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

Case 1:06-cv-00739-JJF D0cument5 Filed 12/21/2006 Page1 0f2 ·
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF DELAWARE
MICHAEL L. CHAMBERS, )
Plaintiff, g
v. g Civil Action No. 06-739 JJF
GOVERNOR RUTH ANN MINNER, g
ATTORNEY GENERAL CARL DANBERG, )
Defendants. g
AUTHORIZATION
I, Michael L. Chambers, SBI #24626l, request and authorize
the agency holding me in custody to disburse to the Clerk of the
Court the initial partial filing fee of $33.32 and the subsequent
payments pursuant to 28 U.S.C. § l9l5(b) and required by the
Court's order dated /J'!/4* , 2006.
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 I
authorization shall apply to any other agency into whose custody
I may be transferred.
Date: ;;2C5wZ%% Cf? , 2006.
` §ww%wmm&mmmM m€ i Signature of Plaintiff
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Cas§11g??§?§{%;00739-JJF D0e0ment 5 Filed 12/21/2006 Page 2 0f 2
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