_____________________________, Petitioner,
                                                                                 No. _____________
v.
                                Judge: ____________

_____________________________, Respondent

    COMES NOW, the petitioner and respectfully moves the court for an order granting said petitioner free process in the above-captioned cause. In support of this application, petitioner has attached to this motion an affidavit of the petitioner's financial status.
Dated this ___ day of _____________, ______.

                        _____________________________
                        Signature of petitioner

                        _____________________________
                        Petitioner's street address

                        _____________________________
                        City, state and zip code

                        _____________________________
                        Petitioner's telephone number

[Approved, effective October 2, 2000.]