1 2 3 4 5 6 7 8 9 10 11 12 Plaintiff, 13 vs. 14 15 16 17 18 19 20 21 22 23 24 25 Defendant 26 27 28 Defendant(s). / (hereinafter Defendant), APPLICATION TO PROCEED IN FORMA PAUPERIS Case No. ________________________ Dept. No.

______ IN THE NINTH JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR DOUGLAS COUNTY

COMES NOW, above named defendant

in propria persona, and hereby requests that the Court permit Defendant to proceed in forma pauperis pursuant to NRS 12.015. This application is based on the following memorandum of points and authorities, the affidavit of Defendant in support of the of the application, together with the pleadings and papers on file. Dated this ____ day of ___________________, 20___.

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MEMORANDUM OF POINTS AND AUTHORITIES Defendant is unable to pay to defend this action and should be permitted to proceed in forma pauperis. A Nevada citizen has a constitutional right to access of the courts regardless of financial status or ability pay court costs. See e.g. Jordan v. State Dep't of Motor Vehicles, 121 Nev. 44, 110 P.3d 30, 121 Nev. 44 (Nev., 2005); Sullivan v. District Court, 111 Nev. 1367, 904 P.2d 1039 (1995); Hollis v. State, 95 Nev. 664, 601 P.2d 62 (1979); Rodriguez v. Eighth Dist. Ct., 120 Nev. 798, 102 P.3d 41 (2004). NRS 12.015 permits a person unable to pay the costs to prosecute or defend a civil action to proceed in forma pauperis, without the payment of court costs and fees. NRS 12.015 provides in pertinent part as follows: 1. Any person who desires to prosecute or defend a civil action may: (a) File an affidavit with the court setting forth with particularity facts concerning the persons income, property and other resources which establish that the person is unable to prosecute or defend the action because the person is unable to pay the costs of so doing; . . . 2. If the court is satisfied that a person who files an affidavit pursuant to subsection 1 is unable to pay the costs of prosecuting or defending the action . . . the court shall order: (a) The clerk of the court: (1) To allow the person to commence or defend the action without costs; and (2) To file or issue any necessary writ, process, pleading or paper without charge. The Nevada Supreme Court has stated that in making a determination of indigency within the context of civil litigation a trial judge must consider a party's complete financial picture, balancing income and assets against debts and liabilities, taking into account the cost of a party's basic needs and living expenses. Rodriguez v. Eighth Dist. Ct., 120 Nev. 798, 806, 102 P.3d 41, 47(2004) (citing Nikander v. Dist. Ct. in & for First. Jud. Dist., 711 P.2d 1260, 1263 (Colo.1986). In making this inquiry the Supreme Court has determined that the following are relevant: (1) employment status and income, including income from government sources such as social security and unemployment benefits; (2) the ownership of any unencumbered assets, including real or personal property and monies on deposit, and finally; (3) the party's total indebtedness and any financial assistance received from family or close friends. Id. (citations omitted).

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Defendants Affidavit filed herewith and supporting this application establishes that the Defendant is unable to pay the costs necessary to defend the above entitled action. According to Defendants Affidavit Defendant is insolvent as defined by NRS 112.160 as Defendants liabilities and debts outweigh Defendants assets. Defendant has no executable or otherwise non-exempt assets pursuant to NRS 21.090(1). Defendant has limited financial resources which are necessary to meet Defendants basic needs and living expenses. After balancing Defendants financial resources against debts and liabilities, and taking into consideration payment of basic needs and necessary living expenses, Defendant has no disposable income to pay the costs of defending this action. Therefore, Defendant respectfully requests that the Court enter an order permitting Defendant to proceed in forma pauperis. AFFIRMATION The undersigned hereby affirms pursuant to NRS 239B.03 that the foregoing does not contain the social security number of any person, or other personal information as defined by NRS 603A.040. Dated this ____ day of ___________________, 20___.

Defendant 19 20 21 22 23 24 25 26 27 28 -3-

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CERTIFICATE OF SERVICE Pursuant to NRCP 5(b) I certify that on this ____ day of ____________, 20____, I deposited for delivery the foregoing document described as Application to Proceed in Forma Pauperis for service by placing an original or true copy thereof in a sealed envelope placed for collection and mailing on said date addressed as follows: Address of Plaintiff or Plaintiffs Counsel:

________________________________ Signature ________________________________ Print Name

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