UNITED STATES COURT OF APPEALS
FOR THE NINTH CIRCUIT

EUN JUNG LIM
Appellant,
v.
IRVINE CITY, et al.
Respondents

CASE NUMBER: __

On Appeal from the US District
Court for the Central District of
California

APPELLANT’S MOTION TO PROCEED IN FORMA PAUPERIS

COMES NOW Appellant, pro se, and moves this Honorable Court to grant
this Motion to Proceed In Forma Pauperis upon filing her Appeal Brief. In support
thereof, Appellant submits the attached Affidavit in Support of Motion. As shown
by the affidavit, Appellant does not have the funds to pay the filing fee to initiate
an appeal of the District Court’s interlocutory decision and requests that the filing
fees be waived.
WHEREFORE, Appellant moves the Court to grant this Motion.

Respectfully submitted: [ENTER DATE]


[ENTER NAME]
[ENTER ADDRESS]
Appellant, Pro Se

UNITED STATES COURT OF APPEALS
FOR THE NINTH CIRCUIT

EUN JUNG LIM
Appellant,
v.
IRVINE CITY, et al.
Respondents

CASE NUMBER: __

On Appeal from the US District
Court for the Central District of
California

AFFIDAVIT IN SUPPORT OF APPELLANT’S MOTION TO PROCEED IN

FORMA PAUPERIS

COMES NOW Appellant under oath and pursuant to Rule 24(5) of the Federal
Rules of Appellate Procedure. In support of this affidavit, Appellant shows the
following:

  1. I am the Appellant in this case.
  2. I am [ENTER AGE] years old.
  3. I am therefore competent to swear on the matters said herein.
  4. I am currently unemployed. I have been unemployed approximately
    [ENTER PERIOD YOU HAVE BEEN UNEMPLOYED].
  5. On [ENTER DATE], I applied for state benefits (Calfresh) and got
    approved on February 1, 2022. Accordingly, I now live on food stamps.

WHEREFORE, I am unable to pay for the cost of filing this Appeal and other court
costs associated with this Appeal, and I request that this Honorable Court allow me to
proceed in forma pauperis.

Respectfully submitted:

[ENTER DATE]

SWORN AND SUBSCRIBED

Before me, this day of , 2022.

Notary Public


[ENTER NAME]
[ENTER ADDRESS]
Appellant, Pro Se

UNITED STATES COURT OF APPEALS
FOR THE NINTH CIRCUIT

EUN JUNG LIM
Appellant,
v.
IRVINE CITY, et al.
Respondents

CASE NUMBER: __

On Appeal from the US District
Court for the Central District of
California

ORDER

Having read and considered Appellant’s Motion To Proceed In Forma
Pauperis and Affidavit in support thereof, the Court finds Appellant is indigent and

IT IS HEREBY ORDERED Appellant be allowed to proceed in forma pauperis in
the above-referenced case.

SO ORDERED, this the _ day _____of, 2022.


JUDGE, US COURT OF APPEALS FOR THE NINTH CIRCUIT

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