On February 15, 2022 a
Appellate Materials
was filed
involving a dispute between
Adimora-Nweke, Ernest,
and
Texas Department Of Public Safety,
for BILL OF REVIEW
in the District Court of Harris County.
Preview
2/15/2022 11:18:49 AM
Marilyn Burgess - District Clerk
Harris County
NOTICE: THIS DOCUME WN HEPWIG HS SENG RAS 3 Envelope No
By: GILBER’
Cause Number: Filed: 2/15/2
Plaintiff: jest Adimora-Nweke In the
oO District Court
(1 County Court
/ County Court at Law
And
(1 Justice Court
Defendant Baylor College of Medicine, Harris Texas
|
artis Health Syste
Statement of Inability to Afford Payment of Court Costs
or an Appeal Bond in Justice Court
1. Your Information
My full legal name is: Ernest Adimora-Nweke My date of birth is: 11_/.05/_1983
My address is:
clo Adimora Law Firm, 3050 Post Oak Blvd, Suite 510, Houston, TX 77056
My phone number: My email:
About my dependents: “The people who depend on me financially are listed below.
>
N/A
2. Are you represented by Legal Aid?
| 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. | have attached the certificate the legal aid provider
gave me as ‘Exhibit: Legal Aid Certificate.
-or-
| asked a legal-aid provider to represent me, and the provider determined that | am financially eligible
for representation, but the provider could not take my case. | have attached documentation from
legal aid stating this.
or-
CX | am not represented by legal aid. | did not apply for representation by legal aid.
3. Do you receive public benefits?
| do not receive needs-based public benefits. -or -
Ir Se benefi en men hat ai cy:
Food stamps/SNAP ANF Medicaid CHIP ssi wic AABD
Public Housing or Section 8 Housing Low-Income Energy Assistance Emergency Assistance
Telephone Lifeline ommunity Care via DADS LIS in Medicare (“Extra Help”)
Needs-based VA Pension hild Care Assistance under Child Care and Development Block Grant
County Assistance, County Health Care, or General Assistance (GA)
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
$__0.00 in monthly wages. | work as a _Attorney/Counsel for Adimora Law Firm, PLLC
$ N/A __in monthly unemployment. | have been unemployed since
$ N/A _ _in public benefits per month
$N/A fi ther le in my household each month
$ N/A from Retirement/Pension Tips, bonuses Disability Worker's Comp
Social Security Military Housing Dividends, interest, royalties
Child/spousal support
My spouse’s income or income from another member of my household
3.0.00 from other jobs/sources of income.
$_0.00 is my fotal 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 $_0 Rent/house payments/maintenance $_~1000_
Bank accounts, other financial assets Food and household supplies $e
0 Utilities and telephone $ ~30-85
Clothing and laundry $ ~ 30 - 40
Medical and dental expenses S_0- 100
Vehicles (cars, boats) Insurance (life, health, auto, etc.) S_0- 80.
School and child care $
Transportation, auto repair, gas $ ~30 - 1500
Child / spousal support SO
Other property (like jewelry, stocks, land Wages withheld by court order
another house, etc.) $ 0
Unliquidated claims TBD Debt payments paid to 0
S$
Unliquidated interest in claims $ TBD $
$
Total value of property —$ TBD Total Monthly Expenses — $ ~1590- 3350
We OF
7. Are there debts or other facts explaining your financial situation?
“My debts include:
plus other litigation loans, unpaid rent, and_personal loans.
A lot of the debts are damages resulting from civil rights violations, and to be claimed and recovered.
io
Check here if you attach another pat
Other facts to be considered are pled in complaint, and can be further explained in court if necessary.
8. Declaration
| declare under penalty of perjury that the foregoing is true and correct. | further swear:
cannot afford to pay court costs
cannot furnish an appeal bond or pay a cash deposit to appeal a justice court decision
My name is _Ernest Adimora-Nweke . My date of birth is: 11 /05/1983.
