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The applicant will also submit a proposed form of poor person order that the applicant wishes the Justice to sign. Print or type using black ink only.The form poor person order is attached hereto. The completed poor person application and affidavit must be presented to the Office of the. Motion for permission to proceed as a poor person; affidavit; certificate; notice; waiver of fee; when motion not required; NY CPLR § 1102. Marital Status: If Married, Spouse's name:. FILING FEES AND "POOR PERSON" STATUS 28 U.S.C. § 1915(e). 1. Motion and Affidavit in Support of Request to Proceed As a Poor Person. 190(2) as follows: (Check one). Some fee waivers use poor person or pauper in the title.