Document for KATHLEEN A HARBER V HEBER SPRINGS POLICE DEPT ETAL

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                                ELECTRONICALLY FILED
                                                                                CLEBURNE COUNTY CIRCUIT COURT
                                                                                  HEATHER SMITH, CIRCUIT CLERK
                                                                                   2024-May-15 16:20:00
                                                                                         12CV-24-108
                                                                                      C16D01 : 3 Pages




 IN THE (1)       Circuit           COURT OF (2)_Cleburne              COUNTY, ARKANSAS

IN RE PETITION OF (3)_ Kathleen Ann Harber
TO PROCEED IN FORMA PAUPERIS

                                                             CASE NO. (4)_12CV-24-108


                 PETITION FOR LEAVE TO PROCEED JN FORMA PAUPERIS

       COMES       NOW the Plaintiff, (5) Kathleen Ann Harber _, pro se, who hereby petitions

the court for Leave to Proceed /n Forma Pauperis and does allege and state as follows:

          1. That Plaintiff, a resident of the State of Arkansas, has prepared and desires to

file with this Court a (6)__   1983 Civil Rights Complaint

        2. That Plaintiff has completed an Affidavit in Support of Request to Proceed In

Forma Pauperis setting out his/her income and assets. Plaintiffs Affidavit accompanies

this petition.

        3. That Plaintiff's income barely suffices to meet the costs of life’s daily essentials

and includes no allotment that could be budgeted to pay for court fees and costs

incident to this proceeding.

        4. That Plaintiff has no other income in addition to that described in his/her

Affidavit and no means of paying such costs without being reduced to total

impoverishment.

        5. That Plaintiff believes that he/she is entitled to the relief requested in the

accompanying (7)1983 Civil Rights Complaintand that such action is not brought for a frivolous

or malicious purpose.
[(To be completed by authorized officer of penal institution)

                                          CERTIFICATE

          | hereby certify that the petitioner herein, Lédnuuun Harbor _, has the sum of $

&   1 .    ° on account to his/her credit at the   Awesr   Bont       institution where he/she

is confined.

| further certify that petitioner likewise has the following securities to his/her credit

according to the records of said institution:




                                              “Shute Sader (9502 Arvest Bank
                                              Authorized Officer of Institution]
WHEREFORE, Plaintiff prays that the court enter an order allowing the Plaintiff to

prosecute this action Jn Forma Pauperis and that the Plaintiff may have the necessary writs and

processes without payment of fees or costs for the same.

                                     Respectfully submitted,

                                     SIGNATURE:                              Le
                                     ADDRESS:          S44  Joptohic Lave Dit
                                                       HeydeeSon    AREAMSAS TLS 4Y
                                     PHONE:            Sie     324   -oetS   7