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

» Case 1:07-cv-00380-SLR Document 5 Filed 07/O2/2007 Page 1 of 2
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF DELAWARE n ‘l II
LOU GARDEN PRICE, SR., ) I
)
Plaintiff, )
)
v. ) Civ. No. 07-380-SLR
TOM CARROLL, ELIZABETH BURRIS, ) ,
D. PIERCE, DAVID K. HOLIVIAN, )
JOSEPH RICHARDSON, A. PROFACI, ) l;
- D. FIEL-DS, C.O. BASSINGER, -) y
C.O.3 UNK.KlTCHEN, QUANI NEAL, ) _“_____ ‘
ora. Louise oesnoslens, ) ‘i`‘ Ii I
DIETICIAN/NUTRITIONIST CIVIS, ) I -__,_:_ ,.,, l i
and IVI. KNIGHT, ) I II ‘ L_
l li ll itil. - 2 ml ll lt
Defendants. ) *3 ll '· ll, li
Il ll F-·s= K
ll ,nOi Kadena
AUTHORIZATION
I, Lou Garden Price, Sr., SBI #454309 request and authorize the agency holding `
me in custody to disburse to the Clerk of the Court all payments pursuant to 28 U.S.C.
[ .
§ 1915(b) and required by the Court’s order dated Jug; Q Q , 2007.
This authorization is furnished to the Clerk of Court in connection with the filing
of a civil action, and I understand that the filing fee for the complaint is $350.00. I also
understand that the entire filing 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 I may be transferred. `
./’
Date: -Du/\€, , 2007. I
( ggnature of Plaintiff I I I

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