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IN THE SUPREME COURT OF FLORIDA
CASE NUMBER: -~-----:=~~---
Petitioner/Appellant
vs.
MOTION FOR LEAVE TO PROCEED IN FORMA PAUPERIS/AFFIDAVIT \
OF INDIGENCY BY PETITIONER/APPELLANT
Petitioner/Appellant in propria persona,
respectfully moves this Court for an order permitting himlher to proceed in forma
pauperis. In support hereof petitioner/appellant submits a financial affidavit of
indigency as required by section 57.081 or 57.085(2), Florida Statutes (1997).
Respectfully submitted,
FINANCIAL AFFIDAVIT
I, hereby depose and say that I am unable to pay
court costs and fees and submit the following information for review: AGE:
DATE OF BIRTH: U/3o/'6 MARITAL STATUS: Married _ Separated
Divorced _ Single _ LIST DEPENDENTS, THEIR NAMES, AND AGES:
=
II. FINANCIAL CONDITION:
Affiant's Gross Income: Weekly ----lieo'--- Bi-Weekly $_ _ Monthly
Spouse's Gross Income: Weekly $_ _ Bi-Weekly $_ _ Monthly
Own Home: Yes _ _ No _ _ Monthly Mortgage Payments $ _
~alueof~eaIProperty~~ned $~~~~~~~~~~~~~~~
Own Automobile: Yes _ _ No ~_ Monthly Payments $ _
~ alue of Automobile: $ Year/Make: ~-~-~~~~~
Value of Personal Property Owned (boats, furniture, stocks, jewelry,
etc.):
List all tangible property ~ith a value over $100.00
Item $ Value
List creditor and the amount owed to each creditor:
2
Amount of cash held by petitioner/appellant: $ -.;;:~--------
Balance of checking account:
Balance of savings account: $
--------------------
Amount held in money-market (stocks, bonds, other tangible personal
property): $~~~ ___
The following applies only to persons who are incarcerated:
My inmate number is: ql~ %'"16
Amount currently held in the petitioner's inmate trust account: $ ---=~-
Attach photocopy of inmate's trust account records for the proceeding six (6)
months or for appellants/petitioner's incarceration, whichever period is
shorter.
Are you presently employed in an inmate work program within the
Department of Corrections? Yes No V
If the answer is "YES" complete the following:
Wages earned: $ Name and Address of employer: _
If answer is "NO" state the date of your last employment and the salary and
wages earned per month. Date: Wages earned:
Are you presently employed in a work release program? Yes _ No
If answer is "YES" complete the following: Wages earned: $ _
Name and address of employer:
If answer is "NO" state the date of your last employment and the salary and
wages earned per month: Date Wages earned: $- - - - - -
I certify that I have have not been adjudicated indigent
under section 57.081, 57.085 or 28 U.S.C. s 1915. If your answer is "YES"
and it occurred twice in the preceding three (3) years, you are required to list
each suit, action, claim, proceeding, or appeal which you have intervened in
3
1. ~1ll..Jl.lLL!Ji£l;11..£i.U....l.l-'L~~~~~~~~--J::I.~~LL!L~~~~~~'.Jt.LLf4/J.
2.
--------------------------
3.
- - - - - - - - - - - - - - - - - - - - - - - - - -
Attach extra sheet(s) if necessary.
Under penalties of perjury, I declare that I have read the following
(document) and that the facts stated in it are true. (92.525(2) Fla. Stat.
(1995))
Dated this --1-- _ _ day of --71--..:.-..;....;;.+-----' 20_, at ---'--~-ll...I:-.-~lI-----Z--'
Florida.
Address:
Signature of Petitioner/Appellant
ONLY NOTARIZE, IF YOU DO NOT SIGN "UNDER PENALITIES OF
PERJURY"
Sworn to and subscribed before me this
_ _ _ day of , 20_ _
My Commission Expires: - - - - -
CERTIFICATE OF SERVICE
I certify that a copy hereof has been furnished to _
(insert name(s) and addressees) of attorney(s) party(ies) in the case) by mail
this day of , 20_
Signature of Petitioner/Appellant
4
IN THE SUPREME COURT OF FLORIDA
Supreme Court Case No. ~-----.;;..~
Lower Tribunal Case No.
vs.
