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Complete all questions in this application and then sign it. Do not leave any blanks: if the answer to a question is "0,".List creditors and amount owed: 6. The motion must include a copy of the affidavit filed in the district court and the district court's statement of reasons for its action. Complete the case caption as you did on the motion for leave to proceed in forma pauperis. You must complete and file a Petition For Leave to File In. Forma Pauperis (Form 1. 1) and a Financial Affidavit (Form 1.2). I, , being duly sworn, state that I am the Plaintiff and that I do not have the funds available to pay the costs of filing and service in this case. Instructions For Completing. Petition To Proceed.