Application to Proceed in District Court Without Prepaying Fees or Costs (Long Form) — Case No. 1:24-cv-03390-RMR (Document 2, USDC Colorado)

Summary

An application to proceed in district court without prepaying fees or costs (AO 239, Long Form), filed 12/06/24 as Document 2 in USDC Colorado Case No. 1:24-cv-03390-RMR by pro se plaintiff Joshua Abrams. In the attached affidavit Abrams states that as of December 6, 2024 total funds available are $117.00, with no significant assets beyond an automobile valued at less than $4,000, and a work contract in the tech field that ends within the next three weeks. The affidavit lists a checking balance of $117, savings of $20, $284 owed on a credit card and a personal loan balance of $1,956, and says the $400 filing fee cannot be paid. It ties the loan in part to the issues in this civil action, described as prolonged underpayment and constitutional violations by the unemployment agency. Account balance documentation and a Navy Federal Credit Union Statement of Account are attached.

Summary drafted by a model from the document's text below and checked by script against that text before publication. It is a navigation aid, not a reading of what the document proves. Where AI is used

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Case No. 1:24-cv-03390-RMR Document2 _ filed 12/06/24

AO 239 (Rev. 01/15) Application to Proceed in District Court Without Prepaying Fees or Costs (Long Form) ,,

of 13

USDC Colorado

pg 1

Page l of 5

UNITED STATES DISTRICT COURT

for the
Plaintiff/Petitioner )
_ f V. ) Civil Action No.
Defendaht/Respondent )

APPLICATION TO PROCEED IN DISTRICT COURT WITHOUT PREPAYING FEES OR COSTS

(Long Form)

Affidavit in Support of the Application

a dismissal of my claims.

Signed:

I am a plaintiff or petitioner in this case and declare
that I am unable to pay the costs of these proceedings
and that I am entitled to the relief requested. I declare
under penalty of perjury that the information below is
true and understand that a false statement may result in

Instructions

Complete all questions in this application and then sign it.
Do not leave any blanks: if the answer to a question is “0,”
“none,” or “not applicable (N/A),” write that response. If
you need more space to answer a question or to explain your
answer, attach a separate sheet of paper identified with your
name, your case's docket number, and the question number.

a

1. For both you and your spouse estimate the average amount of money received from each of the following

sources during the past 12 months. Adjust any amount that was received weekly, biweekly, quarterly,

semiannually, or annually to show the monthly rate. Use gross amounts, that is, amounts before any deductions

for taxes or otherwise.

Income source

Average monthly income

Income amount expected

amount during the past 12 next month
months
You Spouse You Spouse
Employment '
P SZ 5 CO $ SO to §cO
Self-employment $ $ $
Income from real property (such as rental income) $ $ $
Interest and dividends $ § $
Alimony $ $ $
Child support $ $ $
Case No. 1:24-cv-03390-RMR Document2 _ filed

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12/06/24 USDC Colorado pg2

Page 2 of 5
AO 239 (Rev. 01/15) Application to Proceed in District Court Without Prepaying Fees or Costs (Long Form)
Retirement (such as social security, pensions, annuities,
$ $ $ $
insurance)
Disability (such as social security, insurance payments) $ $ § $
Unemployment payment
Public-assistance (such as welfare) $ $ § 5
Other (specify): $ § $ §
Total monthly income: $ ZS co 0.00/18 0.0015 Secs 0.00 |S 0.00
2. List your employment history for the past two years, most recent employer first. (Gross monthly pay is before taxes or
other deductions.)
Employer Address Dates of employment Gross
monthly pay
$
3. List your spouse's employment history for the past two years, most recent employer first. (Gross monthly pay is before
taxes or other deductions.)
Employer Address Dates of employment Gross
monthly pay
/ $
\ 4 $
$
4. slow much cash do you and your spouse have? $ O
Below, state any money you or your spouse have in bank accounts or in any other financial institution.
Financial institution Type of account Amount you have Amount your
spouse has
Now fel Cred Onrlen Check, $ p//7 $
| /
$ $
$ $

If you are a prisoner, you must attach a statement certified by the appropriate institutional officer showing all receipts,
expenditures, and balances during the last six months in your institutional accounts. If you have multiple accounts,
perhaps because you have been in multiple institutions, attach one certified statement of each account.
Case No. 1:24-cv-03390-RMR Document 2
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filed 12/06/24

AO 239 (Rev. 01/15) Application to Proceed in District Court Without Prepaying Fees or Costs (Long Form)

Page 3 of 5

5.
household furnishings.

