On April 08, 2021 a
Appellate Materials
was filed
involving a dispute between
and
for OTHER CIVIL, OTHER
in the District Court of Tarrant County.
Preview
NOTICE: THIS DOCUMENT CONTAINS SENSITIVE DATA
Cause Number: 23 6 32 4 5 7 3 21
( I tie Clerk's office will fill in the Cause Number when you file t/11s form)
Plaintiff: Gabriel Sanchez In the (check one):
(Pnnt first and last name of the person fl/mg the lawswt.)
____ Ii] District Court
Court D County Court/ County Court at Law
-·~
And Number D Justice Court N
Defendant: Spiral Diner & Bake,y, Gabriel ODE, Jane Doe, Jane Dos, John Doe & John Doe
TARRANT Texas
--------- L :x:- ::u
(Print first and last name of the person being sued.)
County
~;, " :::::0
::0 "">~
•J) ' • :z:....:.!
Statement of Inability to Afford Payment of '(> 00 ·-ii
Court Costs or an Appeal Bond -o nfll
:~ :a:: oO
·-- C
1. Your Information ~ W- ~
My full legal name is: _G_a_b_rie_l_ _ _ _ _ _ _ _s_a_nc_h_e_z_ _ _ _ _ My date of birth is: 01 ··f-p9 ~ -<
First Middle Last MonthlDay/Year
My address is: (Home) 1424 Summit Ave Apt 5051
(Mailing)Fort Worth, TX 76102
My phone number: 817 948-1049 My email:_g_a_be_s_a_nc_h_ez_tx_@_gm_ai_l.co_m_ _ _ _ _ _ _ _ _ _ __
About my dependents: "The people who depend on me financially are listed below.
Name Age Relationship to Me
1 Christene Sanchez 41 Spouse
2_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - - - - - - - - - - - - - -
----------
3
----------------------
4_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - - - - - - - - - - - - - -
5_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - - - - - - - - - - - - - -
6_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - - - - - - - - - - - - - - - -
2. Are you represented by Legal Aid?
D I am being represented in this case for free by an attorney who works for a legal aid provider or who
received my case through a legal aid provider. I have attached the certificate thelegal aid provider
gave me as 'Exhibit: Legal Aid Certificate.
-or-
D I asked a legal-aid provider to represent me, and the provider determined that I am financially eligible
for representation, but the provider could not take my case. I have attached documentation from
legal aid stating this.
or-
[i{ I am not represented by legal aid. I did not apply for representation by legal aid.
3. Do you receive public benefits?
D I do not receive needs-based public benefits. - or -
fl[I receive these public benefits/government entitlements that are based on indigency:
(Check ALL boxes that apply and attach proof to t/Jis form, suc/J as a copy of an eligibility form or check)
Ii:Food stamps/SNAP â–¡ TANF â–¡ Medicaid O CHIP O SSI O WIC O AABD
D Public Housing or Section 8 Housing D Low-Income Energy Assistance D Emergency Assistance
D Telephone Lifeline D Community Care via DADS D LIS in Medicare ("Extra Help")
D Needs-based VA Pension D Child Care Assistance under Child Care and Development Block Grant
D County Assistance, County Health Care, or General Assistance (GA)
D Other: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
© Form Approved by the Supreme Court of Texas by order in Misc. Docket No. 16-9122
Statement of Inability to Afford Payment of Court Costs Page 1 of2
4. What is your monthly income and income sources?
"I get this monthly income:
$ in monthly wages. I work as a Unemployed for _ _ _ _ _ _ _ _ _ ____
Your job title Your employer
$ in monthly unemployment. I have been unemployed since (date) _0_11_15_12_0_2_0 _ _ _ _ _ _ ___
_ _ _ _in public benefits per month.
.._$_350
__$_5o____from other people in my household each month: (List only if other members contribute to your
household income.)
=$_ _ _ _from D Retirement/Pension D Tips, bonuses D Disability D Worker's Comp
D Social Security D Military Housing D Dividends, interest, royalties
D Child/spousal support
D My spouse's income or income from another member of my household (If available)
$_ _ _ _from other jobs/sources of income. (Describe) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
$ 400 is my total monthly income.
