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Motion and Declaration for Leave to Proceed in Forma Pauperis. A party may file a motion to proceed on appeal in forma pauperis in the court of appeals within 30 days after service of the notice prescribed in Rule 24(a)(4).The motion must include a copy of the affidavit filed in the district court and the district court's statement of reasons for its action. The court has considered the appellant's motion to proceed in forma pauperis on writ and his supporting affidavit: IT IS ORDERED that the motion be. Remember to answer each question. 5. I, , being duly sworn, state that I am the Plaintiff and that I do not have the funds available to pay the costs of filing and service in this case. The Court waive them and allow Affiant to proceed in forma pauperis. I,. , being first duly sworn, depose and say that I am the petitioner in the above entitled case; that in support of my motion to proceed without being. Make two copies of the papers you are filing. 3. Complete Self Represented Litigant Child Support Modification.