CER~IFICATE REGARDING INMATE ACCOUNT
(Department of Corrections' Represerltative:
Please sign applicable portion of certificate)
I -"'.. . y-.......... that petitioner does not have a bank account within the institution in
which he is confined.
Signature of Authorized Officer of Institution
Address:
Date:
-or
has the sum of $
. . . . , _ ... ,,1,.. ... ,1,.. .... 'on account to his or
...... _ ....
~~~:......:..-~--=-=-----
Correctional Institution where he or
she is confined. I further certify that during the last six months the petitioner's
average daily balance was (} . (Attach a statement of the
inmate's bank account for last six months.)
/\ .
::;. F~
Signature of Authorized Officer of Institution
Name: :::J. flt~L .-'t:-IC
Institution: !J&M:Li-fn {!. T'~
Address: to ~ So?> b kJ Y 19 r"'I. ~,
-0-~tl1bJ= /2-[. .3 ~() or.:t.
Date: -5 --t 2-'bq
5
FLORIDA DEPARTMENT OF CORRECTIONS 05/12/09
IBSR176 (90) INITIAL PAYMENT FOR FILE FEE 13:46:09
FOR: 05/12/2009 PAGE 1
DC # 924820 INMT NAME MCLEOD, STEVEN A. CURR BAL $ 0.00
HOLDS $ 0.00 LIENS $ 1,693.60 SPENDABLE $ 0.00
DATE RANGE MONTHLY AVERAGE DEPOSITS MONTHLY AVERAGE BALANCES
11/13 - 12/12 $ 0.00 $ 0.00
12/13 - 01/11 $ 0.00 $ 0.00
01/12 - 02/10 $ 0.00 $ 0.00
02/11 - 03/12 $ 0.00 $ 0.00
03/13 - 04/11 $ 0.00 $ 0.00
04/12 - 05/11 $ 0.00 $ 0.00
AVERAGE OVER 6 MONTHS DEPOSITS $ 0.00
BALANCES $ 0.00
CALCULATED INITIAL PAYMENT : $ .0.00
FLORIDA DEPARTMENT OF CORRECTIONS 05/05/09
IBSR140 (74) TRUST FUND ACCOUNT STATEMENT 13:30:34
FOR: 11/05/2008 - 05/05/2009 PAGE 1
ACCT NAME: MCLEOD, STEVEN A. ACCT#: 924820
BED: 12214L TYPE: INMATE TRUST
PO BOX:
BEGINNING BALANCE 11/05/08 $0.00
POSTED REFERENCE
DATE NBR TYPE NUMBER FAC REMITTER/PAYEE +/ AMOUNT BALANCE
------- -- -------------- ----------- - - ------------------------ - - --------- --------------
11/13/08 231 LEGAL COPIES WD 20081106 000 - $0.00 $0.00
LIEN CREATED - 11/13/2008 20081106
11/20/08 227 LEGAL COPIES WD 20081112 000 - $0.00 $0.00
LIEN CREATED - 11/20/2008 20081112
11/20/08 234 LEGAL POSTAGE W 11142008 000 - $0.00 $0.00
LIEN CREATED - 11/20/2008 11142008
11/25/08 174 LEGAL POSTAGE W 20081119 000 - $0.00 $0.00
LIEN CREATED - 11/25/2008 20081119
11/25/08 174 LEGAL POSTAGE W 20081119A 000 - $0.00 $0.00
LIEN CREATED - 11/25/2008 20081119A
11/26/08 144 LEGAL POSTAGE W 20081107 000 - $0.00 $0.00
LIEN CREATED - 11/26/2008 20081107
11/26/08 192 LEGAL POSTAGE W 20081120 000 - $0.00 $0.00
LIEN CREATED - 11/26/2008 20081120
12/15/08 236 LEGAL POSTAGE W 120308 000 - $0.00 $0.00
LIEN CREATED - 12/15/2008 120308
12/16/08 199 LEGAL COPIES WD 120208 000 - $0.00 $0.00
LIEN CREATED - 12/16/2008 120208
