Free Order Denying IFP - District Court of Delaware - Delaware

Case 1:07-cv-00230-JJF Document 4 Filed 05/23/2007 Page1 of 2
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF DELAWARE
RAYMOND E. BLAKE and KAREN )
D. GUY, )
Plaintiffs, g
v. g Civ. Action N0. 07-230-JJF
RAYMOND D. ARMSTRONG, SHAWN g
MARGYNIAK and DAVID C. )
Rossmarum, )
Defendants. g
EEE
At Wilmington this Aigi day of May, 2007, the Court having
considered the Application To Proceed Without Prepayment Of Fees
under 28 U.S.C. § 1915;
IT IS ORDERED that:
l. The application is DENIED without prejudice on the basis
that it is a joint motion submitted on behalf of both Plaintiffs
and the plaintiffs are jointly and severally liable for the
$350.00 filing fee.
2. Plaintiffs shall submit separate Applications To Proceed
Without Prepayment Of Fees And Affidavit within thirty days from
the date of this Order. The Clerk of the Court is directed to
send application forms to each Plaintiff.
Plaintiffs are placed on notice that failure to respond to
this order within the thirty day time period may result in

Case 1:07-cv-00230-JJF Document 4 Filed 05/23/2007 Page 2 of 2
dismissal of the case.
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Case 1 :07-cv—00230-JJF Document 4-2 Filed 05/23/2007 Page 1 of 2
AO 240 (Rev. lU,·'03)
DELAWARIE Rev. 4/OS!
UNITED STATES DISTRICT COURT
DISTRICT OF DELAWARE
rumttrr APPLICATION TO PROCEED
V. WITHOUT PREPAYMENT OF
FEES AND AFFIDAVIT
Defendant(s)
CASE NUMBER:
I, declare that I am the (check appropriate box)
D Petitioner/Plaintiff/Movant El Other
in the above-entitled proceeding; that in support of my request to proceed without prepayment of fees or costs under
28 USC §l9l5, 1 declare that I am unable to pay the costs of these proceedings and that l am entitled to the relief
sought in the complaint/petition/motion.
In support of this application, I answer the following questions under penalty of perjury:
l. Are you currently incarcerated? I:] Yes E] No (If "N0" go to Question 2)
If "YES" state the place of your incarceration
Inmate Identification Number (Required):
Are you employed at the institution? Do you receive any payment from the institution?
Attach a ledger sheet from the t`n.vti!utiorz of your incarceration showing at least the gas! sit mort!/1.r ’
transactions
2. Are you currently employed'? E Yes D No
a. If the answer is "YES" state the amount of your take—home salary or wages and pay period a
and give the name and address of your employer.
b. lf the answer is "NO" state the date of your last employment, the amount of your take-home
salary or wages and pay period and the name and address of your last employer.
3. In the past l2 twelve months have you received any money from any of the following sources?
a. Business, profession or other self-employment Et Yes D No
b. Rent payments, interest or dividends Et Yes Et No
c. Pensions, annuities or life insurance payments Et Yes Et No
d. Disability or workers compensation payments III Yes Cl No
e. Gifts or inheritances Ct Yes El No
li Any other sources El Yes El No
Ifthe answer to any of the above is "YES" describe each source of money and state the amount ·
received AND what you expect you will continue to receive. {

Ii Case 1 :07-cv—00230-JJF Document 4-2 Filed 05/23/2007 Page 2 of 2
U csi
4. Do you have any cash or checking or savings accounts? El Yes El No
If "Yes" state the total amount 5
5. Do you own any real estate. stocks, bonds, securities, other financial instruments, automobiles or other
valuable property?
El Yes E1 No
If "Yes" describe the property and state its value.
6. List the persons who are dependent on you for support, state your relationship to each person and
indicate how much you contribute to their support, OR state NONE if applicable.
I declare under penalty of perjury that the above infomation is true and correct.
DATE SIGNATURE OF APPLICANT
NOTE TO PRISONER: A Prisoner seeking t0 proceed without prepayment of fees shall submit an affidavit
stating all assets. ln addition, a prisoner must attach a statement certified by the appropriate institutional
officer showing all receipts, expenditures, and balances during the last six months in your institutional accounts.
If you have multiple accounts, perhaps because you have been in multiple institutions, attach one certified
statement of each account.