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

Case 1:07-cv-00031—G|\/IS Document 6 Filed 02/23/2007 Page 1 of 2

IN THE UNITED STATES DISTRICT COURT i
FOR THE DISTRICT OF DELAWARE E
WILLIAM JOSEPH WEBB, JR. l i
Plaintiff, g
v. g Civil Action No. 07-31 GMS
FIRST CORRECTIONAL MEDICAL, g :
CORRECTIONAL MEDICAL SERVICES, ) Q
GOVERNOR RUTH ANN MINNER, ) .-v#~»<~z~‘c‘ ··oo i·‘‘ S‘’‘S 1
COMMISSIONER STANLEY W. TAYLOR, ) A F I
BUREAU CHIEF PAUL W. HOWARD, ) ..,L- ,... I I . , i .
ISE: ill? l§?K§§“s, 5 J is zz zum ,
DR. JOHN DOE, DR. JANE DOE, ) r HVM,MM__ __,» ,,__ __V, M_ { ;_V I
§§?§‘$§§§§“@E£§?§éC§§.§§?VICES i ¤%饤Ré?@é $l$¤,
MS. ROSALIE VARGAS, I I i
Joan mos, JANE Dos, > Bro $*¤¤’*"‘~*’¤/ [
Defendants. ) l .
· AUTHORIZATION
I, William Joseph Webb, Jr., SBI #256056, request and
authorize the agency holding me in custody to disburse to the
Clerk of the Court the initial partial filing fee of $5.29 and
the subsequent payments pursuant to ?§‘U.S.C. § l9l5(b) and
required by the Court's order 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 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
authorization shall apply to any other agency into whose custody

Case1:07-cv—00O31—G|\/IS D0cument6 Filed 02/23/2007 Page20f2
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