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Complete all questions in this application and then sign it. Read Affidavit to Accompany Motion for Leave to Appeal in Forma Pauperis, , see flags on bad law, and search Casetext's comprehensive legal database.A party may file a motion to proceed on appeal in forma pauperis in the court of appeals within 30 days after service of the notice prescribed in Rule 24(a)(4). If the answer is no, state the date of your last employment and the amount of the salary and wages per month which you received. 2. Plaintiff's Affidavit accompanies this petition. 3. Motion and Affidavit in Support of Request to Proceed As a Poor Person. Marital Status: If Married, Spouse's name: Number of dependents:. (2) District Court's Duty to Complete Case Appeal Statement. That Plaintiff, a resident of the State of Arkansas, has prepared and desires to file with this Court a . 2. The order of the court of appeals denying petitioner leave to appeal in forma pauperis from the denial of his motion for a new trial (Pet. Exh.