List the assets, and their values, which you own or your spouse owns. Do not list clothing and ordinary

Assets owned by you or your spouse

Home (Value)

Other real estate (Value)

$ CO

Motor vehicle #/ (Value)

$3 Sco

Make and year: 2 Ojo Honda

Model: Cruice

Registration #: Vin, 7 HO FALF39AM 3/45

Motor vehicle #2 (Value) $
Make and year:
Model:
Registration #:

Other assets (Value) $ &

Other assets (Value)

$ 0

6.

State every person, business, or organization owing you or your spouse money, and the amount owed.

Person owing you or your spouse
money

Amount owed to you

Amount owed to your spouse

_/ 5 $

7. State the persons who rely on you or your spouse for support.

Name (or, if under 18, initials only) Relationship

Age
Case No. 1:24-cv-03390-RMR Document2 _ filed 12/06/24 USDCColorado pg4
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Page 4 of 5

AO 239 (Rev. 01/15) Application to Proceed in District Court Without Prepaying Fees or Costs (Long Form)

8. Estimate the average monthly expenses of you and your family. Show separately the amounts paid by your
spouse. Adjust any payments that are made weekly, biweekly, quarterly, semiannually, or annually to show the
monthly rate.

You Your spouse

Rent or home-mortgage payment (including lot rented for,mobile home)

Are real estate taxes included? OF Yes M/No $ G Cy iy) $

Is property insurance included? C1 Yes MM No
Utilities (electricity, heating fuel, water, sewer, and telephone) $ $
Home maintenance (repairs and upkeep) $ $
Food $ 5eo ¢ $
Clothing $ $
Laundry and dry-cleaning $ $
Medical and dental expenses $ $
Transportation (not including motor vehicle payments) $ Zco $
Recreation, entertainment, newspapers, magazines, etc. $ $

Insurance (not deducted from wages or included in mortgage payments)

Homeowner's or renter's: $ $
Life: $ $
Health: $ $
Motor vehicle: $ / 60 $
Other: $ $
Taxes (not deducted from wages or included in mortgage payments) (specify): $ 5

Installment payments

Motor vehicle: $ $
Credit card (name): Now fel CU $ ZB0 $
Department store (name): $ $
Other: $ $

Alimony, maintenance, and support paid to others $ $
Case No. 1:24-cv-03390-RMR Document2 filed 12/06/24 USDCColorado pg5

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Page 5 of 5
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): $ $
Total monthly expenses: $ Z3 Go _ 9.0018 0.00

10.

LL.

12.

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. See aT Tce h | Vi Con ee7 or werk end 9

Have you spent — orWvill you be spending — any money for expenses or attorney fees in conjunction with this
lawsuit? O Yes No

If yes, how much? $

Provide any other information that will help explain why you cannot pay the costs of these proceedings.

Identify the city and state of your legal residence.

Your daytime phone number: 609 ~ IEF ~F3E0
Yourage: 36 —-Your years of schooling: A ssoctomes cg rere [4 |
Case No. 1:24-cv-03390-RMR Document2 filed 12/06/24 USDC Colorado pg6

of 13

AFFIDAVIT IN SUPPORT OF REQUEST TO PROCEED IN FORMA PAUPERIS

|, Joshua Abrams, being duly sworn, state the following:

1.

4.

Personal Information: | am currently employed as a contractor in the tech field. However,
as of December 6, 2024, | possess only one hundred seventeen dollars ($117.00) in total
funds available to me.