12/24/08 187 LEGAL POSTAGE W 121208 000 - $0.00 $0.00
LIEN CREATED - 12/24/2008 121208
01/08/09 290 LEGAL POSTAGE W 20081218 000 . $0.00 $0.00
LIEN CREATED - 01/08/2009 20081218
01/08/09 348 LEGAL POSTAGE W 12232008 000 - $0.00 $0.00
LIEN CREATED - 01/08/2009 12232008
01/08/09 386 LEGAL COPIES WD 20081222 000 - $0.00
LIEN CREATED $0.00
- 01/08/2009 20081222
01/08/09 386 LEGAL COPIES WD 20081217 000 - $0.00 $0.00
LIEN CREATED - 01/08/2009 20081217
01/09/09 188 LEGAL POSTAGE W 20081223 000 $0.00 $0.00
LIEN CREATED - 01/09/2009 20081223
01/09/09 188 LEGAL POSTAGE W 20081223A 000 - $0.00 $0.00
LIEN CREATED - 01/09/2009 20081223A
01/09/09 218 LEGAL COPIES WD 20081229 000 - $0.00 $0.00
LIEN CREATED - 01/09/2009 20081229
01/15/09 198 LEGAL POSTAGE W 12.30.08 000 - $0.00 $0.00
LIEN CREATED - 01/15/2009 12.30.08
01/15/09 198 LEGAL POSTAGE W 12.31.08 000 - $0.00 $0.00
LIEN CREATED - 01/15/2009 12.31.08
01/15/09 208 LEGAL POSTAGE W 20081230 000 - $0.00 $0.00
LIEN CREATED - 01/15/2009 20081230
01/20/09 129 LEGAL POSTAGE W 20081216 000 - $0.00
LIEN CREATED $0.00
- 01/20/2009 20081216
01/21/09 126 LEGAL COPIES WD 20090113 000 - $0.00 $0.00
LIEN CREATED - 01/21/2009 20090113
FLORIDA DEPARTMENT OF CORRECTIONS 05/05/09
IBSR140 (74) TRUST FUND ACCOUNT STATEMENT 13:30:34
FOR: 11/05/2008 - 05/05/2009 PAGE 2
ACCT NAME: MCLEOD, STEVEN A. ACCT#: 924820
BED: 12214L TYPE: INMATE TRUST
PO BOX:
POSTED REFERENCE
DATE NBR TYPE NUMBER FAC REMITTER/PAYEE +/ AMOUNT BALANCE
------- -- -------------- ----------- - - ------------------------ -- --------- --------------
01/21/09 126 LEGAL COPIES WD 20090116 000 - $0.00 $0.00
LIEN CREATED - 01/21/2009 20090116
01/29/09 228 LEGAL POSTAGE W 20090122 000 - $0.00 $0.00
LIEN CREATED - 01/29/2009 20090122
01/29/09 228 LEGAL POSTAGE W 20090123 000 - $0.00 $0.00
LIEN CREATED - 01/29/2009 20090123
02/11/09 340 LEGAL COPIES WD 20090203 000 - $0.00 $0.00
LIEN CREATED - 02/11/2009 20090203
02/11/09 340 LEGAL COPIES WD 20090206 000 - $0.00 $0.00
LIEN CREATED - 02/11/2009 20090206
02/13/09 133 LEGAL COPIES WD 012109 000 - $0.00 $0.00
LIEN CREATED - 02/13/2009 012109
02/13/09 133 LEGAL COPIES WD 012209 000 - $0.00 $0.00
LIEN CREATED - 02/13/2009 012209
02/13/09 133 LEGAL COPIES WD 012309 000 - $0.00 $0.00
LIEN CREATED - 02/13/2009 012309
02/19/09 134 LEGAL POSTAGE W 20090202 000 - $0.00 $0.00
LIEN CREATED - 02/19/2009 20090202
02/19/09 134 LEGAL POSTAGE W 20090205 000 - $0.00 $0.00
LIEN CREATED - 02/19/2009 20090205
02/19/09 179 LEGAL POSTAGE W 02132009 000 - $0.00 $0.00
LIEN CREATED - 02/19/2009 02132009
02/24/09 227 LEGAL COPIES WD 20090213 000 - $0.00 $0.00
LIEN CREATED - 02/24/2009 20090213
