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

Case 1:06-cv—00789-SLR Document 6 Filed 02/15/2007 Page 1 of 4
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF DELAWARE
JAN WHITE COLEMAN ) i
)
Plaintiff, )
)
v. ) Civil Action No. 06-789-***
)
COMMISSIONER STANLEY TAYLOR, )
CHIEF ADULT PRISONS PAUL HOWARD, )
WARDEN/awci PATRICK RYAN, )
CAPTAIN JOSEPH MOORE, )
DIRECTOR CHIEF EMANUEL WALKER, )
MEDICAL DIRECTOR SIHAGOMBETH ALLIE,)
DANA BAKER >
)
)
Defendants.
AUTHORIZATION
I, Jan White Coleman, SBI #186376, request and authorize the
agency holding me in custody to disburse to the Clerk of the
Court the initial partial filing fee of $10.37 and the subsequent
payments pursuant to 28 U.S.C.¢§ 19I5(b) and required by the
""`|__:;d¢"—i·3-¢,Z¤·:.-1°¢x".c.-
Court’s order dated 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 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
I may be transferred.
Date: -" "Vunwo , 2007.
@@@’\··
MM2 -*6 / 5餒?£>
S` nature of Plaintiff

Case 1 :06-cv—00789-SLR Document 6 Filed 02/15/2007 Page 2 of 4 ·
“‘“ Date :02/13/2007
Account Activity Ledger Time :+4:46
From: 01/04/2005 To: 02/13/2007
Try; Batch Trx Balance
Comment Date Time /lnv# Trx# Type Invoice Deposit Withdrawal Forward
11) 00186376 NameWH1TE, Jan A Block 9 Previous Balance 13.03
RPL.1D.CHG.6/21 06/21/2006 14:22 8442673 351191 W -4.00 9.03
rec 06/26/06 06/26/2006 14:42 8442713 351644 D 20.00 29.03
MCP.6/22 06/27/2006 14:39 8442733 351757 W -4.00 25.03
ZOE.FNDRSR.7/13—CH1C 06/30/2006 17:19 8442800 352723 W -8.25 16.78
ZOE.FNDRSR.7/13.1CE. 06/30/2006 18:11 8442801 353005 W -5.00 11.78
Sales Transaction 07/11/2006 11:23 1483453 1 10.37 1.41
PROCESSED.REC.7/17 07/18/2006 14:30 8443001 354716 D 30.00 31.41
Sales Transaction 07/25/2006 10:11 1++83827 1 17.56 13.85
PROCESSED.REC.7/27 07/27/2006 16:24 8443126 356140 D 10.00 23.85
PROCESSED.REC.7/27 07/27/2006 16:24 8443126 356142 D 25.00 48.85
COMM.CRDT.7/28 07/28/2006 17:14 8443148 356444 D 1.00 49.85
Sales Transaction 08/01/2006 15:05 1484074 1 26.63 23.22
PRCSSED.REC.8/4 08/07/2006 14:10 8443251 357234 D 20.00 43.22
ZOE.FNDRSR.P1ZZA. 08/07/2006 17:43 8443280 357709 W -7.00 36.22
ZOE.1CE.CRM.FNDRSR. 08/07/2006 18:17 8443281 358031 W -2.50 33.72
Sales Transaction 08/08/2006 10:12 1++84297 1 12.85 20.87
recd 8/10 08/11/2006 10:04 8444146 358264 D 20.00 40.87
test page 08/11/2006 10:11 8444147 358265 W -40.87 0.00
Void Wdr 4 358265 - 08/11/2006 10:11 8444147 358267 W 40.87 40.87
rec 8/10/06 08/11/2006 11:19 8444154 358350 D 10.00 50.87
rec 8/10/06 08/11/2006 11:19 8444154 358352 D 10.00 60.87
rec 8/9/06 08/11/2006 11:40 8444161 358398 D 10.00 70.87
Sales Transaction 08/15/2006 16:15 1484481 1 42.25 28.62
Sales Transaction 08/22/2006 07:42 1++84679 1 28.58 0.04
PRCSSD.REC.8/27 08/28/2006 15:49 8444413 360370 D 30.00 30.04
Sales Transaction 09/05/2006 10:14 1++85088 1 23.62 6.42
Sales Transaction 09/12/2006 13:09 1++85321 1 5.56 0.86
PRCSD.REC.10/20.FR.1 10/20/2006 12:50 8445392 366734 D 25.00 25.86
Sales Transaction 10/24/2006 10:15 1486648 1 25.09 0.77
PRCSD.RCD,10/26.FR.1 10/26/2006 14:46 8445524 367720 D 20.00 20.77
PSTD.REC.11/2 11/02/2006 15:27 8445658 368674 D 10.00 30.77
Sales Transaction 11/07/2006 11:35 1487084 1 29.89 0.88
PRCSD.REC.11/24 11/27/2006 14:27 8446090 371624 D 25.00 25.88
Sales Transaction 11/28/2006 15:08 1487660 1 25.47 0.41
PRCSD.REC.12/8.FR.12 12/11/2006 11:34 8446351 373438 D 25.00 25.41
Sales Transaction 12/12/2006 11:39 1++88059 1 10.13 15.28
MCP.12/9 12/12/2006 12:43 8446386 373913 W -4.00 11.28
PRCSD.REC.12/22.FR.1 12/22/2006 16:29 8446578 374992 D 30.00 41.28
HLDY.KT.12/27 12/27/2006 10:27 8446590 375381 W -6.00 35.28
PRCSD.REC.12/28.FR.1 12/29/2006 10:44 8446654 375920 D 30.00 65.28
PRCSD.REC.12/28.FR.l 12/29/2006 10:44 8446654 375922 D 25.00 90.28
HLDY.K1T.12/29 12/29/2006 16:19 8446664 376099 W -12.00 78.28
Sales Transaction 01/02/200+ 10:42 1++88897 1 20.87 57.41
Sales Transaction 01/09/2007 10:41 1++89114 1 30.28 27.13