Assets and Liabilities: | have no significant assets aside from a modest automobile valued
at less than four thousand dollars ($4,000). | have no stocks, no real estate, and | rent my
residence. | also have a service dog who lives with me and incurs ongoing expenses.

Current Financial Situation:

o Recently, an unexpected reversal of anticipated holiday pay left me without a week’s
expected earnings. This sudden shortfall has severely impacted my immediate
financial position.

o Mycurrent work contract is scheduled to end within the next three weeks, and! do
not have subsequent employment lined up. Given my current circumstances, |
anticipate needing to apply for unemployment benefits and possibly food
assistance when my contract concludes.

o | wish to clarify any discrepancies that may arise from older financial statements. A
previous account statement, last generated on November 23, 2024, may reflect a
balance of a few thousand dollars. Since that time, | have depleted those funds to
cover uninsured healthcare expenses, leaving me with significantly reduced
resources. As of December 6, 2024, | will provide documentation showing my
current account balances: my checking account holds $117, and my savings
account holds $20. | also owe $284 on a credit card and carry a personal loan
balance of $1,956, with at least $230 due this December. Notably, this personal
loan was incurred in part due to the same underlying issues presented in this civil
action—specifically, the prolonged underpayment and constitutional violations by
the unemployment agency that forced me into desperate financial measures.

inability to Pay Filing Fees: Due to my current and forecasted financial hardship, | am
unable to pay the filing fee of four hundred dollars ($400+) plus any additional service or
related court costs. My situation is best described as indigent, both now and in the
foreseeable future, as | have neither the savings nor incoming revenue to cover these fees.

Request for Waiver: In light of the circumstances described—tlimited funds, few assets,
loss of expected income, impending unemployment, and potential reliance on public
assistance—I respectfully request that the Court grant my application to proceed in forma
pauperis. | simply cannot afford the filing fee or associated expenses at this time.

| declare under penalty of perjury that the foregoing is true and correct.

Date: December £, 202
een Ji Joshua Abrams, Pro Se
Case No. 1:24-cv-03390-RMR Document2 _ filed 12/06/24 USDC Colorado
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Accounts |
Checking $117.14
Savings $19.75
Membership Share Savings - 1384 $19.75

Available Balance

My MakingCents
Credit score, financial goals and tips

Credit Card $284.54 @

Secured nRewards Visa - 8665
Current Balance

$284.54

$20.00 due 12/17/2024 MAKE PAYMENT

Loans $1,956.75

Personal Expense with
Signature - 8002 $1,956.75

Current Balance

$210.06 due 12/23/2024 MAKE PAYMENT

Accounts Move Money Deposits Cards More

pg 7
Case No. 1:24-cv-03390-RMR

NAVY ©
FEDERAL |
Credit Union

PO Box 3000 * Merrifield, VA ¢ 22119-3000

#BWNLLSV

JOSHUA ABRAMS

10722 PARFET ST

WESTMINSTER CO 80021-3585

of 13
Page 1 of S
Statement of Account

Statement Period
10/24/24 - 11/23/24

Access f .

Questions about this Statement?
Toll-free in the U.S. 1-888-842-6328
For toll-free numbers when overseas,

visit navyfederal.org/overseas/

Collect internationally 1-703-255-8837

Say "Yes" to Paperless! View your
digital statements via Mobile or
Navy Federal Online Banking.

Say "Yes" to Paperless Statements...

if you haven't already, go paperless! You can access up to 36 months of statements anytime, anywhere.
To get started, select “Statements” in digital banking.*

It's an easy way to reduce the tisk of identity theft and cut down on paper clutter, —

Insured by NCUA. *Message and data rates may apply. Visit navyfederal.org for more information.

