Free Motion for Leave to Proceed in forma pauperis - District Court of Delaware - Delaware

U Case 1:07-cv-00147-SLR Document 1 Filed O3/13/2007 Page 1 013
_.a
IN THE UNITED STATES DISTRICT COURT OF DELAWARE l
ANTHONY PORTERFIELD, _ : CIVIL ACTION
` Plaintiff :
‘ : No. T 0 7 ` 1 4 7 “*
v. :
CORRECTIONAL MEDICAL :
SERVICES (CMS), et al., : _
Defendants : JURY TRIAL DE +,». ey vs _ .. --iaa Q _
` 1`1ARl32@BYi
APPLICATION TO PROCEED IN FORMA PAUPERI§ g E Q
f`‘‘ “
__....13.{.. ! TF*| a;...
_ _ _ \§pS¢~v.nn·—/
I, Anthony Porterfxeld, declare that I am the Plamntxff mn
the above—captioned 42 U.S.C. § 1983 civil rights action, and
that I am entitled to proceed gg forma pauperis pursuant to 28
U.S.C. § 1915 because of my inability to prepay the full filing
fee to file this action or give security therefor. I understand
that the granting· of gn forma pauperis status does ·not waive
payment of the full filing fee.
In further support of this application, I provide the
following information: _
1. I am not presently employed by the prison where I am
housed. -
2. I have no other income.
3. My last place of employment was August 4, 1999 where I
worked as a Front Packer for the Food Center making $250.00 a
month. g
4. I presently have $3.86 in my prison account.
5. I do not have a bank account or interest in any valuable

I Case 1:07-cv-00147-SLR Document 1 Filed O3/13/2007 Page 2 of 3
X
property.
6. I have receive no money other than a $100.00 gift from a
friend in the past 12 months. -
I declare under the penalty of perjury that the foregoing is
true and correct.
Respectfully Submitted,
Date: Q"~"·’\¤-f·O¤ @007
Anthony orterfield
AM-5025
SCI—Retreat
660 State Route 11
. _ Hunlock Creek, P.A. 18621-3136

Case 1:07-cv-00147-SLR Document 1 Filed O3/13/2007 Page 3 of 3
t l ‘ l I
AUTHORIZATION
(Piis oner‘s Account Only) · `
. i Case N0. pl _
. 1»tor;s§ campaaag I aathaagatiba term as Linder clnl Qgj Y
§.l9l5(a)(2) to-.subrnit_a-certified copy ‘of.yotu· tmst fiindraccount. ¢_ ...· " _ .
l, ?0 tl {·f`{¥F—-L{1`€qUBSt and authorize the agency holding nip in custody
to send to the Clerlt oi Court, United-States District Court for the Middle District of Petiiisylvania, -a
certified copy- oithetstate-rne·nt-for the past six months of my ttust1°uInd account (or institutional equivalent) -
at the institution. wlierei a.miincarcerated.. I further request and authorize the agencyholding me-in custody as ·
to calculate and dish-urse funds "frotu my trust account (or institutional equivalent) in theY.an:tottnts.specifiedI I I e I
hy28.UQ-S.C§l9l5(h). - y ` . ‘ > _ _
_ This authorization is furnished in connection with the filing of a civil action, and Iunderstand that {gi:
the tiling fee for the complaint is $350.00. I also understand that the entire tiling fee will be-deducted fIOI]T;§s .
my account; regardless of nie outcome of my civil action. This authorization shall apply toany other agency- ._-· .
into whose custody I may he transferred. n I ‘ I ‘=‘. -. I _
r Date: 5fg;g_x.___g QJ g E36 7 l ._ I
I y 0% Q d>oQgg$ Q Qi _
i . _ Signature of Prisoner