WPC 6# UN %] 0(cw4  E= 0J 0T  0^` 0h 0r& 0| 0 0 1u* 0d AQ T 0D 0@^ 0D U > D/ BBO Bl D3 U* U6 B) DCE AM U*  v~ vy D3L BTraining RoomHPPCL5MS,,,,,,0nLV(hH  Z 6Times New Roman RegularX($|\! 3|x*#H2 0Indent123  2" 0Indent20 23  2, 0Indent30 0 23  26 0Indent40 0 0 23  2@ 0Indent50 0 0 0 23  2J 0Indent60 0 0 0 0 23  2T 0Indent70 0 0 0 0 0 23  2^ 0Indent80 0 0 0 0 0 0 23   ?AGMSYaioIndent0I.A.1.a.(1)(a)i)a)P 8Mac DefaultMac Default ` X!"#$&C<< CLevel 1Level 2Level 3Level 4Level 5(3$ !  ("$    ($$   1  <  9p`(&Times New Roman((' dxd dP Pd'''''dxd<  9p`(Times<  9p`(Courier New% Line 7 d,,,,7Border 1dd!#-C << G<  9p`(Arial !%  ""  //   YYY FILED/XOctober28,1996CecilW.CrowsonAppellateCourtClerk  PtPtHH(FG(HH(d'@Styl{WP}01  HH  2$HH  Geneva  <Px443!#4$*$$*$ KK  Geneva  Geneva .,6 Geneva   BA Op Geneva  BA Op Geneva 5555'dxd  d ! . %    X &**Xd&!     \RA'\+L.0-;+'h|`  `L@ INTHESUPREMECOURTOFTENNESSEE@ ATNASHVILLE%  INRE:0 AMENDMENTTORULE29,0 0 RULESOFTHESUPREMECOURTOFTENNESSEE @ ORDER  PursuanttoTenn.CodeAnn.2012127(a)(2),theUniformCivilAffidavitofIndigencydocumentthatispresentlyappendedtoRule29oftheRulesoftheSupremeCourtisherebydeletedinitsentiretyandreplacedwiththeUniformCivilAffidavitofIndigencydocumentappendedtothisOrder. ItissoORDEREDthisthe28thdayofOctober,1996.0 0 0 0 0 FORTHECOURT:0 0 0 0 0 򀀀0 0 0 0 0 ADOLPHOA.BIRCH,JR.0 0 0 0 0 ChiefJustice         +&%%  @ INTHE_______________COURTOF_______________COUNTYA') dE A      )(PLAINTIFF)     )      )VS.      ) CASENO:A')dE$ A      )      )A') dE  A  (DEFENDANT)A') xdExA@ UNIFORMCIVILAFFIDAVITOFINDIGENCY A') xdE-xA  I,______________________________,havingbeendulyswornaccordingtolaw,makeoaththatbecauseofmypoverty,IamunabletobeartheexpensesofthiscaseandthatIamjustlyentitledtothereliefsoughttothebestofmybelief.Thefollowingfactssupportmypoverty.Ӏ1. FullName: A') dE À2. Address: A') dE À3. TelephoneNumber:A')F dEF ]À4. DateofBirth:A') TdE TAӀ5. NamesandAgesofAllDependents: A')P dEP A     RelationshipA')P d?EP A A')P dEP A     RelationshipA')P d?EP A A')P dE !P A     RelationshipA')P d?E !P A A')P dEN"P A     RelationshipA')P d?EN"P A A')P dE#P A     RelationshipA')P d?E#P À6. Iamemployedby:A') LdE &LA Myemployersaddressis:A')$dER'$A Myemployerstelephonenumberis:A')$dE($À7. Mypresentincome,afterfederalincomeandsocialsecuritytaxesarededucted,is:  $____________perweekor$____________permonth.̀8. Ireceiveorexpecttoreceivemoneyfromthefollowingsources:~V` X X%AFDC $A')dE/A  permonthbeginningA')dE/ASSI $A')dE0A  permonthbeginningA')dE0ARetirement $A')dE1A  permonthbeginningA')dE1ADisability $A')dE2A  permonthbeginningA')dE2AUnemployment $A')YdEY/A permonthbeginningA'){!CdE{!/CAWorker'sComp. $A')YdEY0A permonthbeginningA'){!CdE{!0CAOther  $A')YdEY1A permonthbeginningA'){!CdE{!1CA%%&Ҁ9. Myexpensesare:q},n%Rent/HousePymt. $A') HdE 6HA  permonthGroceries  $A') HdE 7HA  permonthElectricity  $A') HdE 8HA  permonthWater  $A') HdE 9HA  permonthGas  $A') HdE ;HA  permonthTransportation $A') HdE <HA  permonthMedical&Dental $A') HdE =HA  permonthTelephone  $A')YdEY6A߀  permonthSchoolSupplies $A')YdEY7A  permonthClothing  $A')YdEY8A  permonthChildCare  $A')YdEY9A  permonthorCourtOrderedChildSupportOther  $A')YdEY <A  permonth%%&10. Assets:% Automobile   $A')HdEHA  (FairMarketValue) Checking/SavingsAccount $A')HdEHA   House   $A')HdEHA  (FairMarketValue) Other   $A')HdE HA  %&11. Mydebtsare: AmountOwed      ToWhom A')4dE4A A')4dE4A  A')4dE4PA A')4dE4A  Iherebydeclareunderthepenaltyofperjurythattheforegoinganswersaretrue,correct,andcompleteandthatIamfinanciallyunabletopaythecostsofthisaction.      A')dEA      PLAINTIFF@ ORDERALLOWINGFILINGONPAUPER'SOATH ItappearsbasedupontheAffidavitofIndigencyfiledinthiscauseandafterdueinquirymadethatthePlaintiffisanindigentpersonandisqualifiedtofilethiscaseonapauper'soath. Itissoorderedthisthe_____dayof_______________,19_____.      A')dE A      JUDGE@ DETERMINATIONOFNONINDIGENCY ItappearingbasedupontheAffidavitofIndigencyfiledinthiscauseandafterdueinquirymadethatthePlaintiffisnotanindigentpersonbecauseA')dEE&AA') xdE,(xA ITISORDEREDANDADJUDGEDthatthePlaintiffdoesnotqualifyforfilingthiscaseonapauper'soath. Thisthe_____dayof_______________,19_____.      A')dE.A      JUDGE54@Z2-58 8 NOTICE:Ifthejudgedeterminesthatbaseduponyouraffidavityouarenoteligibletoproceedunderapauper'soath,youhavetherighttoahearingbeforethejudgeor,inthosecasesthatcanbeappealedtoCircuitCourt,ahearingbeforetheCircuitCourtjudge.%X