1

IN THE CIRCUIT COURT OF THE (Your Courts District Number, e.g., FIRST, SECOND,
THIRD, and etc.) JUDICIAL CIRCUIT AND IN FOR SAINT LUCIE COUNTY, (Your state).
YOUR REAL NAME
)
(Affiant/Secured Party) )
VS.
)
)
STATE OF _________
)
(Respondents)
)
________________________)

CASE NO: _____________________

JUDGE: _______________________

AFFIDAVIT TO PROCEED IN FORMA PAUPERIS

The affiant, Your Real Name, in Propria Persona (my own proper self), formerly known as the
artificial person, STRAWMAN NAME, is a Noble of the Washitaw Nation of Muurs (Moors),
better known as, Uaxashaktun de Dugdahmoundyah, also known as, Amurru Washitaw de
Dugdahmoundyah, which is an off branch of the Kushite Empire, the Ottoman Empire, and the
Songhai Empire, which later became the Al-Moroccan Empire; to wit: North, South, Central
America, and the including the adjoining Islands; upon his inherited Nobility, and upon his
private Aboriginal/Indigenous, In Full Life, status and commercial liability, I, Your real name,
being duly affirmed under Consanguine Unity; pledge my national, political, and spiritual
allegiance to my Moabite/Moorish Nation; being the archaic Aboriginals/Indigenes of
Amexem/Ameru/Amurru/Al-Moroco/Amaru-Ka/Amen-Ra-Ka (the Americas), standing squarely
affirmed upon my Oath to the Five Points of Light - Love, Truth, Peace, Freedom, and Justice;
deposes as follows:
The affiant is not a lawyer and his pleadings cannot be treated as such. In fact, according to
Haines v. Kerner, 404 U.S. 519 (1972), a complaint, "however inartfully pleaded," must be held
to "less stringent standards than formal pleadings drafted by lawyers" and can only be dismissed
for failure to state a claim if it appears "beyond doubt that the plaintiff can prove no set of facts
in support of his claim which would entitle him to relief." Id., at 520-521, quoting Conley v.
Gibson, 355 U.S. 41, 45-46 (1957).
1. Affiant is currently on unemployed.

2. Affiant is currently receiving food stamps.

3. The affiant owns no assets, stocks, bonds, car(s), and etc.

4. The affiant cannot possible pay for filing fees and/or court fees associated with the action
due to his present income.

5. The affiant is not receiving any funds anywhere else; therefore, prepayment of fees
should be waived.

6. Affiant asserts that according to Article 1, Section X of the United States Constitution,
All debts shall be payable in gold or silver coin. The affiant clearly has no gold or
silver to pay all of the debt associated with this action. This fact alone, coupled with all of
the other grounds, gives this Honorable good cause to allow this case to proceed without
the prepayment of fees.

7. Not allowing the affiants action to proceed without prepayment of fees when affiant has
clearly demonstrated that he cannot afford to pay the filing fees is a denial of Access to
the Courts, in violation of the First, Fifth, and Fourteenth Amendments of the United
States Constitution.

WHEREFORE, based upon the foregoing grounds and the authority cited therein, the affiant
respectfully requests this Honorable Court to allow this action to proceed without prepayment of
filing fees, In The Interest of Justice.

VERIFICATION
STATE OF FLORIDA
SS. AFFIDAVIT
COUNTY OF SAINT LUCIE
I, ___________________________, being first duly sworn, under oath, says: that he is the
affiant in this Affidavit and he knows the content of its body; that it is true of his own
knowledge, except as to those matters that are stated in it on his information and belief, and as to
those matters he believes to be true (All Rights Reserved Without Prejudice; U.C.C. 1-207/1308, U.C.C. 1-103.).

_______________________
(Affiant, Your Real Name)
All Rights Reserved Without Prejudice;
U.C.C. 1-207/1-308, U.C.C. 1-103.
Your real name
(Your address)

Sworn to and subscribed before me on this ____ day of_____________ 2013.

____________________________________________
Notary Public At Large State of your state.

My Commission expires: ____________________________________

CERTIFICATE OF SERVICE
I hereby certify that a true and correct copy of the foregoing affidavit has been furnished by US
Mail to: The Clerk of The Circuit Court, P. O. Box 700, Fort Pierce, Florida, 34954, on this
___day of ________________2013. (File with your clerk of circuit court. You file this only if
you have to record everything as a law suit against the state.)

Respectfully Submitted
by: ______________________
Affiant, Your Real Name.
All Rights Reserved Without Prejudice;
U.C.C. 1-207/1-308, U.C.C. 1-103.
Your real name
(Your Address)