Summary of your deposit accounts

Previous Deposits/ Withdrawals/ Endin YTD
Balance redits "Dobie Ba ance Dividends
71673196 $86.97 $8,666.58 $7,0 18.4 2 $1,718.43 $1.23
Membership Savings oe a :
Totals $341.54 $8,666.70 $7,018.12 $1,990.12 $1.58
ue __ REMITTANCE REREIVED AFTER STATEMENT. PERIOD WILL APPEAR OW your NEXT STATEMENT.
JOSHUA ABRAMS ee ee
oe DEPOSIT VOUCHER
19735578 ~- (FOR MAIL USE ONLY. DO NOT SEND CASH THROUGH THE MAIL
DEPOSITS MAY NOT BE AVAILABLE FOR IMMEDIATE WITHDRAWAL)
MARK "X” TO CHANGE —_— 7167319602 Checking
ADDRESS/ORDER > i
ITEMS ON REVERSE “— 3195941384 Savings
NFCU
PO BOX 3100
MERRIFIELD VA 22119-3100 TOTAL

4057167319602319594134840000000000000000000000000000005
Case No. 1:24-cv-03390-RMR Document2 _ filed 12/06/24

USDC Colorado pgii

of 13
@ Page 4 of 6
NAVY
FEDERAL
Credit Union Statement Period
PO Box 3000 © Merrifield, VA * 22719-3000 10/24/24 - 11/23/24
navytederal.org
Statement of Account Access f
For JOSHUA ABRAMS

e-Checking - 7167319602 (Continued from previous page)
Joint Owner(s): NONE
Date Transaction Detail Amount($) Balance($)
11-07 POS Debit - Debit Card 1414 Transaction 11-06-24 Costco Whse 40440 Westminster

CO 180.71- 4,465.64
11-08 ATM Fee - Withdrawal 11-07-24 Stars Pecos Den Denver CO 1.00- 4,464.64
11-08 ATM Withdrawal 11-07-24 Stars Pecos Den Denver CO 113.30- 4,351.34
11-08 POS Debit- Debit Card 1414 11-07-24 Spothero 844-356-8 Httpsspothero Le 4,75- 4,346.59
11-08 POS Debit- Debit Card 1414 11-07-24 Sushi Neko Arvada co! 43.62- 4,302.97
11-12 ATM Fee - Withdrawal 11-09-24 Pai Iso Broomfield CO i 1.00- 4,301.97
11-12 ATM Withdrawal 1 1-09-24 Pai Iso Broomfield GO 103.50- 4,198.47
11-12 POS Debit- Debit Card 1414 11- 11-24 Spothero 844-356-8 Httpsspothere IL 4.75- 4,193.72
11-12 POS Debit- Debit Card 1414 11-07-24 Safeway #1 $98 Arvada CO 12.09- 4,181.63
11-12 POS Debit- Debit Card 1414 11-09-24 Arbys 8624 Broomtield CO o ~15.34- 4,166.29
11-12 POS Debit - Debit Card 1414 Transaction 1 1-09-24 Costco Gas #0480 Superior CO 20.70- 4,145.59
11-12 POS Debit - Debit Card 1414 Transaction 14-08-04 King Soop 9983 Wadswor :

