Severson, Paula et al v. University of Wisconsin, Madison, WI et al

IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF WISCONSIN
PAULA MARIE SEVERSON and
GEORGE LEROY SEVERSON,
Plaintiffs,
v.
UNIVERSITY OF WISCONSIN,
MADISON, WI, et al.,
Defendants.
ORDER
Case No. 25-cv-942-wmc
Plaintiffs Paula Marie Severson and George Leroy Severson have filed a proposed civil
complaint. 	Plaintiff Paula Severson asks for leave to proceed without prepayment of fees or
costs. 	To make a determination as to whether plaintiffs qualify for indigent status, plaintiff
George Severson must submit a financial affidavit, which I am enclosing with this order.
ORDER
IT IS ORDERED that plaintiff George Leroy Severson may have until December 15,
2025, in which to submit an affidavit of indigency and return it to the court.
Entered this 17th day of November, 2025.
BY THE COURT:
/s/
ANDREW R. WISEMAN
United States Magistrate Judge
Case: 3:25-cv-00942-wmc Document #: 5 Filed: 11/17/25 Page 1 of 5

UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF WISCONSIN
GEORGE LEROY SEVERSON, et al.
Plaintiffs,
v.
UNIVERSITY OF WISCONSIN,
MADISON, WI, et al.,
Defendants.
ORDER
Case No. 25-cv-942-wmc
NON-PRISONER REQUEST TO PROCEED IN DISTRICT COURT
WITHOUT PREPAYING THE FILING FEE
Answer the following questions to the best of your ability.
Note: If you do not tell the truth, the court may dismiss your lawsuit.
I. 	Personal Information
1) 	Are you employed? 	□Yes 	□ No
2) 	Are you married? 	□ Yes 	□ No
If “Yes,” is your spouse employed? 	□ Yes 	□ No
3) 	Do you have any dependents that you are responsible for supporting?
□ Yes 	□ No
If “Yes,” list them below:
Name or initials (for 	Relationship to You 	Age 	Amount of Support
minor children only) 	Provided per Month
________________________ 	_________________ 	________ 	$____________
________________________ 	_________________ 	________ 	$____________
________________________ 	_________________ 	________ 	$____________
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II. 	Income - If you are married, your answers must include your spouse's income.
(When calculating income, include any wages, salary, rent, child support, public
assistance, unemployment compensation, disability payments, life insurance payments,
pensions, annuities, workers' compensation, stock dividends and interest, gifts and
inheritance, or other money you receive from any source.)
1) 	State your total monthly wages or salary? 	$ ______________
2) 	Provide the name and address of your employer(s):
______________________________________________________________
3) 	State your spouse's total monthly wages or salary? 	$ ______________
State the amount of money you have received from any other source in the last twelve months,
such as the sources listed above. Please attach an additional sheet if necessary.
Source of income 	Amount
______________________________________________ 	$ ______________________
______________________________________________ 	$ ______________________
III. 	Expenses - If you are married or have dependents, your expenses should also include
your household's expenses.
(When calculating household expenses, you may include groceries, clothing, medical
costs, utilities that are not included in your rental payments, transportation, and
insurance.)
1) 	Identify the following amounts that you pay per month:
□ Rent or 	□ Mortgage 	$ __________________________________
Car payment(s) 	$ __________________________________
Alimony or court-ordered child support 	$ __________________________________
Credit card payment(s) 	$ __________________________________
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2) 	Do you have any other monthly expenses that you have not already listed?
□ Yes 	□ No
If “Yes,” list them below:
Expense 	Amount
____________________________ 	$ __________________________________
____________________________ 	$ __________________________________
____________________________ 	$ __________________________________
3) 	What are your total monthly expenses? 	$___________________________________
IV. 	Property - If you are married, your answers must include your spouse's property.
1) 	Do you own a car? 	□ Yes 	□ No 	If “Yes,” list car(s) below:
Make and Model 	Year 	Approximate Current
Value
_______________________________________________ __________ 	$________________
_______________________________________________ __________ 	$________________
2) 	Do you own your home(s)? 	□ Yes 	□ No
If “Yes,” state the approximate value(s). 	$ ____________________
What is the amount of equity (assessed value of residence minus outstanding
mortgage balance) in the home(s)? 	$ ____________________
3) 	Do you have any cash or checking, savings, or other similar accounts?
□ Yes 	□ No
If “Yes,” state the total of such sums. 	$_____________________________
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4) 	Do you own any other property of value, such as real estate, stocks, bonds, trusts, or
individual retirement accounts (e.g., IRA, 401 k), artwork or jewelry?
□ Yes 	□ No
If “Yes,” describe the property and the approximate value(s).
________________________________________________________________
V. 	Other Circumstances - Describe any other financial circumstance(s) that you would like
the court to consider when reviewing this petition.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
I, ____________________, declare that I am the plaintiff bringing this complaint. I
declare that I am unable to prepay the fee and that I am entitled to the relief sought in the
complaint.
___________________________ 	_________________________________________
Date 	Signature - Signed Under Penalty of Perjury
Case: 3:25-cv-00942-wmc Document #: 5 Filed: 11/17/25 Page 5 of 5