In Forma Pauperis Declaration

UNITED STATES DISTRICT COURT
WESTERN DISTRICT OF TEXAS
San Antonio Division

Barbara Ann Johnson,
Plaintiff,
Civil Action No. __________
[Defendants],
Defendants.

I, Barbara Ann Johnson, declare under penalty of perjury pursuant to 28 U.S.C. § 1746 and request to proceed in forma pauperis under 28 U.S.C. § 1915:

  1. My income is limited to: ______________________________.
  2. I do not have sufficient funds to pay filing fees or court costs.
  3. I do not own substantial assets beyond basic personal property and necessities.
  4. I am unable to afford the costs of appeal should such be necessary.

Accordingly, I respectfully request leave to proceed in forma pauperis.

Executed on this _____ day of __________, 2025.

_________________________
Barbara Ann Johnson
SWORN TO AND SUBSCRIBED before me on this _____ day of __________, 2025.

_________________________
Notary Public, State of Texas