Clerk

UNITED STATES COURT OF APPEALS
FOR THE NINTH CIRCUIT

FILED

AUG 11 2014

MOLLY C. DWYER, CLERK
U.S. COURT OF APPEALS

In re: HIGH-TECH EMPLOYEE
ANTITRUST LITIGATION,

SIDDHARTH HARIHARAN; et al.,

Plaintiffs - Appellees,

v.

ADOBE SYSTEMS, INC.; et al.,

Defendants - Appellees,

v.

BRAD GREENSPAN, Proposed
Intervenor,

Movant - Appellant.
No. 14-16528

D.C. No. 5:11-cv-02509-LHK

U.S. District Court for Northern
California, San Jose

ORDER

A review of the docket reflects that appellant has not paid the docketing and
filing fees for this appeal. Within 21 days from the date of this order, appellant
shall: (1) file a motion with this court to proceed in forma pauperis; (2) pay $505 to
the district court as the docketing and filing fees for this appeal and provide proof
of payment to this court; or (3) otherwise show cause why the appeal should not be
dismissed for failure to prosecute. The filing of a motion to proceed in forma
pauperis will automatically stay the briefing schedule under Ninth Circuit Rule 27-
Case: 14-16528 08/11/2014 ID: 9199536 DktEntry: 2-1 Page: 1 of 2 (1 of 9)
11. Any motion to proceed in forma pauperis must include a financial declaration
such as the attached Form 4.
If appellant fails to comply with this order, this appeal will be dismissed
automatically by the Clerk for failure to prosecute. See 9th Cir. R. 42-1.

FOR THE COURT:
Molly C. Dwyer
Clerk of Court

Cyntharee K. Powells
Deputy Clerk

Form 4. Affidavit Accompanying Motion for Permission to Appeal In Forma Pauperis
Appellant(s) or Petitioner(s)
v.
Appellee(s) or Respondent(s)
Affidavit in Support of Motion
I swear or affirm under penalty of perjury that, because of
my poverty, I cannot prepay the docket fees of my appeal
or post a bond for them. I believe I am entitled to redress. I
swear or affirm under penalty of perjury under United
States laws that my answers on this form are true and
correct. 28 U.S.C. sec. 1746; 18 U.S.C. sec. 1621.
Signed:
Case No.
Instructions
Complete all questions in this application and then sign it. Do
not leave any blanks: if the answer to a question is "0," "none,"
or "not applicable (N/A)," write in that response. If you need
more space to answer a question, attach a separate sheet of
paper identified with your name, your case's docket number, and
the question number.
Date:
My issues on
appeal are:
-1-
UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT
Average monthly amount during
the past 12 months
Amount expected next month
Income Source
You Spouse You Spouse
Employment
$
$
$
Self-Employment
Income from real property
(such as rental income)
Interest and Dividends
$
$
Gifts
Alimony
Other (specify)
Public-Assistance (such as welfare)
Unemployment Payments
Disability (such as social security,
insurance payments)
Retirement (such as social security,
pensions, annuities, insurance)
$
$
Child Support
$
$
$
$
$
TOTAL MONTHLY INCOME:
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
For both you and your spouse estimate the average amount of money received from each of the
following sources during the past 12 months. Adjust any amount that was received weekly, biweekly,
quarterly, semiannually, or annually to show the monthly rate. Use gross amounts, that is, amounts
before any deductions for taxes or otherwise.
1.
-2-
List your employment history for the past two years, most recent employer first.
(Gross monthly pay is before taxes or other deductions.)
2.
Employer Address
Dates of
Employment
Gross Monthly
Pay
From
To
To
From
To
From
$
$
$
To
From
$
List your spouse's employment history for the past two years, most recent employer first.
(Gross monthly pay is before taxes or other deductions.)
Employer Address
Gross Monthly
Pay
From
To
To
From
To
From
$
$
$
To
From
$
Dates of
Employment
3.
-3-
4.
How much cash do you and your spouse have? $
Below, state any money you or your spouse have in bank accounts or in any other financial institution.
Financial Institution Type of Account Amount You Have
Amount Your Spouse
Has
$
$
$
$
$
$
$
$
If you are a prisoner seeking to appeal a judgment in a civil action or proceeding, you must attach a
statement certified by the appropriate institutional officer showing all receipts, expenditures, and balances
during the last six months in your institutional accounts. If you have multiple accounts, perhaps because
you have been in multiple institutions, attach one certified statement of each account .
List the assets, and their values, which you own or your spouse owns. Do not list clothing and ordinary
household furnishing.
5.
Home
$
Value Other Real Estate
Value
$
Motor Vehicle 1: Make & Year
Motor Vehicle 2: Make & Year
Model
Model
Registration #
Registration #
Value
Value
$
$
-4-
Other Assets
Value
$
$
$
State every person, business, or organization owing you or your spouse money, and the amount owed. 6.
Person owing you or your spouse Amount owed to you Amount owed to your spouse
$
$
$
$
$
$
Name Relationship Age
State the persons who rely on you or your spouse for support. If a dependent is a minor, list only the
initials and not the full name.
7.
-5-
Estimate the average monthly expenses of you and your family. Show separately the amounts paid by
your spouse. Adjust any payments that are made weekly, biweekly, quarterly, semiannually, or annually
to show the monthly rate.
8.
-6-
You Spouse
$ $
Rent or home-mortgage payment (include lot rented for mobile home)
- Are real estate taxes included?
- Is property insurance included?
Yes
Yes
No
No
Utilities (electricity, heating fuel, water, sewer, and telephone)
$ $
$ $
$ $
Home maintenance (repairs and upkeep)
Food
$ $
$ $
$ $
$ $
$ $
Clothing
Laundry and dry-cleaning
Medical and dental expenses
Transportation (not including motor vehicle payments)
Recreation, entertainment, newspapers, magazines, etc.
Insurance (not deducted from wages or included in mortgage payments)
- Homeowner's or renter's.........................................................................................................
$
- Life..........................................................................................................................................
$
- Health......................................................................................................................................
$
- Motor Vehicle.........................................................................................................................
$
- Other:
$
$
$
$
$
Taxes (not deducted from wages or included in mortgage payments)
Specify:
$
$
$
$ $
$ $
$ $
$ $
- Motor Vehicle.........................................................................................................................
- Department Store
- Credit Card
- Motor Vehicle.........................................................................................................................
Installment payments
(name):
(name):
Alimony, maintenance, and support paid to others
$ $
Regular expenses for the operation of business, profession, or farm
(attach detailed statement)
$ $
Other (specify) $ $
Total Monthly Expenses:
$ $
Do you expect any major changes to your monthly income or expenses or in your assets or liabilities
during the next 12 months?
9.
No Yes
If yes, describe on an attached sheet.
No Yes
Have you spent--or will you be spending--any money for expenses or attorney fees in connection with
this lawsuit?
10.
If yes, how much? $
-7-
Provide any other information that will help explain why you cannot pay the docket fees for your
appeal.
11.
State the city and state of your legal residence. 12.
State City
Your age: Your years of schooling:
Your daytime phone number (ex., 4153558000):
Last four digits of your Social Security Number (ex.,6789):

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UNITED STATES COURT OF APPEALS

FOR THE NINTH CIRCUIT

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