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

Case 1:07-cv-00230-JJF Document 10 Filed 07/16/2007 Page 1 012
IN THE UNITED STATES DISTRICT COURT - |
I FORCLTHE DISTRICT OF DELAWARE
RAYMOND E. BLAKE, ) ‘ I I
Plaintiff, I I
v. I Civil Action No. 07-230 JJF
RAYMOND D. ARMSTRONG, SRANN I
MARGYNIAR, DAVID c. ROSENELUM,) I
Defendants. I ,I
AUTHORIZATION I
I, Raymond E. Blake, SBI #377092, request and authorize the I
agency holding me in custody to disburse to the Clerk of the i
Court the initial partial filing fee of $19.15 and the subsequent ,
payments pursuant to 28 U.S.C. § l915(b) and required by the I
Court’s order dated ;h)A4,f5%Mh , 2007. I
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 I
authorization shall apply to any other agency into whose Custody I
I may be transferred. I
Date; `?`[/iél /0% , 2007.
I
, _,,_ ..,..
Q WTTITTT IE Q Signa ure of Plaintiff j
VIIII1@zIIII1 A
. -,,,,.
I

Case ·`L*‘*·~;.;_..
`I;()7_. Q -·-—
» ·- °"*002s0-.1J -—--... .
i I F V *-r· . 7 W7-L;
-_»;,i“:_- I (fx; r___ I"
2.; 6/2007 p
i. *1 age 2 gf 2

E .
é>"" In
3; e
a ·¤!`;:"%:"E* {S3 LC
* =¢:;»;_`2e;»i ;;é ‘ Si 53

::5 `
A
§;$;i;§ BQ I
" ·**· ~¤%¥¤e:5a5;.f¤‘ 1 Pjjjxi
1 D \ °\
S <>
wk E} S?
2) ¤¤
§ Q :5; f
$ "‘· ` 555
%$&2 “
Q} % .3 ‘*I·.s-
Wh}
W Q< ::2:]
A` __ .,,!
\.L *3 Q E j·;¤:·
% V x ba S » ¥‘;.
M" Q Q lpu-it IE5.;
\`n: as ir ,._ {Qi
-p® -f..
SQ M Q :-:g;§
§ @1*;
Q Z 'gn}
éz. M *
Q` »·1 `
x E z - E “
:> G 4 Q
W Q ; ·-¤
ug RU Q na "
géé E S Bi
Q {pj ? 1
0
E gi .¤¤ 3 E
Q g Q
-- B <: §
EE D-• .
E pq “ "‘
H U] H co
¤ Z
. w