Professional Documents
Culture Documents
Defendants-Appellees.
It appears that the district court’s order challenged in this appeal may not
have disposed of the action as to all claims and all parties. Within 21 days after the
date of this order, appellant shall move for voluntary dismissal of this appeal or
show cause why it should not be dismissed for lack of jurisdiction. See Fed. R.
Civ. P. 54(b); Chacon v. Babcock, 640 F.2d 221 (9th Cir. 1981). If appellant elects
to show cause, a response may be filed within 10 days after service of the
memorandum.
A review of this court’s docket also reflects that the filing and docketing fees
for this appeal remain due. If appellant elects to show cause, appellant shall also
pay to the district court the $505.00 filing and docketing fees for this appeal and
file in this court proof of such payment or file in this court a motion to proceed in
AC/MOATT
(2 of 9)
Case: 18-15886, 05/29/2018, ID: 10887380, DktEntry: 2-1, Page 2 of 2
If appellant does not fully comply with this order, the Clerk shall dismiss
MOLLY C. DWYER
CLERK OF COURT
AC/MOATT 2
(3 of 9)
Form 4. Case: 18-15886,
Affidavit 05/29/2018,
Accompanying ID: Permission
Motion for 10887380, to
DktEntry: 2-2,
Appeal In PagePauperis
Forma 1 of 7
Instructions: Complete all questions in this application and then sign it. Do not leave any
blanks: if the answer to a question is "0," "none," or "not applicable (N/A)," write in that
response. If you need more space to answer a question, attach a separate sheet of paper identified
with your name, your case's docket number, and the question number.
Case No.
Appellant(s) or Petitioner(s)
v.
Appellee(s) or Respondent(s)
Signed: Date:
-1-
(4 of 9)
Case: 18-15886, 05/29/2018, ID: 10887380, DktEntry: 2-2, Page 2 of 7
1. For both you and your spouse estimate the average amount of money received from each of the
following sources during the past 12 months. (Adjust any amount that was received weekly, biweekly,
quarterly, semiannually, or annually to show the monthly rate. Use gross amounts, that is, amounts
before any deductions for taxes or otherwise.)
Employment $ $ $ $
Self-Employment $ $ $ $
Gifts $ $ $ $
Alimony $ $ $ $
Child Support $ $ $ $
Unemployment Payments $ $ $ $
Other (specify) $ $ $ $
-2-
(5 of 9)
Case: 18-15886, 05/29/2018, ID: 10887380, DktEntry: 2-2, Page 3 of 7
2. List your employment history for the past two years, most recent employer first.
(Gross monthly pay is before taxes or other deductions.)
From
$
To
From
$
To
From
$
To
From
$
To
3. List your spouse's employment history for the past two years, most recent employer first.
(Gross monthly pay is before taxes or other deductions.)
From
$
To
From
$
To
From
$
To
From
$
To
-3-
(6 of 9)
Case: 18-15886, 05/29/2018, ID: 10887380, DktEntry: 2-2, Page 4 of 7
Below, state any money you or your spouse have in bank accounts or in any other financial institution.
Financial Institution Type of Account Amount You Have Amount Your Spouse
Has
$ $
$ $
$ $
$ $
If you are a prisoner seeking to appeal a judgment in a civil action or proceeding, you must attach a
statement certified by the appropriate institutional officer showing all receipts, expenditures, and
balances during the last six months in your institutional accounts. If you have multiple accounts,
perhaps because you have been in multiple institutions, attach one certified statement of each account .
5. List the assets, and their values, which you own or your spouse owns. (Do not list clothing and ordinary
household furnishing.)
Home Value
-4-
(7 of 9)
Case: 18-15886, 05/29/2018, ID: 10887380, DktEntry: 2-2, Page 5 of 7
6. State every person, business, or organization owing you or your spouse money, and the amount owed.
Person owing you or your spouse Amount owed to you Amount owed to your spouse
$ $
$ $
$ $
7. State the persons who rely on you or your spouse for support. (If a dependent is a minor, list only
the initials and not the full name.)
-5-
(8 of 9)
Case: 18-15886, 05/29/2018, ID: 10887380, DktEntry: 2-2, Page 6 of 7
8. Estimate the average monthly expenses of you and your family. Show separately the amounts paid by
your spouse. (Adjust any payments that are made weekly, biweekly, quarterly, semiannually, or annually
to show the monthly rate.)
You Spouse
Food $ $
Clothing $ $
- Life.......................................................................................................................................... $ $
- Health...................................................................................................................................... $ $
- Motor Vehicle......................................................................................................................... $ $
- Other: $ $
Specify: $ $
Installment payments
- Motor Vehicle......................................................................................................................... $ $
- Department Store $ $
(Name):
- Motor Vehicle......................................................................................................................... $ $
-6-
(9 of 9)
Case: 18-15886, 05/29/2018, ID: 10887380, DktEntry: 2-2, Page 7 of 7
Other (specify) $ $
9. Do you expect any major changes to your monthly income or expenses or in your assets or liabilities
during the next 12 months?
Yes No
If yes, describe on an attached sheet.
10. Have you spent--or will you be spending--any money for expenses or attorney fees in connection with
this lawsuit?
Yes No
11. Provide any other information that will help explain why you cannot pay the docket fees for your
appeal.
City State
-7-