5. What is the value of your property? 6. What are your monthly expenses?
"My property includes: Value• "My monthly expenses are: Amount
Cash $ 10.00 Rent/house payments/maintenance $1,240.0(
Bank accounts, other financial assets Food and household supplies $ 500.00
$ 290.00 Utilities and telephone $ 120.00
$ Clothing and laundry $ 60.00
$ Medical and dental expenses $
Vehicles (cars, boats) (make and year) Insurance (life, health, auto, etc.) $ 120.00
Nissan 2017 $ 13,000.0C School and child care $
$ Transportation, auto repair, gas $ 40.00
$ Child / spousal support $
Other property (like jewelry, stocks, land, Wages withheld by court order
another house, etc.) $
$ Debt payments paid to: (List) $
$
--------
$
$ $
Total value of property âž”$ 13,300.0I Total Monthly Expenses âž” $2,080.00
*The value is the amount the item would sell for less the amount you still owe on it, if anything.
7. Are there debts or other facts explaining your financial situation?
"My debts include: (List debt and amount owed)
car payment
------------------------
(If you want the court to consider other facts. such as unusual medical expenses. family emergencies, etc.. attac/J another page to
O
Check here if you attach another page.
this form labeled "Exhibit." Additional Supporting Facts.')
8. Declaration
I declare under penalty of perjury that the foregoing is true and correct. I further swear:
ri:I cannot afford to pay court costs.
c.-;
I cannot furnish an appeal bond or pay a cash deposit to appeal a justice court decision.
My name is Gabriel Sanchez . My date of birth is : ;!2_ / 09/ 1976 .
Summit Ave, Apt 5051 Fort Worth, TX 76102 USA
City State Zip Code Countr;
â–º
-:-:----:-r-t'-=-"':,,.,C--------
signed on 04 /08 / 2021 in
-
Tarrant
-------
County, Texas
- ,.-----
Mont/JIO ayI Ye ar county name State
© Form Approved by the Supreme Court of Texas by order in Misc. Docket No. 16-9122
Statement of Inability to Afford Payment of Court Costs Page 2of2
Document Filed Date
April 08, 2021
Case Filing Date
April 08, 2021
Category
OTHER CIVIL, OTHER
Status
PENDING, TRANSFERRED FROM ANOTHER DISTRICT COURT
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Preview
NOTICE: THIS DOCUMENT CONTAINS SENSITIVE DATA Cause Number: 23 6 32 4 5 7 3 21 ( I tie Clerk's office will fill in the Cause Number when you file t/11s form) Plaintiff: Gabriel Sanchez In the (check one): (Pnnt first and last name of the person fl/mg the lawswt.) ____ Ii] District Court Court D County Court/ County Court at Law -·~ And Number D Justice Court N Defendant: Spiral Diner & Bake,y, Gabriel ODE, Jane Doe, Jane Dos, John Doe & John Doe TARRANT Texas --------- L :x:- ::u (Print first and last name of the person being sued.) County ~;, " :::::0 ::0 "">~ •J) ' • :z:....:.! Statement of Inability to Afford Payment of '(> 00 ·-ii Court Costs or an Appeal Bond -o nfll :~ :a:: oO ·-- C 1. Your Information ~ W- ~ My full legal name is: _G_a_b_rie_l_ _ _ _ _ _ _ _s_a_nc_h_e_z_ _ _ _ _ My date of birth is: 01 ··f-p9 ~ -< First Middle Last MonthlDay/Year My address is: (Home) 1424 Summit Ave Apt 5051 (Mailing)Fort Worth, TX 76102 My phone number: 817 948-1049 My email:_g_a_be_s_a_nc_h_ez_tx_@_gm_ai_l.co_m_ _ _ _ _ _ _ _ _ _ __ About my dependents: "The people who depend on me financially are listed below. Name Age Relationship to Me 1 Christene Sanchez 41 Spouse 2_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - - - - - - - - - - - - - - ---------- 3 ---------------------- 4_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - - - - - - - - - - - - - - 5_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - - - - - - - - - - - - - - 6_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - - - - - - - - - - - - - - - - 2. Are you represented by Legal Aid? D I am being represented in this case for free by an attorney who works for a legal aid provider or who received my case through a legal aid provider. I have attached the certificate thelegal aid provider gave me as 'Exhibit: Legal Aid Certificate. -or- D