Free Authorization Form (PLRA) - District Court of Delaware - Delaware

· Case 1:07-cv-00392-SLR Document 8 Filed 07/25/2007 Paget of2
IN THE UNITED STATES DISTRICT couRT
f FOR THE DISTRICT OF DELAWARE. l
SALIH -I-I/-\LL, KENNETH M. SMITH, ) f " 1 1 T f E T
A and LLOYD DIXON, iii, ) , A .
Plaintiffs, g 1
v. g Civil Action No. 07-392-SLR
GOVERNOR RUTH ANN MINNER, g f __ F .,_ U,
JOSEPH SEAU SiDEN, JAMES T. ) { 1 E ,
`,§§§,‘§$,[,“L,°,-?i’{`,,§E,$" DA"'BERG· ""‘°' § .1uL 2 5 20ui T
DGTGHCIGHTS. g ._ ._ M Q
· AUTHORIZATION A EQ Smmhwi
I, Lloyd Dixon, SBI #122634, request and authorize the agency holding me in l
custody to disburse to the Clerk of the Court the initial partial tiling fee of $18.23 and th y
Subsequent payments pursuant to 28 U.S.C. § 1915(b) and required by the Courts l V
order dated June 29, 2007.
This authorization is furnished to the Clerk of Court in connection with the filing
of a civil action, and l understand that the filing fee for the complaint is $350.00. l also
understand that the entire tiling fee may be deducted from my trust account regardless
of the outcome of my civil action. This authorization shall apply to any other agency
into whose custody l may be transferred.
Date: Z · ZJ - ·=¤ Z ,2007. ··
arr we LA

Case'1:07-ci;/;09’§92-SLR D0cument&0.0q Filed 07/25/2007 Page20f2
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