EUN JUNG LIM
[Enter Address]
Plaintiff In Pro Per
UNITED STATES DISTRICT COURT
CENTRAL DISTRICT OF CALIFORNIA
EUN JUNG LIM,
Plaintiff,
vs.
CITY OF IRVINE et al.,
Defendant
Case No.:
DECLARATION IN SUPPORT OF
MOTION FOR LEAVE TO PROCEED IN
FORMA PAUPERIS
COMES NOW Appellant under oath and pursuant to Rule 24 of the Federal Rules of
Appellate Procedure and L.R. 5-2 of the Local Rules for the U.S. District Court, Central District
of California. In support of this affidavit, Plaintiff shows the following:
1. I am the Plaintiff in this case.
2. I am [ENTER AGE] years old.
3. I am of sound mind.
4. I am therefore competent to swear on the matters said herein.
5. I am currently unemployed. I have been unemployed approximately [ENTER
PERIOD YOU HAVE BEEN UNEMPLOYED].
6. I am currently on medical benefits.
7. I am unable to pay the fees and costs for the writ of mandamus.
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MOTION TO PROCEED IN FORMA PAUPERIS
8. I have been proceeding in forma pauperis in the state court, at the trial stage of the
instant action.
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.
Dated: _________________
__________________________
Eun Jung Lim
State of California County of _______________
Subscribed and sworn to (or affirmed) before me on this ______ day of _____________, 20___,
by _______________________ ___________________________________________________,
proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.
(Seal)
Signature______________________
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