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

Case 1:06-cv-00791-SLR Document 1 Filed 12/27/2006 Page 1 of 2 -
AO 2d0(Rev. I0/O3)
DELAWARE Rev. 4/05
UNITED STATES DISTRICT COURT
DISTRICT OF DELAWARE
BAXMQN) BR TON
_ Plaintiff APPLICATION TO PROCEED
v. VVITHOUT PREPAYMENT OF
PAMELA A. MINOR,et:,al FEES AND AFFIDAVIT
Defendant(s) . E
cast; NUMBER; —- Y Q 1
I, R a y m 0 n d L . B r u t 0 n declare that I am the (check appropriate box)
° X Petitioner/Plaintiff/Movant ° ° Other
in the above—ent“itled proceeding; that in support of my request to proceed without prepayment of fees or costs under
28 USC §l9 15, I declare that I am unable to pay the costs ofthese proceedings and that I ameentitleditoitlre relief
sought in the complaint/petition/motion.
In support ofthis application, I answer the following questions under penalty of perjury;
1. Are you currently incarcerated? ° Wes ° °No (If "No" go to Question 2)
If"YES" state the place of your incarceration H · R · Y ‘ C ‘ I ‘ ·
Inmate Identification Number (Required); S B Iii O 6 9 O 5
Are you employed at theinstitution? UO Do you receive any payment from the institution'? UO I
i Attach a ledger sheet Qom the institution ot vour incarceration showing at least the gast six months'
transactions
2. Are you currently employed? ° ° Yes ° No
a. If the answer is "YES" state the amount of your tal and give the name and address of your employer.
b. If the answer is "NO" state the date of your last employment, the amount ofyour take-home
salary or wages and pay period and the name and address of your last employer.
3. In the past l2 twelve months have you received any money from any of the following sources?
a. Business, profession or other self-employrnent • • Yes • X No
b. Rent payments, interest or dividends • · Yes • X No
c. Pensions, annuities or life insurance payments ° • Yes • X No
d. Disability or workers compensation payments • • Yes • X No
e. Gifts or inheritances • · Yes • X No
f. Any other sources f am 1 I Y • • Yes • • No
If the answer to any ofthe above is "YES" describe each source ofmoney and state the amount
received AND what you expect you will continue to receive.

_, Case 1:06-cv-00791-SLR Document 1 Filed 12/27/2006 Page 2 of 2 it
AO 2-10 Reverse (Rev. IO/O3)
DELAWARE Rev -l/05 .
l 4. Do you have any cash or checking or savings accounts? · • Yes • XNo
If "Yes" state the total amount S ‘
5. Do you own any real estate, stocks, bonds, securities, other tinancial instruments, automobiles or other
valuable property? ‘
• K Yes • •No
It "Yes" describe the property and state its value.
Home at 2718 N. Van Buren ST. _
gi)iLmi}J3’lE»~i {Qi; ict 8 LQ`,
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 it` applicable.
I declare under penalty of perjury that the above infomation is true and correct.
W Q., . ar . I
DATE SIGNATURE OF APPLICANT
NOTE TO PRISONER: A Prisoner seeking to proceed without prepayment of tees shall submit an affidavit
stating all assets. In addition, a prisoner must attach a statement certilied by the appropriate institutional
ofticer showing all receipts, expenditures, and balances during the last six months in your institutional accounts.
If you have multiple accounts, perhaps because you have been in multiple institutions, attach one certitied
statement of each account.

Case 1:06-cv—00791-SLR Document 1-2 Filed 12/27/2006 Page 1 012
STATE or DELAWARE
DEPARTMENT or CORRECTION
BUREAU or ADULT CORRECTION
HOWARD R. YoUNc; CORRECTIONAL INSTITUTION
R0. Rox 9279
WILMINGTON DE 19801
(BUSINESS ADDRESS)
Memorandum
To: Raymond Bruton — Pod 2Q
From: Ms. Hill (Business Office)
Date: November 27, 2006
Re: Response to your letter.
Mr. Bruton,
Please provide your SBI# on ALL letters sent to the Business
Office. Here is your resident account history per your request.
cb A1
$¢’“

Case 1 :06-cv-00791-SLR Document 1-2 Filed 12/27/2006 Page 2 of 2
RESIDENT HISTORY REPORT Page 1 of 1
HRYCI
11/27/O6 12:52
ST OO7 / OPR JMH
S8I z 069025
Resident Name : BRUTON, RAYMOND
Time Frame : 06/05/2006 13:29 - 11/27/2006 12:52
Date Time Type ST OPR Receipt # Amount Balance
06/05/2006 13:29 Add 4 SEA D48889 70.00 70.10
06/12/2006 14:43 Rec Payment 10 bsp J3814 0.75 69.35
06/13/2006 08:16 Order 2 DDT 8119336 45.43 23.92
06/14/2006 14:47 Rec Payment 10 bsp J3884 0.23 23.69
06/20/2006 08:36 Order 2 DDT 8120316 3.14 20.55
06/21/2006 11:38 Add 4 SEA D49924 80.00 100.55
06/27/2006 10:43 Order 2 DDT 8121394 48.24 52.31
06/28/2006 08:51 Credit 3 WLH C13011 0.91 53.22
06/28/2006 15:24 Rec Payment 10 bsp J4014 1.25 51.97
07/04/2006 08:49 Order 2 DDT 8122384 22.87 29.10
07/11/2006 13:41 Order 2 IAK 8123741 3.90 25.20
07/20/2006 06:05 Order 2 DDT 8124813 2.82 22.38
07/27/2006 09:17 Rec Payment 7 jmh @10687 4.00 18.38
08/08/2006 13:32 Order 2 WLH 8127672 5.61 12.77
08/08/2006 13:56 Order 2 WLH 8127709 10.16 2.61
08/15/2006 13:31 Order 2 DDT 8128708 2.57 0.04
08/31/2006 12:14 Add 4 SED D53766 25.00 25.04
09/01/2006 11:26 Order 2 WLH 8131035 19.08 5.96
09/07/2006 11:10 Add 8 DSE H24006 100.00 105.96
09/08/2006 11:03 Order 2 WLH 8131906 40.64 65.32
09/12/2006 10:01 Order 2 WLH 8132347 56.12 9.20
09/13/2006 13:11 Credit 3 WLH C14603 3.78 12.98
09/19/2006 05:49 Order 2 WLH 8133287 9.75 3.23
10/04/2006 05:47 Order 2 DDT 8135556 3.23 0.00
10/14/2006 09:10 Add 8 e1j H24992 200.00 200.00
10/16/2006 10:04 Order 2 DDT 8137168 158.86 41.14
10/16/2006 12:47 Credit 3 WLH C15531 99.00 140.14
10/16/2006 12:54 Credit 3 WLH C15535 6.58 146.72
10/23/2006 08:16 Order 2 DDT 8138286 32.79 113.93
10/26/2006 11:31 Add 4 SED D57101 50.00 163.93
10/30/2006 13:04 Order 3 WLH C15896 51.34 112.59
11/06/2006 06:51 Order 2 WLH 8140212 11 82 100.77
11/09/2006 11:39 Add 4 SED D57962 237.00 337.77
11/13/2006 07:04 Order 2 WLH 8141300 48.61 289.16
11/14/2006 14:20 Add 4 SED D58192 25.00 314.16
11/16/2006 08:36 Order 2 WLH 8142090 237.00 77.16
11/20/2006 05 54 Order 2 WLH 8142304 25.37 51.79
11/27/2006 10:49 Order 2 WLH 8143481 31.51 20.28