Texas Court of Appeals, 1st District (Houston) October 6, 2015, 01-15-00849-CV (in Re Derrick A. Polly)

01-15-00 <M<i-cv

AFFIDAVIT

UNSWORN DECLARATION

IN FORMA PAPERIS

My name is Derrick Anthony Polly/ my date of birth is/ 12/10/1963, and

my inmate identifying number is 609271. I am presently incarcerated in the

Texas Department of Criminal Justice's Robertson Unit/ in Abilene/ Jones

County/ Texas/ 79601.