In Form Pauperis Overview and Sample Forms

In Forma Pauperis is a Latin term that means in the form of a pauper. It is used when you cannot
afford to proceed with a civil cause of action because of the fees, costs, or security required.

Law You Should Know

A Petition to Proceed In Forma Pauperis (IFP) is a request to the court, that due to your
poverty, you should not have to pay the filing fee ($140 in most Arkansas counties) or
service costs. Note that this is a sworn statement to the court, and any false or misleading
information could be punishable by law.

Whenever you plan to file a civil action, a petition for In Forma Pauperis can be submitted to get
the court to waive the costs involved. Generally, a court will base you ability to pay on what you
own and how much money you make. To get a court to waive the costs, you must file 1) a
petition for In Forma Pauperis; 2) an affidavit of means for In Forma Pauperis; and 3) the judge
must sign the Order Granting Leave to Proceed in Forma Pauperis.

In a IFP, the party seeking a waiver should fill in her name as petitioner. You will need to sign the
Petition and the Supporting Affidavit. You must have the Supporting Affidavit notarized.
Most banks have a notary that can do this for you for free

For the affidavit, the party should fill in her name as the Plaintiff, and then answer each question
honestly and completely. Failing to answer either honestly or completely can result in your
petition being denied and could result in criminal perjury charges being filed against you.

What Happens Next

Although most documents are to be filed in the Court Clerk’s Office of your county these IPF
documents need to be taken directly to the Judge’s Clerk for approval. You may take the forms to
any Circuit Judge in your county. You will also need to take a copy of the Complaint you want to
file with the court to the judge.

If the judge decides that you are unable to pay the filing fee then the judge will sign the Order
Granting Leave to Proceed in Forma Pauperis.

You will then file the Request, Affidavit, and Order with the court clerk. Once all of this has been
filed with the court clerk, you may proceed in filing your Complaint or Petition. The clerk of the
court will generally not file the Request and Affidavit until the Order is entered.

Make sure to keep a copy of all forms for yourself. These forms are available as interactive forms
on www.ArkansasLegalServices.org

Disclaimer:
The ALSP Series is produced by the Arkansas Legal Services Partnership, a
collaboration of the Center for Arkansas Legal Services, and Legal Aid of Arkansas,
Inc. These nonprofit organizations provide free legal services to eligible Arkansans
who meet income, asset and other guidelines. Legal services may include advice and
counsel, brief services, or full representation depending on the situation. Additional
information can be found at: http\\www.arlegalservices.org. To apply for services, call 1-800-9LAW AID.

The information and statements of law in this fact sheet should not be considered legal advice. This fact sheet is provided as a broad
guide to help you understand how consumer law matters are handled in general. Courts may interpret the law differently. Before you
take action, talk to an attorney and follow his or her advice. Always do what the court tells you to do.
 IN THE CIRCUIT COURT OF ________________ COUNTY, ARKANSAS

________________ DIVISION

________________ PLAINTIFF

v. CASE NO. ____________

________________ DEFENDANT

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PETITION FOR LEAVE TO PROCEED IN FORMA PAUPERIS

Comes now the plaintiff ________________, who hereby petitions the court for
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leave to Proceed In Forma Pauperis does allege and state:

1. That plaintiff, a resident of the State of Arkansas, has prepared and desires
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to file with this Court a ________________.

2. That plaintiff’s only income is: ________________.

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3. That plaintiff’s income barely suffices to meet the costs of daily essentials

of life and includes no allotment that could be budgeted to pay for court fees and costs

incident to this proceeding.

4. That plaintiff has no other income in addition to that described above and

no means of paying such costs without being reduced to total impoverishment. An

Affidavit in Support of Request to Proceed In Forma Pauperis is attached as Exhibit “A”.

5. That plaintiff is entitled to the relief requested in the accompanying

complaint and that such action is not brought for a frivolous or malicious purpose.
 WHEREFORE, plaintiff prays that the court enter an order allowing the plaintiff

to prosecute this action In Forma Pauperis and that the plaintiff may have the necessary

writs and processes without payment of fees or costs for the same.

Respectfully submitted,

___________________________________
NAME, pro se

Address: ________________
______________
Phone: ________________

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PL
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 IN THE CIRCUIT COURT OF ________________ COUNTY, ARKANSAS

________________ DIVISION

________________ PLAINTIFF

v. CASE NO. ____________

________________ DEFENDANT

ORDER GRANTING LEAVE TO PROCEED IN FORMA PAUPERIS

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On this day comes on to be heard the petition of ________________
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________________, that he/she be permitted to prosecute the above action in forma

pauperis. The Court being satisfied of the truth of the facts alleged and good cause

appearing thereto, IT IS HEREBY ORDERED:

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1. That ________________ be authorized and permitted to prosecute the

above-captioned action against ________________, in forma pauperis.

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2. That the Clerk of the Court shall receive and file any necessary forms or

pleadings incident to petitioner’s action without requiring the payment of fees or costs.

3. That the sheriffs of the counties of the State of Arkansas shall serve writs

or processes incident to petitioner’s action without requiring the payment of fees or costs.

4. That no other officer shall require of the petitioner any fee or cost incident

to this action.

AND IT IS SO ORDERED.
________________________________
Circuit Judge
________________________________
Date
 IN THE CIRCUIT COURT OF ________________ COUNTY, ARKANSAS

________________ DIVISION

________________ PLAINTIFF

v. CASE NO. ____________

________________ DEFENDANT

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AFFIDAVIT IN SUPPORT OF REQUEST TO PROCEED IN FORMA PAUPERIS
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I, ________________, being first duly sworn, depose and say that I am the

plaintiff in the above entitled cause; that in support of my petition to proceed without
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being required to prepay fees, costs or to pay the costs of said proceeding or to give

security therefore; that I believe I am entitled to redress.

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I further swear that the responses that I have made to questions and instructions

below are true:

1. Are you presently employed? ________

(A) If the answer is yes, state the amount of your salary or wages per month,

and give the name and address of your employer.

________________________________________________

(B) If the answer is no, state the date of last employment and the amount of
the salary and wages per month which you received.
________________________________________________
 2. Have you received within the past twelve (12) months any money from any of the

following sources:

a. Business, profession or any form of self-employment? ________________

b. Rent payments, interest or dividends? ________________

c. Pensions, annuities or life insurance payments? ________________

d. Gifts or inheritances? ________________

e. Any other sources? ________________

f. Explanation of any income sources listed above: ________________

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3. Do you own any cash, or do you have money in a checking or savings

account? If the answer is yes, state the total amount in each account.
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________________

4. Do you own any real estate, stocks, bonds, notes, automobiles, or other
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valuable property (excluding ordinary household furnishings and

clothing)? If the answer is yes, describe the property and states its
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approximate value. ________________

5. List the person(s) who are dependent upon you for support, state your

relationship to those persons, and indicate how much you contribute

toward their support. _______________________________________

________________________________________________________

I understand that a false statement or answer to any questions in this affidavit will
subject me to penalties of perjury.

_____________________________
NAME
 Acknowledgment

On this day before the undersigned, a Notary Public, duly qualified and acting in

and for the county and state aforesaid personally appeared ________________, known to

me or satisfactorily proven, whose name appears as AFFIANT in the foregoing

instrument, and stated that he/she had executed the same for the uses and purposes

therein stated.

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IN WITNESS WHEREOF, I have hereunto set my hand and seal this _________

day of_______, _______.PL

NOTARY PUBLIC
My Commission Expires:
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____________________
SEAL
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