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

. Case 1 :06—cv—00742-Gl\/IS Document 1 Filed 12/06/2006 Page 1 of 2
l · l
i AO 240 (Rev. 10/CB)
DELAWARE {Rev. QUE!
UNITED STATES DISTRICT COURT
‘ DISTRICT OF DELAWARE
ll\Q\C/3
Ptnmarr APPLICATION TO PROCEED
. V. ~ WITHOUT PREPAYMEN T OF
;\r~»\i\ L `*“¤. ¤"@
NQ €..\ V ERLL ‘i‘ l lri,'tV\l}{\ l`- '€__t)('] AND
Defendant(s) 51 rs 7
y criss NUMBER: ` "' ’ Zi 2
. I, Q3V`¤~—*1.-»"°L—~ MD *°\ 3 declare that l am the (check appropriate box)
° ' Petitioner/Plaintiii7Movant ° ° Other W _ _, ___ W
in the above—entit1ed proceeding; that in support of my request to proceed without repa ;== »---» up
28 USC §1915, I declare that I am unable to pay the costs of these proceedings d I am entitled to " lief
sought in the complaint/petition/motion. =__ S
In support of this application, I answer the following questions under penalty of A-
l. Are you currently incarcerated? ° °No (lf "No" go to Question 2) "" ‘
_ If "YES" state the place of your incarceration 6 (-LL;. Q>€’—O<—¢’ Dx}: <'\ \ gf.
Inmate Identification Number (Required): l jb i
. _ I) ‘
Are you employed at the institution? Miibarou receive any payment ti·om the institution? M
Attacb a ledger sheet from the institution oi your incarceration showing at leg! the gt six months ’
‘ __ p_p_:_ ___
T 2. Are you currently employed? ° ° Yes
P a. If the answer is "YES" state the amount of your take-home salary or wages and pay period a
` and give the name and address of your employer.
` A b. If the answer is "NO" state the date of your last employment, the amount of your take-home
salary or wages and pay period and the name and address of your last employer.
. 3. . `In the past I2 twelve months have you received any money from any of the following sources?
I a. Business, profession or other self-employment · · Yes CE 0
A b. Rent payments, interest or dividends ' • Yes ••
c. Pensions, annuities or life insurance payments · · Yes • _
d. Disability or workers compensation payments • · Yes • ‘ 0
c. Gifts or inheritances · · Yes • q_ No
f. Any other sources • · Yes · · o
_ A If the answer to any ofthe above is "YES" describe each source of money and state the amount
received AND what you expect you will continue to receive.

Case 1 :06—cv—00742-Gl\/IS Document 1 Filed 12/06/2006 Page 2 of 2
AO 240Revuse ('Rev.10/U3)
DELAWARE!Rzv. 4[C5!
4. Do you have any cash or checking or savings accounts? · • Yes _ •®
If "Yes" state the total amount S
5. Do you own any real estate, stocks, bonds, securities, other financial instruments, automobiles or other
valuable property? v"
- n If "Yes" describe the property and state its value.
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 if applicable.
. , - 2 ,
Cl. _ leo. Li $6 e 0 ~¤n~i\/\
a oa _ Qy {4)%/ 6D "“‘“\`i\\
I declare under penalty of perjury that the above information is true and correct.
L DATE - SIGNAT * OF APPLICANT
NOTE T0 PRISONER: A Prisoner seeking to proeeed without prepayment of fees shall submit an affidavit
stating all assets. In addition, a prisoner must attach a statement certified by the appropriate institutional
- . ofiicer showingtall receipts, expenditures, and balances during the last six months in your institutional accounts. _
· l If you have multiple accounts, perhaps because you have been in multiple institutions, attach one certiiicd
statement of each account.

Case 1:06-cv-00742—GI\/IS Document 1-2 Filed 12/06/2006 Page 1 0f 2
1°“““I’d‘ 1// 21/ 20% Averaze Dailv Balance Far Pauper Filing P“0‘I’ 1 °*‘
Far Days the Individual was in Residence at SCI _)0·0m 4/I/2006 rhraugh 10/31/2006
SBI: 00170369 NAME: WAPLES, BRUCE L

