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

xg- Case 1:07-cv-00147-SLR Document 10 Filed 04/20/2007 Page 1 of 3
IN THE UNITED STATES DISTRICT COURT
B FOR THE DISTRICT OF DELAWARE
ANTHONY PORTERFIELD, )
I
Plaintiff, )
I
v. I Civ. No. 07-147-SLR
I
C.O. JOHN DOE, DEPUTY WARDEN I
BURRIS, VVARDEN CARROLL, )
l\/IICHAEL l\/ICGREANOR, )
LISE IVIERSON, DEBORAH )
RODWELLER, JOHN RUNDLE, )
LEE ANNE DUNN, OSHENKA )
GORDEN, BRENDA HEDDINGER, ) _:__
DR. ROGERS, DR. DLIRST, ) .Z I '' `A`' `I`:
DIRECTOR OF NURSING GAIL ) _, I----- — -e»-. C< . ..... F .... ji ‘e,- ___:_L=__ g g if
ELLER, REGISTERED NURSE ) _ _
IVIEGGETT, cnnisfiwe DOE, I Ilfjli 20 ZUQ? nni
JOHN DOE 2, and CORRECTIONAL )
MEDICAL SERVICES, ) gggbrta-
I -:»- - ·I.. ·
Defendants. ) gp sc-¤;·m(," I``` F I ``'` i`'`‘‘
AUTHORIZATION
I, Anthony Porterfield, SBI #Al\/1-5025, request and authorize the agency holding
me in custody to disburse to the Clerk ofthe Court all payments pursuant to 28 U.S.C.
§ 1915(b) and required by the Court’s order dated QM [Z , 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 forthe complaint is $350.00. I also
understand that the entire filing fee may be deducted from my trust account regardless
ofthe outcome of my civil action. This authorization shall apply to any other agency

Case 1:07-cv-00147-SLR Document 10 Filed 04/20/2007 Page 2 of 3
into whose custody I may be transferred.
Date; éktovl I ,2007. I
Signature of Iaintiff
I

Case1:O7-cv-00147-SLR D0cument1O Filed O4/20/2007 Page30f3
§
5
S9? 2 2 Q
$5 gm Q ?
gm zag 2 $4
2% Y~
O]- Fg; L ,L
Q Tag n
· Ju E6 EO
Q gz ¤ ji
;· 2 w
2 2 <»=
5 w g ' Z)
F
5
P
4
(`I
id
J
0
.I ‘
ni?
u?
K
Y
"’ E ‘§ Q 0
5%; 5; Zf'.2
3. l •’“
T :7 ? "° n
é L; gi O'- /°
E-; rf · ’ ¤
g g iq +’—
? ' <>=
g V Fi £ Q;
1 i F
Q_ - `:
é 5 _.‘ :“?}_ -_,,
i 9: YL 'T Fw $1:}:} YÂ¥?} =Y
Q. ,-0 - 2}; f .f ; _
E; (S
. / S
- ·~·» ; ;; :» ¤
V " /y was
3 °‘
0* QT?f ¥} 4··<