IN THE _________ COURT _________ , COUNTY,
ARKANSAS
IN RE PETITION OF _________________
TO PROCEED IN FORMA PAUPERIS
NO.___
AFFIDAVIT IN SUPPORT OF REQUEST TO PROCEED IN FORMA PAUPERIS
I, ____________ , being first duly sworn, depose and say that I am the petitioner in the above entitled case; that in support of my motion to proceed without being required to prepay fees, costs or give security therefor, I state that because of my poverty I am unable to pay the costs of said proceeding or to give security therefor; that I believe I am entitled to redress.
I further swear that the responses which I have made to questions and instructions below are true.
Yes ___ No ___
If the answer is yes, state the total amount in each account.
Yes ___ No ___
If the answer is yes, describe the property and state its approximate value.
Do you have any funds in the inmate welfare funds?
Yes ___ No ___
If the answer is yes, state the total amount in such account and have the certificate found below completed by the authorized officer of the institution.]
I understand that false statement or answer to any questions in this affidavit will subject me to penalties for perjury.
______________________________
Signature of Petitioner
STATE OF ___________________
COUNTY OF __________________
Petitioner, ____________ , being first duly sworn under oath, presents that he/she has read and subscribed to the above and states that the information therein is true and correct.
SUBSCRIBED AND SWORN to before me this _____ day of _________ , 2____.
______________________
Notary Public
My commission expires: _________
[(To be completed by authorized officer of penal institution)
CERTIFICATE
I hereby certify that the petitioner herein, _____________ , has the sum of $ ______ on account to his/her credit at the _____________ institution where he/she is confined.
I further certify that petitioner likewise has the following securities to his/her credit according to the records of said institution:
______________________________________________________________________
Authorized Officer of Institution]
Ark. R. Civ. P. 72
COMMENT
Reporter’s Notes: New Rule 72 tracks, with some changes, the former statutory provisions governing suits by indigents. A similar rule was proposed in 1986 but was withdrawn by the Supreme Court prior to its effective date. The former statutes, Ark. Stat. Ann. ยงยง 27-401, 27-403 to -406 (Repl. 1979), were repealed by Act 208, 75th General Assembly, in 1985. Section 27-402 [Ark. Code Ann. 16-58-133 (1987)], adopted in 1981 to replace an earlier provision, was not repealed; however, it is superseded by this rule, which contains in paragraph (b) the requirements of 27-402. The new rule departs from the former statutes and the rule previously proposed by the Court in two ways. First, the rule does not require that the trial court assign counsel, without fee, for the petitioner. Second, the rule does not include the statutory provision allowing the trial court, in its discretion, to annul the in forma pauperis order in the event of “improper conduct” or “willful or unnecessary delay” on the part of the petitioner. The Rules of Civil Procedure contain adequate sanctions that the court may employ in the event of such misconduct. Rules 73-76. [Reserved.]
Reporter’s Notes, 2019: Subdivision (a) was amended to delete “against another” in the first sentence, which had been a source of confusion to some as to its effect on the scope of the rule.