Free Order (PLRA) Missing Documents - District Court of Delaware - Delaware

Case 1:07-cv—00146-SLR Document 3 Filed 03/27/2007 Page 1 of 4
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF DELAWARE
EMANUEL H. JONES, )
Plaintiff, ;
v. ) Civ. N0. 07-148-SLR
CORRECTIONAL MEDICAL SERVICE, g
Defendant. g
O R D E R
1. The plaintiff Emanuel H. Jones, SBI #557338, a rm se litigant who is
presently incarcerated, has filed this action pursuant to 42 U.S.C. § 1983 without
prepayment of the filing fee or a request to proceed m pauperis.
2. Pursuant to 28 U.S.C. § 1915(b), the plaintiff shall be assessed the
filing fee of $350.00.
3. Pursuant to the requirements of 28 U.S.C.
§ 1915(a)(1) and (2), and in order to determine the schedule of payment of the filing
fee, the plaintiff shall submit to the Clerk of Court, a request to proceed Q
pauperis and a certified copy of his prison trust fund account statement
(memorandum or institutional equivalent, with attachments) showing all deposits,
expenditures and balances during the six-month period immediately preceding the
filing of the complaint, obtained from the appropriate official at each institution at which
the plaintiff is confined. FAILURE OF THE PLAINTIFF TO RETURN THE
REQUESTED INFORMATION WITHIN 30 DAYS FROM THE DATE THIS ORDER IS

Case 1:07-cv—00146-SLR Document 3 Filed O3/27/2007 Page 2 of 4
SENT SHALL RESULT IN DISMISSAL OF THIS ACTION WITHOUT PREJUDICE.
4. Unless the Court determines from the plaintiffs financial information
that he has no assets whatsoever, an initial partial filing fee of 20 percent (20%) ofthe
greater of the plaintiffs average monthly deposit or average monthly balance in the trust
fund account shall be required to paid before the court reviews the complaint.
NOTWITHSTANDING ANY PAYMENT MADE OR REQUIRED, THE COURT SHALL
DISMISS THE CASE IF THE COURT DETERMINES THAT THE ACTION IS
FRIVOLOUS OR MALICIOUS, FAILS TO STATE A CLAIM UPON WHICH RELIEF
MAY BE GRANTED, OR SEEKS MONETARY RELIEF AGAINST A DEFENDANT
WHO IS IMMUNE FROM SUCH RELIEF.
5. Pursuant to 28 U.S.C. § 1915(g), if the plaintiff has had three or more
actions dismissed by the Court on the grounds that they were frivolous, malicious, or
failed to state a claim upon which relief may be granted, then the Court shall deny the
plaintiff leave to proceed m pauperis in all future suits filed without prepayment of
the filing fee, unless the Court determines that the plaintiff is under imminent danger of
serious physical injury.
DATED: 3 l¤`*¢=· l°'l
2

Case 1:07-cv—O0146-SLR Document 3 Filed O3/27/2007 Page 3 of 4
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UNITED STATES DISTRICT COURT
DISTRICT OF DELAWARE
piaamarr APPLICATION TO PROCEED
V. WITHOUT PREPAYMENT OF
FEES AND AFFIDAVIT
Defendant(s)
CASE NUMBER: Civ Action O7—l46 SLR
l. declare that I am the (check appropriate box)
El PetitionerlPlaintifflMovant El Other
in the above-entitled proceeding; that in support of my request to proceed without prepayment of fees or costs under
28 USC §19l5, I declare that I am unable to pay the costs of these proceedings and that I am entitled to the relief
sought in the complaintlpetitionlmotion.
ln support ofthis application, I answer the following questions under penalty of perjury:
l. Are you currently incarcerated? El Yes El No (If"No" go to Question 2)
If "YES" state the place ofyour incarceration
Inmate Identification Number (Required):
Are you employed at the institution'? Do you receive any payment from the institution?
Attach a ledger sheet from tlze institution o[ your incarceration detailing all transactions over the gas!
six months.
2. Are you currently employed? El Yes El No
a. Ifthe answer is "YES" state the amount of your take-home salary or wages and pay period
and give the name and address ofyour employer.
b. Ifthe answer is "NO" state the date ofyour last employment, the amount ofyour take-home
salary or wages and pay period and the name and address ofyour last employer.
3. In the past l2 twelve months have you received any money from any ofthe following sources?
a. Business, profession or other self-employment D Yes El No
b. Rent payments, interest or dividends El Yes El No
c. Pensions, annuities or life insurance payments El Yes El No
d. Disability or workers compensation payments El Yes El No
e. Gifts or inheritances El Yes El No
fi Any other sources El Yes El No
Ifthe answer to any ofthe above is "YES" describe each source of money and state the amount
received AND what you expect you will continue to receive.

Case 1:07-cv—O0146-SLR Document 3 Filed O3/27/2007 Page 4 of 4
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l`)El.AWARE (Rev ${06)
4. D0 you have any cash or checking or savings accounts'? El Yes E1 No
lt` "Yes" state the total amount $
5. Do you own any real estate, stocks, bonds, securities, other financial instruments, automobiles or other
valuable property?
El Yes EI No
lt"'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.
l declare under penalty of perjury that the above information is true and correct.
DATE SIGNATURE OF APPLICANT
NOTE TO PRISONER: A Prisoner seeking to proceed without prepayment of fees shall submit an affidavit
stating all assets. In 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.
ll` you have multiple accounts, perhaps because you have been in multiple institutions, attach one certified
statement ol` each account.