01-17-00450-CV, 2018 WL 542409, at *1 (Tex. App.— Houston [1st Dist.] Jan. 25, 2018, no pet.) (dismissing for failure to file Statement of Inability as ordered and failing to pay fee). It is so ORDERED. Judge’s signature: ____/s/ Richard Hightower_____ Acting individually Acting for the Court Date: ___September 10, 2020____ NOTICE: THIS DOCUMENT CONTAINS SENSITIVE DATA Cause Number: (The Clerk’s office will fill in the Cause Number when you file this form) Plaintiff: In the (check one): (Print first and last name of the person filing the lawsuit.) District Court Court County Court / County Court at Law And Number Justice Court Defendant: Texas (Print first and last name of the person being sued.) County Statement of Inability to Afford Payment of Court Costs or an Appeal Bond 1. Your Information My full legal name is: My date of birth is: / / First Middle Last Month/Day/Year My address is: (Home) (Mailing) ___________________________________________________________________________________ My phone number: My email: About my dependents: “The people who depend on me financially are listed below. Name Age Relationship to Me 1 2 3 4 5 6 2. Are you represented by Legal Aid? I am being represented in this case for free by an attorney who works for a legal aid provider or who received my case through a legal aid provider. I have attached the certificate the legal aid provider gave me as ‘Exhibit: Legal Aid Certificate. -or- I asked a legal-aid provider to represent me, and the provider determined that I am financially eligible for representation, but the provider could not take my case. I have attached documentation from legal aid stating this. or- I am not represented by legal aid. I did not apply for representation by legal aid. 3. Do you receive public benefits? I do not receive needs-based public benefits. - or - I receive these public benefits/government entitlements that are based on indigency: (Check ALL boxes that apply and attach proof to this form, such as a copy of an eligibility form or check.) Food stamps/SNAP TANF Medicaid CHIP SSI WIC AABD Public Housing or Section 8 Housing Low-Income Energy Assistance Emergency Assistance Telephone Lifeline Community Care via DADS LIS in Medicare (“Extra Help”) Needs-based VA Pension Child Care Assistance under Child Care and Development Block Grant County Assistance, County Health Care, or General Assistance (GA) Other: © Form Approved by the Supreme Court of Texas by order in Misc. Docket No. 16-9122 Statement of Inability to Afford Payment of Court Costs Page 1 of 2 4. What is your monthly income and income sources? “I get this monthly income: $ in monthly wages. I work as a for . Your job title Your employer $ in monthly unemployment. I have been unemployed since (date) . $ in public benefits per month. $ from other people in my household each month: (List only if other members contribute to your household income.) $ from Retirement/Pension Tips, bonuses Disability Worker’s Comp Social Security Military Housing Dividends, interest, royalties Child/spousal support My spouse’s income or income from another member of my household (If available) $ from other jobs/sources of income. (Describe) $ is my total monthly income. 5. What is the value of your property? 6. What are your monthly expenses? “My property includes: Value* “My monthly expenses are: Amount Cash $ Rent/house payments/maintenance $ Bank accounts, other financial assets Food and household supplies $ $ Utilities and telephone $ $ Clothing and laundry $ $ Medical and dental expenses $ Vehicles (cars, boats) (make and year) Insurance (life, health, auto, etc.) $ $ School and child care $ $ Transportation, auto repair, gas $ $ Child / spousal support $ Other property (like jewelry, stocks, land, Wages withheld by court order another house, etc.) $ $ Debt payments paid to: (List) $ $ $ $ $ Total value of property $ Total Monthly Expenses $ *The value is the amount the item would sell for less the amount you still owe on it, if anything. 7. Are there debts or other facts explaining your financial situation? “My debts include: (List debt and amount owed) “ (If you want the court to consider other facts, such as unusual medical expenses, family emergencies, etc., attach another page to this form labeled “Exhibit: Additional Supporting Facts.”) Check here if you attach another page. 8. Declaration I declare under penalty of perjury that the foregoing is true and correct. I further swear: I cannot afford to pay court costs. I cannot furnish an appeal bond or pay a cash deposit to appeal a justice court decision. My name is . My date of birth is : / / . My address is Street City State Zip Code Country signed on / / in County, Signature Month/Day/Year county name State © Form Approved by the Supreme Court of Texas by order in Misc. Docket No. 16-9122 Statement of Inability to Afford Payment of Court Costs Page 2 of 2