Walter Francisco Salinas v. Patricia Melton

FILED lN \ST couat oF APPEALS HQUSTO!‘ `\'EX 05 DEC -7 2015 NO_ H/// §:.OWQ g% G::a::rop§'_.?/:\ \»’F\lr\ii:W [leave blanl<; case number will be assigned later] [insert caption used in appeal i..e, [name of appellant] v. [name of appellee]] M /////f /a///‘?//‘f //5 /Mvd/JH/W%Q/ cary Affidavit of lndigence [sample; for use in appeals; file with trial-court clerk with or before filing notice of appea|] //fQ/f?&§ l, [appellant’s name], swear [or affirm] the following: M,,_` /_,-_-__'_"_`) \ 1. l have filed an appeal in the case described above. Tc@n )70/` _ _ _ _ 2.i-l~aan pay the following amount of court costs in this appeal, which includes the $175 filing fee, the $‘l 0 or $15 filing fee for each motion l may file, the trial-clerk’s fee for the clerk’s record, and the Court reporter’s fee for the reporter’s record1 if any: [describe in detail amount, if any, you can pay]. 3. The nature and amount of my current employment income is [describe in detai|]l , 4. The nature and amount of my current government”entitlement income is [describe in detai|]£1 ~755’/;.{/” /14//»'¢!~ 5. The nature and amount of my current income, other than that described in my answers to 3 and 4 above, is [describe in detail]. /// 6. T e income of my spouse is [describe in detail]. lVly spouse's income [is o@ available to me. 7. l own the following real property: [describe in detai|]. /{/7//£ 8. l own the following personal property: [describe in detail]./V///E 9. l have the following amount of cash: [describe in detail]./@/J 10. l have the following amounts of funds on deposit that l may withdraw: [describe in detail]. ,g/ 11. l have the following assets, other than those described in my answers to 3 through 10 above: [describe in detail].,Q/' 12. l have [provide number] dependants. lVly relationship to each of them is [describe in detail]. 3 13. The nature and amount of my debts are [describe in detail]. @/ 14. The nature and amount of my monthly xpenses are [describe i deming/953 WW+ //%M/Z@ MQ/a/r§?/@A “/??a¢W¢a/a,,§ao 15. iviy ability to obtain a ioan for court costs is [describe in detail]. [/y//a/ 16. An attorney [is or is not] providing free legal services to me without a contingent fee. 17. An attorney [has or‘agreed to pay or advance court costs. 18. [lf the trial-court proceedings were recorded electronicallyg or lack] the skills and access to equipment necessary to prepare the appendix required by Texas Ru|e of Appe|late Procedure 38.5(d). flotilla lot/ii [Signature of party claiming indigence, who is swearing or affirming information given above; must be signed in presence of person described below] Certificate of Oath or Affirmation On this date, l administere he bo e ath or ffir tio 0 person named above. l ama W&¢%: %YW and am authorized to administer an oath or affirmation pursuant to Texas Government Code section 602.002, 602.003, 602.004, or 602.005. lfl have a seal of office that l am required by law to affix to documents when administering an oath or aermation, then l have included an original impression of my ochial seal below. [uo!J,ei,uiii,ie .io uJ,eo Buuei,siuii.upe uosied 40 ‘Aue ,ti ‘|ees |eiog,io to uo!sseidtui |euiBi.io] leieol ,5/% ~‘ w /t§/ [uogeuu!ge Jo uteo Buuei,siuiiupe uosied 40 eJnJ,euB!S] WWWW