Fill and Sign the Fifteenth Judicial District Court Parishes of Acadia Lafayette Form

_____________ : ________ JUDICIAL DISTRICT COURT VS : PARISH OF ________, LOUISIANA _____________ : DOCKET NO. ________ _______________________________________________________________________________ PETITION FOR CONTEMPT FOR NON-PAYMENT OF MEDICAL EXPENSES NOW INTO COURT, through undersigned counsel, comes mover, _____________, who suggests to this Honorable Court that pursuant to the Judgment previously rendered herein on t he ___ day of ________ 20___, Defendant, _____________, was ordered to pay one-half ( 2) of the medical expenses not covered by insurance from ________ ___, 20___ forward. A copy of said Judgment is attached hereto and marked Exhibit "A". Respondent, _____________, has not made any payments on the medical expenses as per said Judgment. Mover, _____________, is entitled to attorney's fees and Court cost s incurred for prosecution of this rule. Mover, _____________, is a citizen of this State, and because of her poverty and wa nt of means, she is unable to pay the costs of this petition in advance or as they accrue, or to give security therefor, and desires to file and prosecute this action under the provisions of L a. C.C.P. Arts. 5l8l- 5l88. WHEREFORE, Mover, _____________, prays that she be permitted to prosecute t his action without prior payment of costs or as they accrue and without giving bond for cos ts, according to the provisions of La. C.C.P. Art. 5181. Mover, _____________, further prays that this Honorable Court order Respondent, _____________, to show cause, if he can, on a date and at a time to be fixed by thi s Honorable Court, why: l. He should not be held in contempt of this Court for failing and refusing to pay one-half of the medical expenses not covered by insurance from ________ ___, 20___ forward. 2. Respondent, _____________, should not be ordered to pay attorney's fees and Court costs incurred by mover for prosecution of this rule. ________________________________ _____________ Attorney at Law ________, LA ________ (___)________ La. Bar Roll No. ________ _____________ : ________ JUDICIAL DISTRICT COURT VS : PARISH OF ________, LOUISIANA _____________ : DOCKET NO. ________ _______________________________________________________________________________ O R D E R Considering the foregoing motion, IT IS ORDERED that the Mover, _____________, be permitted to prosecute this action without prior payment of costs or as they accrue and without giving bond for cos ts, according to the provisions of La. C.C.P. Art. 5l8l. IT IS FURTHER ORDERED that a Petition for Contempt for Non-Payment of Medical Expenses issue herein directed unto Respondent, _____________, ordering him to appear and show cause, if he can, on the _____ day of ____________, 20___, at ___ o’clock ___.M., wh y: l. He should not be held in contempt of this Court for failing and refusing to pay one-half ( 2) of the medical expenses not covered by insurance from ___ ___, 20___forward. 2. Respondent, _____________, should not be ordered to pay attorney's fees and Court costs incurred by Mover for prosecution of this rule. THUS DONE AND SIGNED this _____ day of _______________, 20___, at _____________, Louisiana. ______________________________ DISTRICT JUDGE Please serve Defendant at: _____________ ________, LA ________