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This is a request asking the Court to let you file your case for free. A judge does not automatically grant these requests.I receive the following public benefits and my gross income, including the cash benefits marked below, does not exceed 187. You need only complete the Poverty Affidavit if you are requesting to proceed IFP and do NOT receive Department of Human Services (DHS) assistance or SSI. If you are filing more than one case, a separate Poverty Affidavit is required for each case. Motion and Affidavit in Support of Request to Proceed As a Poor Person. Affidavit of Poverty — April 2011. I am financially unable to pay the filing fee. Complete and sign the Pauper's Affidavit. Is your Poverty Affidavit completely filled out?