I asked a legal-aid provider to represent me, and the provider determined that I am financially eligible for representation, but the provider could not take my case. I have attached documentation from legal aid stating this. or- [i{ I am not represented by legal aid. I did not apply for representation by legal aid. 3. Do you receive public benefits? D I do not receive needs-based public benefits. - or - fl[I receive these public benefits/government entitlements that are based on indigency: (Check ALL boxes that apply and attach proof to t/Jis form, suc/J as a copy of an eligibility form or check) Ii:Food stamps/SNAP □ TANF □ Medicaid O CHIP O SSI O WIC O AABD D Public Housing or Section 8 Housing D Low-Income Energy Assistance D Emergency Assistance D Telephone Lifeline D Community Care via DADS D LIS in Medicare ("Extra Help") D Needs-based VA Pension D Child Care Assistance under Child Care and Development Block Grant D County Assistance, County Health Care, or General Assistance (GA) D Other: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - © Form Approved by the Supreme Court of Texas by order in Misc. Docket No. 16-9122 Statement of Inability to Afford Payment of Court Costs Page 1 of2 4. What is your monthly income and income sources? "I get this monthly income: $ in monthly wages. I work as a Unemployed for _ _ _ _ _ _ _ _ _ ____ Your job title Your employer $ in monthly unemployment. I have been unemployed since (date) _0_11_15_12_0_2_0 _ _ _ _ _ _ ___ _ _ _ _in public benefits per month. .._$_350 __$_5o____from other people in my household each month: (List only if other members contribute to your household income.) =$_ _ _ _from D Retirement/Pension D Tips, bonuses D Disability D Worker's Comp D Social Security D Military Housing D Dividends, interest, royalties D Child/spousal support D My spouse's income or income from another member of my household (If available) $_ _ _ _from other jobs/sources of income. (Describe) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ $ 400 is my total monthly income. 5. What is the value of your property? 6. What are your monthly expenses? "My property includes: Value• "My monthly expenses are: Amount Cash $ 10.00 Rent/house payments/maintenance $1,240.0( Bank accounts, other financial assets Food and household supplies $ 500.00 $ 290.00 Utilities and telephone $ 120.00 $ Clothing and laundry $ 60.00 $ Medical and dental expenses $ Vehicles (cars, boats) (make and year) Insurance (life, health, auto, etc.) $ 120.00 Nissan 2017 $ 13,000.0C School and child care $ $ Transportation, auto repair, gas $ 40.00 $ Child / spousal support $ Other property (like jewelry, stocks, land, Wages withheld by court order another house, etc.) $ $ Debt payments paid to: (List) $ $ -------- $ $ $ Total value of property ➔$ 13,300.0I Total Monthly Expenses ➔ $2,080.00 *The value is the amount the item would sell for less the amount you still owe on it, if anything. 7. Are there debts or other facts explaining your financial situation? "My debts include: (List debt and amount owed) car payment ------------------------ (If you want the court to consider other facts. such as unusual medical expenses. family emergencies, etc.. attac/J another page to O Check here if you attach another page. this form labeled "Exhibit." Additional Supporting Facts.') 8. Declaration I declare under penalty of perjury that the foregoing is true and correct. I further swear: ri:I cannot afford to pay court costs. c.-; I cannot furnish an appeal bond or pay a cash deposit to appeal a justice court decision. My name is Gabriel Sanchez . My date of birth is : ;!2_ / 09/ 1976 . Summit Ave, Apt 5051 Fort Worth, TX 76102 USA City State Zip Code Countr; ► -:-:----:-r-t'-=-"':,,.,C-------- signed on 04 /08 / 2021 in - Tarrant ------- County, Texas - ,.----- Mont/JIO ayI Ye ar county name State © Form Approved by the Supreme Court of Texas by order in Misc. Docket No. 16-9122 Statement of Inability to Afford Payment of Court Costs Page 2of2