Application To Proceed In District Court Without Prepaying Fees Or Costs Page 5
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AO 239 (Rev. 01/15) Application to Proceed in District Court Without Prepaying Fees or Costs (Long Form)
Regular expenses for operation of business, profession, or farm
(attach detailed
$
$
statement)
Other
:
$
$
(specify)
$
0.00
$
0.00
Total monthly expenses:
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 conjunction with this
’ Yes ’ No
lawsuit?
If yes, how much? $
11.
Provide any other information that will help explain why you cannot pay the costs of these proceedings.
12.
Identify the city and state of your legal residence.
Your daytime phone number:
Your age:
Your years of schooling:
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