IN THE SUPERIOR COURT OF ______________ COUNTY

 

STATE OF GEORGIA

 

_____________________________,                  ]

     ]

Petitioner                                       ]

     ]

V.                                                                            ] Civil Action File No. _____________

     ]

_____________________________,                  ]

     ]

Respondent                                   ]

 

PAUPER’S AFFIDAVIT

 

Personally appeared before the undersigned officer, duly authorized by law to administer oaths in the State of Georgia, _____________________________, Petitioner in the above styled case and on oath states that:

I am the Petitioner in the above styled case and that owing to my poverty I am unable to pay any costs in the foregoing matter.  My monthly income is ____________________ and I pay ____________________ per month as rent.

This Affidavit is made pursuant to O.C.G.A. §§ 9-15-2-4 and 15-6-77.

 

_____________________________________

Sworn to and subscribed before me

this _______ day of ____________, 2________

 

________________________________

Notary Public

My commission expires _________________


IN THE SUPERIOR COURT OF ______________ COUNTY

STATE OF GEORGIA

 

_____________________________,                  ]

     ]

Petitioner                                       ]

     ]

V.                                                                            ] Civil Action File No. _____________

     ]

_____________________________,                  ]

     ]

Respondent                                   ]

 

ORDER

 

This Court, having considered the Petitioner’s request to proceed in forma pauperis, hereby grants the request.

 

This __________ day of _______________________, 2________.

 

 

 

___________________________

Judge, Superior Court

_______________ County