Westminster 27 :34- 4,118.25
11-12 POS Debit- Debit Card 1414 11-10-24 Uber Help -Uber.Com CA 27.50 4,090.75
11-12 POS Debit- Debit Card 1414 11-11-24 Chipotle 0009 Denver CO 28.30- 4,062.45
11-12 POS Debit- Debit Card 1414 11-11-24 Red Robin No 20 Broomfield CO 29.18- 4,033.27
11-12 POS Debit- Debit Card 1414 11-08-24 Tst* Pizza 3.14 DE Denver CO ~ 40.59- 3,992.68
11-12 POS Debit- Debit Card 1414 11-09-24 Walmart. Com 800-925-6278 ART 41.85- 3,950.83
11-12 POS Debit- Debit Card 1414 14-11-24 Djo, LLG 800-336-6569 CA 83.59- 3,867.24
11-13 Deposit - RTP Paid From Venmo. 98.25 3,965.49
11-13 Deposit - ACH Paid From Robert Half Inc. Payroll 01Afd1 707.27 - 4,672.76
11-13 POS Debit- Debit Card 1414 11-12-24 Wmt Plus Nov 2024 800-966- 6546 AR » 7.01- 4,665.75
11-14 ATM Fee - Withdrawal 11-13-24. Pai Iso Broomfield CO = 1.00+ 4,664.75
11-14 ATM Withdrawal 11-13-24 Pai Iso Broomfield CO 83.50- 4,581.25
11-14 POS Debit- Debit Card 1414 11-12-24 Parrys Pizzeria - 303-451 1313CO. 35,.35- 4,545.90
11-14 POS Debit- Debit Card 1414 11-12-24 Walmart.Com 800925 800-966-6546 AR 42.08- 4,503.82
11-14 POS Debit- Debit Card 1414 11-13-24 Wag N Wash 3011 Broomfield CO. 71.55- 4,432.27
11-14 POS Debit- Debit Card 1414 11-13-24 Church Ranch Veter Westminster CO 272.35- 4,159.92
11-15 POS Credit Adjustment 1414 Transaction 11-12-24 Walmart.com 800926 4.05 4,160.97
11-15 ATM Withdrawal 11-14-24 7Eleven-FC Denver CO 120.00- 4,040.97
11-15 POS Debit- Debit Card 1414 11-14-24 Spothero 844-356-8 Hitpsspothero iL 4.75- 4,036.22
11-18 POS Debit- Debit Card 1414 11-14-24 McDonald's F20128 Lakewood CO 11.59- 4,024.63
11-15 POS Debit - Debit Card 1414 Transaction 11-14-24 Costco Whse #0443 Littleton CO. 113.14- 3,911.49
11-18 POS Debit- Debit Card 1414 11-15-24 Spothero 844-356-8Httpsspothero Ik 4.75- 3,906.74
11-18 POS Debit - Debit Card 1414 Transaction 11-16-24 King Soopers #00 9983

Westminster CO 11.75- 3,894.99
11-18 POS Debit- Debit Card 1414 11-14-24 Fooda Cnp 312-6603250 IL 12.42- 3,882.57
11-18 POS Debit- Debit Card 1414 11-16-24 Arbys 8624 Broomfield CO 15.34- 3,867.23
11-18 POS Debit- Debit Card 1414 11-17-24 Uber Help.Uber.Com CA 36.21- 3,831.02
11-18 POS Debit- Debit Card 1414 11-17-24 Uber Help. Uber.Com CA 46,47- 3,784.55
11-18 POS Debit- Debit Card 1414 11-17-24 Tst*pjs Diner Superior CO 53.41- 3,731.14
11-18 POS Debit- Debit Card 1414 11-15-24 Mika Sushi Il Westminster CO 87 42- 3,643.72
11-18 Transfer To Credit Card 200.00- 3,443.72
11-18 Transfer To Loan 210.06- 3,233.66
11-18 Paid To - Prog Direct Ins Ins Prem Chk 2100002 152.48- 3,081.18
11-19 POS Debit- Debit Card 1414 11-18-24 Spothero 844-356-8 Httpsspothero IL. 4.75- 3,076.43
11-19 POS Debit- Debit Card 1414 11-18-24 Chipotle 0009 Denver CO 11.88- 3,064.55
11-19 POS Debit - Debit Card 1414 Transaction 11-18-24 Costco Gas #0440 Westminster

co 24.69- 3,039.86
of 13

NAVY @
FEDERAL
Credit Union

PO Box 3000 + Merrifield, VA » 22119-3000
navyfederal org

Statement of Account
For JOSHUA ABRAMS

e-Checking - 7167319602
Joint Owner(s): NONE

Case No. 1:24-cv-03390-RMR Document2 _ filed 12/06/24

Statement Period
10/24/24 - 11/23/24

Page 5 of 6

(Continued from previous page)

Date Transaction Detail Amount($) Balance($)
11-19 POS Debit- Debit Card 1414 11-18-24 Welscomm.Com Welscomm.Com CA 1,925.00- 1,114.86
11-20 POS Debit - Debit Card 1414 Transaction 11-19-24 Costco Whse #0440 Westminster
co 2.90- 1,111.96