Page : 4

Case 1 :06-cv—00789-SLR Document 6 Filed 02/15/2007 Page 3 of 4
’ ` Date :02/l3/2007
Account Activity Ledger Time ;;q;l6
From: 01/U4/2005 To: 02/I3/2{N]7
Trx Batch Trx Balance
Comment Date Time /lnv# Trx# Type Invoice Deposit Withdrawal Forward
ID 00186376 Name WHITE, JAN A Block 9 Previous Balance 27·l3
PRCSD.REC.1/6 01/09/2007 l5:53 B#468l9 377178 D 30.00 57.13
REC 01/11/07 01/ll/2007 16:28 B#46902 377698 D 40.00 97.13
Sales Transaction 01/l5/2007 1l:37 I#89320 I 41.40 55.73
Sales Transaction 01/23/2007 14:50 I#89499 I 30.15 25.58
REC 01/24/07 01/25/2007 12:05 E#47146 379052 D 40.00 65.58
COMl4.CRDT.l/26 01/26/2007 16:56 E#47l93 379344 D 5.60 71.18
Sales Transaction Ol/30/2007 13:16 I#89689 I 25.44 45.74
Sales Transaction O2/06/2007 10:41 I#89935 I l3.26 32.48
Sales Transaction 02/13/2007 12:04 I#90155 I 19.55 l2.93
Deposits 75 For S 1, 911.93
Withdraws 41 For S -271.38
Invoices 69 For $ 1, 627.62
Page : 5

Case1:O6-cv—QU(g;§gg§L:l§ D0cL1ment6 Filed O2/15/2007 Page40f4
”E%€®?§
I if VI] WJ ,
. == Qin
H '§ \§
gg " D Q xm
Q E! gf \
` K ®
1 z<~._ 2..r Ki) Q c\ `°$* Q
Q3; Z § "·— E
?··I f-' 7 _ •"I
» *` Q ww
j ii? \ an ~—— A
Y Q Qi “Q; »
; ;>>§<;;£
i EU {I':
» w*~ z 5
I Q § R, *+2
Q-;
I wg
® Q @2 "
. - N
A Q
r _ \
$
§\ $@
~ Q x>