AO 240 Application to Proceed — Athens (Dkt. 63-1, D.N.H.)

Summary

An AO 240 short-form application to proceed without prepaying fees or costs, filed by plaintiff Natasha Athens in Athens v. Megan Scholz & Bank of America, Civil Action No. 1:21-cv-00748-SM (D.N.H.), on December 20, 2021 as Document 63-1. Answering under penalty of perjury, Athens lists pay of $500.00, $750.00 in cash or bank accounts, and 2 loans and 2 rents for a house and store. The application states that Athens's business was closed most of 2021 and that court work has cost revenue, and it objects that the court has defied a right to forgiveness. The 2-page form is dated 11/30/2021 and signed by Athens.

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Full text

                        Case 1:21-cv-00748-SM Document 63-1 Filed 12/20/21 Page 1 of 2

AO 240 (Rev. 07/10) Application to Proceed in District Court Without Prepaying Fees or Costs (Short Form)


                                        UNITED STATES DISTRICT COURT
                                                                  for the
                                                    New HampshireDistrict
                                                      __________  Districtof __________

                          Natasha Athens                                      )
                          Plaintiff/Petitioner                                )
                                   v.                                         )      Civil Action No. 1:21-cv-00748-SM
              Megan Scholz & Bank of America                                  )
                        Defendant/Respondent                                  )


        APPLICATION TO PROCEED IN DISTRICT COURT WITHOUT PREPAYING FEES OR COSTS
                                        (Short Form)

         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.

          In support of this application, I answer the following questions under penalty of perjury:

         1. If incarcerated. I am being held at:                                                                       .
If employed there, or have an account in the institution, I have attached to this document a statement certified by the
appropriate institutional officer showing all receipts, expenditures, and balances during the last six months for any
institutional account in my name. I am also submitting a similar statement from any other institution where I was
incarcerated during the last six months.

          2. If not incarcerated. If I am employed, my employer’s name and address are:




My gross pay or wages are: $                             500.00 , and my take-home pay or wages are: $                   500.00 per
 (specify pay period)                                        .

          3. Other Income. In the past 12 months, I have received income from the following sources (check all that apply):

       (a) Business, profession, or other self-employment                            ✔ Yes
                                                                                     ’                      ’ No
       (b) Rent payments, interest, or dividends                                     ’ Yes                  ’ No
       (c) Pension, annuity, or life insurance payments                              ’ Yes                  ’ No
       (d) Disability, or worker’s compensation payments                             ’ Yes                  ’ No
       (e) Gifts, or inheritances                                                    ’ Yes                  ’ No
       (f) Any other sources                                                         ’ Yes                  ’ No

         If you answered “Yes” to any question above, describe below or on separate pages each source of money and
state the amount that you received and what you expect to receive in the future.
 My business was closed most of 2021, only open scant hours and part time while owing rent. Every day that I have to
 do court issues is a day of revenue lost & there have been many of those while this court has defied my right to
 forgiveness. I should be open today, but I am doing court paperwork (again) I have maxed out my credit cards this
 year due to this fact. And the cost of oil is over $300 a gallon. Frightening times as this court continues to force me to
 appeal a defaulted case.
                       Case 1:21-cv-00748-SM Document 63-1 Filed 12/20/21 Page 2 of 2

AO 240 (Rev. 07/10) Application to Proceed in District Court Without Prepaying Fees or Costs (Short Form)



          4. Amount of money that I have in cash or in a checking or savings account: $                                             750.00 .

         5. Any automobile, real estate, stock, bond, security, trust, jewelry, art work, or other financial instrument or
thing of value that I own, including any item of value held in someone else’s name (describe the property and its approximate
value):

2008 Suburu 1993 Mustang




          6. Any housing, transportation, utilities, or loan payments, or other regular monthly expenses (describe and provide
the amount of the monthly expense):
yes, 2 loans, 2 rents house and store




        7. Names (or, if under 18, initials only) of all persons who are dependent on me for support, my relationship
with each person, and how much I contribute to their support:




          8. Any debts or financial obligations (describe the amounts owed and to whom they are payable):
maxed out credit cards




       Declaration: I declare under penalty of perjury that the above information is true and understand that a false
statement may result in a dismissal of my claims.


Date:             11/30/2021                                                                                Natasha Athens
                                                                                                            Applicant’s signature

                                                                                                            Natasha Athens
                                                                                                               Printed name


File and source

File

63-att1-attachment-to-exhibit-fee-waiver.pdf

Size

276,103 bytes

SHA-256

6188b972c5bae0e783a7fb4f6453ff131082b1372823e3b611de68adb711c75b

Our copy

63-att1-attachment-to-exhibit-fee-waiver.pdf

Original

archive.org