Petition for contempt for nonpayment of medical expenses and order louisiana form
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_____________ : ________ 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 the
___ 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 costs incurred for
prosecution of this rule.
Mover, _____________ , is a citizen of this State, and because of her poverty and want 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 La. C.C.P.
Arts. 5l8l-5l88.
WHEREFORE, Mover, _____________ , prays that she be permitted to prosecute this
action without prior payment of costs or as they accrue and without giving bond for costs,
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 this 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 costs, 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., why:
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 ________
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