Date Balance
O4/01/2006 $8.85
04/02/2008 $8.85
04/03/2008 $8.85
I 04/04/2008 $8.85
``ii ii```i 6 2£J6I8}§I66I8I ``iii`````1``iii```l`` I iii``` I ‘"`` 66II66I i1``'ii I `ii1`iii``
I i``-»i''0ii 621/6Ié}2I00I8I '0''`iii`'`i0`` I i`'_i'4’iiii-' $ 25I.85I 'V'iii`Aii'-'>ii0`'i
ii`'0i’'-iii' 0 E}0?./20I08 iii'`'''00''ii`'-'i'0`ii`'_»ii' II$E8I.68II i”'-'iii''''i II
-'ii I `0i' II62666}6666 '00ii` I '>i0''ii`'-'i'0i` I `'-ii $28.86 ii`0'i`'-'iii'`0
``1` I iii```1 6>666i§666 ``iii``1``1``iii```l````iii``````` $66I66IIIII ``1``1`i
```ii````ii` II6EHI6}6I666IIIIII ``1````’ii`` I `1```i I i``` II6é6I.I66 "V`iii`` I 1”`"`i I IIII
I IIIIIIIIII 6E/IiII66668II IIII I IIIIIII I IIII II IIIIIIIIII 66666 IIIIIIIII I IIIIIIII I
II0II I IIII 6I£H526I6é IIIIII IIIIIIII IIIIIIIIIIIII QE 2568 IIIIII I I0III IIII .
I IIIIIIIIIIII 6Q6I1I6}éI666IIII IIIIII II IIIIIIIIIIIII I IIIII 6£6I66 IIIIIIIIIIIIII
IIIIIIIIIIIIIII I0IE}I1I}i/2008I IIIII I IIIIII I IIII I IIIIIIIIIIIII I$25.I85I IIIIIIIIIIIIII II
IIII IIIIII6Q6HI8/26I66 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 6 26§66IIII IIIIIIII I
II IIII I IIII I66IiI6ii666 IIIIIIIIIIIIIII IIQI? IIIIIIIIIII 66666 IIII II IIIII
IIIII II IIIII 66/hIiF§666IIII IIIII II III·Z IIIIII I:}26§66II IIII I IIIIII I
IIII I IIII II62iHI6i6I666IIIII IIIIIIIIIIIIIIIIIIIIIIIIII $2I5IQ8§ IIIIIIIIIIIIIIIIIII
05/12/2008 $25.85 --····~ ···e —--~ = 8- 8-=_ =--» L -—l
IIIII IIIII6éHI6?6666IIIII IIII IIII I IIIIIIIIIIII II62I6QI66IIIII IIII I IIIII F i Q
I IIIIIIIIIIIII 00/I0/Y?-/606 IIIII . IQ IIIII IIIII QI IIII0 IIIIII I II`` I ` IIIII II`II I IIII II I`II` IIII
05/15/2008 $25.85 i _ 5
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IIIIIIIIIIIIII 6 6262666 IIII IIIIIIIIIIIIIIIII II666I66I IIII II IIIIIIIIIII -
. ............. 90/23/2099. .... .......... . ...... ............. 0a81*§?6;6’Er_?5§ §
00/20/2000 $30-00 ,e.. . ..... I I 0/ FE
IIII II IIIIIII 66226/2666I IIIIIIII IIIIIIIIIIIIIIIIIIII 66666 IIIIIIIIIIIII II IIII
III IIII 6626612*66éII IIIII I IIII I IIII III$66]66IIIIIIII
IIIIIIIIIIIIIIII 66iii/6666II IIIII I IIIIIIIIIIIIIIIIIIIIII 66I6.I66I IIII I IIII
08/28/2008 $38.08 ·
08:/29/2008 $38.08
06/30/2006 $36.08
IT!/01/2008 $38.08
07/02/2008 ‘· $38.08
07/03/2008 $38.08
07/04/2008 $38.08
07105/2008 $38.08
07/08/2008 $38.08
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IIIIIII II IIII 6ii66/6666 IIII IIIIIIIIIII I IIII I IIIIIIIII $66f66II IIIIIIIIIIIIIIIII
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I IIIIIIIIIIII 6i/162666 IIII I IIIII II IIIII II IIIIIIIIIIII I666Z6I6I IIIII I IIII I IIIIIII
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I IIIIIIIIII 66/§6i§666I IIIIIIIIIII II IIIIIIIIIIIIIIIIII 6666 IIIIIIIIIIIIIIIIIIIIII
II IIIIIIIIIII 66/66Y6I6I66I IIIIIIIIII I IIIIIII I IIIII I IIII 6666 IIII IIIIIII
I S0aamarj/ f0:0'SBlI= 00170360 (4IT detafl:;ec0rds)I II II II II Average Duiiy Baléiilécg

Case 1 :06-cv-00742—GI\/IS Document 1-2 Filed 12/06/2006 Page 2 0f 2
,
TO: InmateName: tgggtglgj, @ L > l
y_ (La t) (First) (M.I.)
SBI Number: lll 0 (3 (QQ]
Housing Unit: _ 1
FR: Inmate Ac count Technician ‘
DA:
RE: Summary Of Account g
Attached is your account statement for the six month period of [ or , .2 0 0 la _
I through .*0/31 .5200* . 0 ‘
Utilizing the calculation formula described in BOP Procedure 5.4, your average daily balance for this
peri0dis$ $2`I.t¤€' . wl Q U
/ ,4; &_/ E13-iii {if? .;»1 ,
Notary g I g 1 g l ZUU6
’· SGl BUSMESS OFFICE