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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)
)
________________________)
JUDGE: _______________________
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)
____________________________________________
Notary Public At Large State of your state.
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)