11-20 POS Debit- Debit Card 1414 11-19-24 Outback #0611 Westminster CO 2 oyu, 35.81- 1,076.15
11-20 POS Debit - Debit Card 1414 Transaction 11-19-24 Costeo Whse #0440 Westminster
11-21 Deposit - RTP Paid From Venmo cee 142.47 1,051.05
11-21 Deposit - ACH Paid From Robert Halt inc. Payroll O1Afdi a 873.05 1,924.10
11-21 POS Debit- Debit Card 1414 11-20-24 Spothero 844-356-8 Httpsspothero IL 4.75- 1,919.35
11-21 POS Debit- Debit Card 1414 11-20-24 Gomer Bakery Cafe Denver CO °14.84- 1,904.51
11-21 POS Debit- Debit Card 1414 11-19-24 Burger King #3897 Westminster CO 17.61- 1,886.90
11-21 POS Debit- Debit Card 1414 11-21-24 Atticus Software Atticus.Pub WY 147.00- 1,739.90
11-22 POS Debit- Debit Card 1414 11-21-24 Uber Help.Uber.ComCA —34.47- 1,705.43
11-22 ATM Rebate 10.00 1,715.43
11-23 Ending Balance . 1,715.43
Average Daily Balance - Current Cycle: $2,294.70 Eee Pe oe :
Your account earned $0.02, with an annual percentage yield earned of 0.05%, for the dividend period trom 10-01-2024 through 10-31-2024

11-18 ACH ee 152.48 11-07 POS - 7.30

10-24 POS 16.23 11-08 POS - 43.62

10-24 POS 22.05 11-08 POS. 4.75

10-24 POS 4.75 11-12 POS: 12.09

10-25 POS 4,75 11-12 see: 15.34

10-28 POS 4.75 11-12 POS 20.70

10-28 POS 9.00 11-12 POS 27.34

10-28 POS. 9.99 11-12 POS 27.50

10-28 POS. SAAS? OPTI POS 28.30

10-28 POS: 22:87 Ph t2 ‘POS 29.18

10-28 POS: 28.44 11-12 POS 40.59

10-28 POS: = 29.90 11-12 POS 41.85

10-28 POS 30.29 11-12 POS 83.59

10-28 POS 38.31 11-12 POS 4.75

10-28 POS. 242.81 11-13 POS 7.01

10-28 POS: 50.29 11-14 POS 42.08

10-29 POS “oot B88 11-14 POS 71.55

10-29 POS Sere. Fd eee odtetaes POS 272.35

10-29 POS “35.56 epg POS 35.35

10-29 POS 40.47. 11-18 POS 11.59

10-29 POS 4179. 11545 POS 113.14

10-29 POS 53:57. . Al POS 4.75

10-29 POS 0:29 “44-18 POS 11.75

10-30 POS 6.76 44-18 POS 12.42

10-30 POS 10.68 11-18 POS 16.34

10-30 POS 13.83 11-18 POS 36.21

10-30 POS 16.58 11-18 POS 46.47

10-30 POS 23.83 11-18 POS §3.41

10-30 POS 81.39 11-18 POS 87.42

10-30 POS 2.90 11-18 POS 4.75

10-31 POS 4.75 11-19 POS 4.75

10-31 POS 950.00 11-19 POS 11.88

10-31 POS 3. 11-19 POS 24.69

11-01 POS 6.65 11-19 POS 1,925.00

11-01 POS 14.04 11-20 POS 2.90

11-01 POS 16.86 11-20 POS 35.81

11-01 POS 4.7 11-20 POS 167.57

11-04 POS 20.00 11-21 POS 4.78

11-04 POS 46.99 11-21 POS 14.84

11-04 POS 86.83 11-21 POS 17.61

11-04 POS 10.07 11-21 POS 147.00

11-05 POS 34.00 11-22 POS 34.47

11-06 POS 11.78 10-34 ATMO 43.50

11-06 POS 19.78 11-07 ATMO 103.50

11-06 POS 4.78 11-07 ATMO 203.25

11-07 POS 21.16 11-08 ATMO 113.30

11-07 POS 26.07 11-12 ATMO 103,50

11-07 POS 180.71 11-14 ATMO 83.50


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