My address is _C/oAdimora Law Firm, 3050 Post Oak Suite 510 Houston TX 77056 U. S. A
) /s/ Emest Adimora-Nwekesigned on 02/13 12022 Harris ne County, Texas
Signature
© 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 2 of 2
Document Filed Date
February 15, 2022
Case Filing Date
February 15, 2022
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2/15/2022 11:18:49 AM Marilyn Burgess - District Clerk Harris County NOTICE: THIS DOCUME WN HEPWIG HS SENG RAS 3 Envelope No By: GILBER’ Cause Number: Filed: 2/15/2 Plaintiff: jest Adimora-Nweke In the oO District Court (1 County Court / County Court at Law And (1 Justice Court Defendant Baylor College of Medicine, Harris Texas | artis Health Syste Statement of Inability to Afford Payment of Court Costs or an Appeal Bond in Justice Court 1. Your Information My full legal name is: Ernest Adimora-Nweke My date of birth is: 11_/.05/_1983 My address is: clo Adimora Law Firm, 3050 Post Oak Blvd, Suite 510, Houston, TX 77056 My phone number: My email: About my dependents: “The people who depend on me financially are listed below. > N/A 2. Are you represented by Legal Aid? | 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. | have attached the certificate the legal aid provider gave me as ‘Exhibit: Legal Aid Certificate. -or- | asked a legal-aid provider to represent me, and the provider determined that | am financially eligible for representation, but the provider could not take my case. | have attached documentation from legal aid stating this. or- CX | am not represented by legal aid. | did not apply for representation by legal aid. 3. Do you receive public benefits? | do not receive needs-based public benefits. -or - Ir Se benefi en men hat ai cy: Food stamps/SNAP ANF Medicaid CHIP ssi wic AABD Public Housing or Section 8 Housing Low-Income Energy Assistance Emergency Assistance Telephone Lifeline ommunity Care via DADS LIS in Medicare (“Extra Help”) Needs-based VA Pension hild Care Assistance under Child Care and Development Block Grant County Assistance, County Health Care, or General Assistance (GA) 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 $__0.00 in monthly wages. | work as a _Attorney/Counsel for Adimora Law Firm, PLLC $ N/A __in monthly unemployment. | have been unemployed since $ N/A _ _in public benefits per month $N/A fi ther le in my household each month $ N/A from Retirement/Pension Tips, bonuses Disability Worker's Comp Social Security Military Housing Dividends, interest, royalties Child/spousal support My spouse’s income or income from another member of my household 3.0.00 from other jobs/sources of income. $_0.00 is my fotal 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 $_0 Rent/house payments/maintenance $_~1000_ Bank accounts, other financial assets Food and household supplies $e 0 Utilities and telephone $ ~30-85 Clothing and laundry $ ~ 30 - 40 Medical and dental expenses S_0- 100 Vehicles (cars, boats) Insurance (life, health, auto, etc.) S_0- 80. School and child care $ Transportation, auto repair, gas $ ~30 - 1500 Child / spousal support SO Other property (like jewelry, stocks, land Wages withheld by court order another house, etc.) $ 0 Unliquidated claims TBD Debt payments paid to 0 S$ Unliquidated interest in claims $ TBD $ $ Total value of property —$ TBD Total Monthly Expenses — $ ~1590- 3350 We OF 7. Are there debts or other facts explaining your financial situation? “My debts include: plus other litigation loans, unpaid rent, and_personal loans. A lot of the debts are damages resulting from civil rights violations, and to be claimed and recovered. io Check here if you attach another pat Other facts to be considered are pled in complaint, and can be further explained in court if necessary. 8. Declaration | declare under penalty of perjury that the foregoing is true and correct. | further swear: cannot afford to pay court costs cannot furnish an appeal bond or pay a cash deposit to appeal a justice court decision My name is _Ernest Adimora-Nweke . My date of birth is: 11 /05/1983. My address is _C/oAdimora Law Firm, 3050 Post Oak Suite 510 Houston TX 77056 U. S. A ) /s/ Emest Adimora-Nwekesigned on 02/13 12022 Harris ne County, Texas Signature © 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 2 of 2