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

Case1:06-cv—00781—G|\/IS D0cument5 Filed 01/08/2007 Page10f1
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF DELAWARE
WARREN L. HARRIS, ) _ i
pialnrirr, g
v. g Civil Action No. 06-781 GMS E
ROBERT E. SNYDER, ; E
Defendant. —g g
S I. ` g. `AUTHORIZATION . {
I, Warren L. Harris, SBI #00162299 request and authorize the
agency holding me in custody to disburse to the Clerk of the
Court all payments pursuant to 28 U.S.C. § l9l5(b) and required i
by the Court's order dated%gg(Md§ 5 , 200%
This authorization is furnished to the Clerk of Court in E
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. l I
Date: "`/Kdzgfiz Eiifd gyyg , 2006.
0 s sss C yy
_ 00 0. Signature of Plaintiff
I C5 JAN r~8 ZW?
5
BD s qwm - S 5