02/24/09 227 LEGAL COPIES WD 20090213A 000 - $0.00 $0.00
LIEN CREATED - 02/24/2009 20090213A
02/26/09 210 LEGAL POSTAGE W 20090220 000 - $0.00 $0.00
LIEN CREATED - 02/26/2009 20090220
02/26/09 210 LEGAL POSTAGE W 20090209 000 - $0.00 $0.00
LIEN CREATED - 02/26/2009 20090209
02/26/09 210 LEGAL POSTAGE W 20090209A 000 - $0.00 $0.00
LIEN CREATED - 02/26/2009 20090209A
03/05/09 128 ID CARDS WD 021809 000 - $0.00 $0.00
LIEN CREATED - 03/05/2009 021809
03/05/09 128 ID CARDS WD 021709 000 - $0.00 $0.00
LIEN CREATED - 03/05/2009 021709
03/05/09 230 LEGAL POSTA.GE W 20090225 000 - $0.00 $0.00
LIEN CREATED - 03/05/2009 20090225
03/05/09 230 LEGAL POSTAGE W 20090227 000 - $0.00 $0.00
LIEN CREATED - 03/05/2009 20090227
03/11/09 177 LEGAL COPIES WD 030609 000 - $0.00 $0.00
LIEN CREATED - 03/11/2009 030609
03/12/09 123 LEGAL COPIES WD 22709 000 - $0.00 $0.00
LIEN CREATED - 03/12/2009 22709
03/12/09 151 LEGAL POSTAGE W 03032009 000 - $0.00 $0.00
LIEN CREATED - 03/12/2009 03032009
FLORIDA DEPARTMENT OF CORRECTIONS 05/05/09
IBSR140 (74) TRUST FUND ACCOUNT STATEMENT 13:30:34
FOR: 11/05/2008 - 05/05/2009 PAGE 3
ACCT NAME: MCLEOD, STEVEN A. ACCT#: 924820
BED: 12214L TYPE: INMATE TRUST
PO BOX:
POSTED REFERENCE
DATE NBR TYPE NUMBER FAC REMITTER/PAYEE +/- AMOUNT BALANCE
-------- --- --------------- ------------ - -- ------------------------- --- ---------- ---------------
03/25/09 148 LEGAL COPIES WD 20090320 000 - $0.00 $0.00
LIEN CREATED - 03/25/2009 20090320
03/26/09 223 LEGAL POSTAGE W 031309 000 - $0.00 $0.00
LIEN CREATED - 03/26/2009 031309
04/14/09 176 LEGAL COPIES WD 20090403 000 - $0.00 $0.00
LIEN CREATED - 04/14/2009 20090403
04/15/09 168 LEGAL POSTAGE W 040209 000 - $0.00 $0.00
LIEN CREATED - 04/15/2009 040209
04/16/09 127 LEGAL COPIES WD 040309 000 - $0.00 $0.00
LIEN CREATED - 04/16/2009 040309
04/24/09 291 LIEN PAYMENT 030509128011 000 - $0.00 $0.00
ID CARDS WD - 03/05/2009 021709
04/24/09 292 LIEN PAYMENT 030509128010 000 - $0.00 $0.00
ID CARDS WD - 03/05/2009 021809
04/24/09 316 LEGAL COPIES WD 2053412 000 - $0.00 $0.00
LIEN CREATED - 04/24/2009 2053412
04/24/09 316 LEGAL COPIES WD 2053413 000 - $0.00 $0.00
LIEN CREATED - 04/24/2009 2053413
04/29/09 174 LEGAL COPIES WD 042209 000 - $0.00 $0.00
LIEN CREATED - 04/29/2009 042209
ENDING BALANCE 05/05/09 $0.00
LIEN LIEN AMOUNT AMOUNT
DATE TYPE OF LIEN FACL OF LIEN STILL OWED
SUMMARY LEGAL POSTAGE $104.46 $104.46
SUMMARY LEGAL COPIES $284.70 $284.69
SUMMARY MEDICAL CO-PAYMENT $8.00 $8.00
SUMMARY STATE PRISON LITIGATION $806.09 $526.09
11/13/08 LEGAL COPIES 000 $3.45 $3.45
11/20/08 LEGAL COPIES 000 $8.25 $8.25
11/20/08 LEGAL POSTAGE 000 $4.76 $4.76
