Re: Seizure # 144503
                                                                                                            Case # R3920128
                                                                                                            Prop: assorted weapons
                                                                                                            Seizure date: 93 Sept. 22
                                                                                                            Seizure place: Windsor CA
                                                                                                            Owner: John Doe

I, John 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 the cost bond, I state that because of my poverty I am unable to pay the cost bond.

I further swear that the responses which I have made to the questions and instructions below relating to my ability to pay the cost bond are true.

1. Are you presently employed? Yes

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 currently employed in the prison laundry room. I make $___ per month.

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 received $8600 in rental income in the past 12 months. $2300 was used to pay property taxes, utilities, and repairs, and the mortgage on the house in which my children live.

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.

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: My residence at 1234 Main Street, Anytown, CA has been forfeited to the government. (See attached order). The equity in the property was approximately $83,000.

1234 Eastlawn Street, Oakland, CA - Probably worth around $________ - Note -- two of my children and their mother live in this house, rent free, in lieu of child support. The mortgage on this property is in foreclosure.

1234 39th Street, Oakland - Probably worth around $________

The court said of these properties "the value of these properties appears outweighed by [my] various obligations, including child support obligations." See attached order p. 8.

Automobiles and their approximate value:

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

ANSWER: I have seven children -- Richan (date of birth: 2/6/69), Richard Jr. (7/23/71), Samari (4/29/74), Raziel (3/4/85), Richodd (4/10/86), Darreis (12/12/87), Dorado (7/26/94). He also has a granddaughter, Kenshawna (11/20/90). Richan, Richard Jr. and Samari are adults and support themselves. All the rest depend solely on me for support.
 

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

Executed on _________.                                                                    ____________________________
                                                                                                            [signature of claimant]