Re: Seizure #38957
                                                                                                                Case # GGBB0027
                                                                                                                 Prop: $9,340.00
                                                                                                                 Seizure date: 3-7-88
                                                                                                                 Seizure place: Raleigh, North Carolina
                                                                                                                 Owner: Michael Doe
 

I, Michael Doe, declare under penalty of perjury that I am the claimant in the above-entitled case; that in support of my motion to proceed without being required to pay a cost bond, I state that because of my poverty I am unable to pay the cost bond; that I believe I am entitled to redress; and that the issues which I desire to present on appeal are the following:

I further swear that the responses which I have made to the questions and instructions below relating to my ability to pay the cost of prosecuting the appeal 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 your last employment and the amount of the salary and wages per month which you received.

ANSWER: I am not presently employed because I am incarcerated in the Cuyahoga County Jail in Cleveland, Ohio. Before my arrest and extradition to Ohio on February 15, 1990, I was employed at [employer & address omitted], New York. I earned $175 per week.

2. Have you received within the past twelve months any income from a business, profession or other form of self-employment, or in the form of rent payments, interest, dividends, or other source?

a. If the answer is yes, describe each source of income, and state the amount received from each during the past twelve months.

ANSWER: I earned $175 per week while I was working at Ronnie's Auto Garage. Other than that the only money I earned was occasional temporary jobs as a disk jockey at parties. I worked as a disk jockey once every two months or so. I earned approximately $5000 or less last year in my disk jockey jobs.

3. Do you own any cash or checking or savings account?

a. If the answer is yes, state the total value of the items owned.

ANSWER: No, I do not own any cash or checking or savings account.

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

a. If the answer is yes, describe the property and state its approximate value.

ANSWER: Yes, I own a 1987 Nissan Maxima worth $9,500.

5. List the persons who are dependent upon you for support and state your relationship to those persons.

ANSWER: I have three children who were dependent upon me until my arrest.

I declare under penalty of perjury that the foregoing is true and correct.
 

Executed on _________.                                                                            __________________________
                                                                                                                                Michael Doe