11/25/08 LEGAL POSTAGE 000 $1.65 $1.65
11/25/08 LEGAL POSTAGE 000 $24.45 $24.45
11/26/08 LEGAL POSTAGE 000 $1.74 $1.74
11/26/08 LEGAL POSTAGE 000 $6.43 $6.43
12/15/08 LEGAL POSTAGE 000 $10.50 $10.50
12/16/08 LEGAL COPIES 000 $41.55 $41.55
12/24/08 LEGAL POSTAGE 000 $0.59 $0.59
FLORIDA DEPARTMENT OF CORRECTIONS 05/05/09
IBSR140 (74) TRUST FUND ACCOUNT STATEMENT 13:30:34
FOR: 11/05/2008 - 05/05/2009 PAGE 4
ACCT NAME: MCLEOD, STEVEN A. ACCT#: 924820
BED: I2214L TYPE: INMATE TRUST
PO BOX:
LIEN LIEN AMOUNT AMOUNT
DATE TYPE OF LIEN FACL OF LIEN STILL OWED
------- ----------------------------- - - - ---------- ----------
01/0S/09 LEGAL COPIES 000 $S.40 $S.40
01/08/09 LEGAL COPIES 000 $0.90 $0.90
01/08/09 LEGAL POSTAGE 000 $2.10 $2.10
01/08/09 LEGAL POSTAGE 000 $3.55 $3.55
01/09/09 LEGAL POSTAGE 000 $0.42 $0.42
01/09/09 LEGAL COPIES 000 $42.60 $42.60
01/09/09 LEGAL POSTAGE 000 $0.42 $0.42
01/15/09 LEGAL POSTAGE 000 $13.97 $13.97
01/15/09 LEGAL POSTAGE 000 $0.59 $0.59
01/15/09 LEGAL POSTAGE 000 $0.59 $0.59
01/20/09 LEGAL POSTAGE 000 $0.42 $0.42
01/21/09 LEGAL COPIES 000 $9.45 $9.45
01/21/09 LEGAL COPIES 000 $1.50 $1.50
01/29/09 LEGAL POSTAGE 000 $3.24 $3.24
01/29/09 LEGAL POSTAGE 000 $7.71 $7.71
02/11/09 LEGAL COPIES 000 $43.50 $43.50
02/11/09 LEGAL COPIES 000 $3.00 $3.00
02/13/09 LEGAL COPIES 000 $0.90 $0.90
02/13/09 LEGAL COPIES 000 $1.65 $1.65
02/13/09 LEGAL COPIES 000 $31.65 $31.65
02/19/09 LEGAL POSTAGE 000 $9.12 $9.12
02/19/09 LEGAL POSTAGE 000 $8.05 $8.05
02/19/09 LEGAL POSTAGE 000 $9.89 $9.89
02/24/09 LEGAL COPIES 000 $37.50 $37.50
02/24/09 LEGAL COPIES 000 $2.55 $2.55
02/26/09 LEGAL POSTAGE 000 $1.68 $1.68
02/26/09 LEGAL POSTAGE 000 $5.20 $5.20
02/26/09 LEGAL POSTAGE 000 $1.68 $1.68
03/05/09 LEGAL POSTAGE 000 $1.93 $1.93
03/05/09 LEGAL POSTAGE 000 $7.46 $7.46
03/11/09 LEGAL COPIES 000 $0.60 $0.60
03/12/09 LEGAL COPIES 000 $4.50 $4.50
03/12/09 LEGAL POSTAGE 000 $5.80 $5.80
03/13/09 FEDERAL PRISON LITIGATION 215 $350.00 $350.00
03/25/09 LEGAL COPIES 000 $1.80 $1.80
03/26/09 LEGAL POSTAGE 000 $3.70 $3.70
04/14/09 LEGAL COPIES 000 $2.70 $2.70
04/15/09 LEGAL POSTAGE 000 $0.42 $0.42
04/16/09 LEGAL COPIES 000 $0.60 $0.60
04/24/09 LEGAL COPIES 000 $0.30 $0.30
FLORIDA DEPARTMENT OF CORRECTIONS 05/05/09
IBSR140 (74) TRUST FUND ACCOUNT STATEMENT 13:30:34
FOR: 11/05/2008 - 05/05/2009 PAGE 5
ACCT NAME: MCLEOD, STEVEN A. ACCT#: 924820
BED: I2214L TYPE: INMATE TRUST
PO BOX:
LIEN LIEN AMOUNT AMOUNT
DATE TYPE OF LIEN FACL OF LIEN STILL OWED
---------- ----------
04/24/09 LEGAL COPIES 000 $0.45 $0.45
04/29/09 LEGAL COPIES 000 $1.95 $1.95
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