U.S. District Court Case No.49-MC-2016 Chapter 11 Bankruptcy Appeal Re in Forma Pauperis Application June 13, 2016

7/26/2019 U.S. District Court Case No.49-MC-2016 Chapter 11 Bankruptcy Appeal Re in Forma Pauperis Application June 13,

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PAE AO 240 (Rev. 10/ 09) - Appli cati on to Proceed in Di st rict Court W ithout Prepayi ng Fees or Costs (Short F orm) Page 1

_____________________________________________________________

UNITED STATES DISTRICT COURTFOR THE

EASTERN DISTRICT OF PENNSYLVANIA______________________________________________________________________________

__________________________________ ) ____________________________________Plaintiff )

__________________________________ ) ____________________________________v. ) Civil Action No.

__________________________________ ) ____________________________________

Defendant )__________________________________ ) ____________________________________

)

__________________________________ ) ____________________________________)

__________________________________ ) ____________________________________

______________________________________________________________________________APPLICATION FOR PRISONERS TO PROCEED IN DISTRICT COURT WITHOUT PREPAYING FEES OR COSTS

(Short Form)

I am a plaintiff or petitioner in this case and declare that I am unable to pay the costs of these proceedingsand that I am entitled to the relief requested.____________________________________________________________________________________________

In support of this application, I answer the following questions under penalty of perjury:

1. If incarcerated. I am being held at: _________________________________________________

____________________________________________________________________________________________

I am employed there, or have an account in the institution, I have attached to this document a statementcertified by the appropriate institutional officer showing all receipts, expenditures, and balances during the last sixmonths for any institutional account in my name. I am also submitting a similar statement from any other institutionwhere I was incarcerated during the last six months.

2. If not incarcerated. If I am employed, my employers name and address are:________________________________________________________________________________________________________________________________________________________________________________________

My gross pay or wages are: $ , and my take-home pay or wages are: $________________

per _______________________.(specify pay period)

3. Other Income. In the past 12 months, I have received income from the following sources (checkall that apply):

(a) Business, profession, or other self-employment G Yes G No(b) Rent payments, interest, or dividends G Yes G No(c) Pension, annuity, or life insurance payments G Yes G No(d) Disability, or workers compensation payments G Yes G No(e) Gifts, or inheritances G Yes G No(f) Any other sources G Yes G No

16-MC-2016

In Re Stanley J. Caterbone, MOVANT

Not Employed

Case No 16-MC-2016 In Forma Pauperis Page 1 of 23 June 13, 2016

U.S. Bankruptcy Court for the Eastern District of

Pennsylvania Case No. 16-10517


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PAE AO 240 (Rev. 10/ 09) - Appli cati on to Proceed in Di st rict Court W ithout Prepayi ng Fees or Costs (Short F orm) Page 2

If you answered Yes to any question above, describe below or on separate pages each source of money

and state the amount that you received and what you expect to receive in the future.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

4. Amount of money that I have in cash or in a checking or savings account: $

5. Any automobile, real estate, stock, bond, security, trust, jewelry, art work, or other financialinstrument or thing of value that I own, including any item of value held in someone elses name(describe the property and its approximate value):

______________________________________________________________________________

6. Any housing, transportation, utilities, or loan payments, or other regular monthly expenses

(describe and provide the amount of the monthly expense): _______________________________

______________________________________________________________________________

______________________________________________________________________________

7. Names (or, if under 18, initials only) of all persons who are dependent on me for support, myrelationship with each person, and how much I contribute to their support:______________________________________________________________________________

8. Any debts or financial obligations(describe the amounts owed and to whom they are payable):______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

____________________________________________________________________________________________

Declaration: I declare under penalty of perjury that the above information is true and understand that afalse statement may result in a dismissal of my claims.

______________________ __________________________________________Date Applicants signature

__________________________________________Printed name

____________________________________________________________________________________________

9. Certification of Prisoners Institutional Account Balance:An authorized prison official mustcomplete the certification below, and furnish a certified copy of your institutional account statement showing alldeposits, withdrawals, and balances for the prior six-month period, to be filed with this application.

I certify that the prisoner named herein has the sum of $ __________________ on account at_______________________________________ correctional institution, where he is presently confined.

I further certify that during the prior six-month period, the prisoners average monthly account balance was$ _________________; and that the average amount deposited monthly in the account during the prior six-monthperiod was $ __________________.

__________________________________________ ________________________Signature and Title of Authorized Prison Official Date

See Attached Schedules For More Detailed Financial Information

Social Security Benefits of $1,357.00 per month from 2008; declaredDisabled in December 2005; Verified Benefits for Symptoms and IllnessesRelated to U. S. Sponsored Mind Control Technologies.

See Schedules Attached

None


None


June 13, 2016

Stanley J. Caterbone



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U.S. District Court Case No.49-MC-2016 Chapter 11 Bankruptcy Appeal Re in Forma Pauperis Application June 13, 2016