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Montana Affidavit of Inability to Pay Form

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Montana Affidavit of Inability to Pay Form
Montana Affidavit of Inability to Pay Form
[Affidavit of Inability to Pay Filling Fees and Costs and Order], Page 1 of 3
© 20__ Montana Supreme Court Commission on Self-Represented Litigants and [8 April 2010, Self-Help Law Center]
Use of this form is restricted to not-for-profit purposes.
____________________________________
Name
____________________________________
Address
____________________________________
City State Zip Code
____________________________________
Phone Number
PETITIONER PRO SE
Montana_______Judicial District Court
__________________________County
_______________________,
Petitioner/Plaintiff
and
________________________,
Respondent /Defendant
Cause No.: ________________
Affidavit of Inability to Pay
Filing Fees and Other Costs
in Accordance with § 25-10-
404 through 406, MCA
STATE OF MONTANA )
) ss
County of _______________________ )
I, _____________________________________, being first duly sworn, upon oath depose and
say:
1. I am the petitioner/plaintiff or respondent/defendant in the above-entitled proceeding.
2. I have a good cause of action and am unable to pre-pay the costs or to procure security to
secure the same, in accordance with § 25-10-404 through 406, MCA. See Attachment A.
DATED this _____ day of ______________________________, 20___.
Subscribed and sworn to before me this _____ day of ______________, 20___.
___________________________________________
Sign Name
___________________________________________
Signature, Notary Public for the State of Montana
___________________________________________
Print Name
Residing at___________________________________
My Commission expires:________________________
Montana Affidavit of Inability to Pay Form
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