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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 Petition to Proceed In Forma Pauperis and Affidavit: 1.Complete the caption. Motion and Affidavit to Proceed In Forma Pauperis to the Clerk of Court. Petitioner submits the following financial affidavit of. I have attached an Affidavit to this Petition concerning my financial situation. 5. ☐ I cannot support my family and myself and also pay filing fees and costs. Motion and Affidavit to Proceed In Forma Pauperis to the Clerk of Court. Motion to Proceed On Appeal. The law says an "individual who is unable to pay the costs of court because of his poverty and lack of means" may file without paying court costs.