FILED BY. aN
1
IN THE THIRD JUDICIAL DISTRICT KS, DISTRICT COUR’
SHAWNEE COUNTY, KANSAS TARO 7 DIT.
Rove EON mt MAR 13 A 153
Plaintiff
. case wonde VO OD IY
Defendant—
POVERTY AFFIDAVIT
In the district court of Shawnee County; I do solemnly swear that the claim set forth in the petition
herein is just, and I do further swear that, by reason of my poverty, I am unable to pay a docket fee.
My income and assets are as follows: _ 100% Ss OF
Current monthly income:_< C1). Checking account
Savings account: Cash
Home equity:
Estimated automobile value:
Other pertinent financial information:
VERIFICATION
Under penalty of ps certify that the above information and statements are true to the best of