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

Case 1 :06-cv—OO736-SLB Document 1 Filed 12/O4/2006 Page 1 of 2
' ` AO 240(Rev. IDIO3)
DEL/\WAR.EifRev. 4lU5)
UNITED STATES DISTRICT COURT
DISTRICT OF DELAWARE
RAYMOND L. BRUTON, .
Plaintiff i APPLICATION TO PROCEED
V. WITHOUT PREPAYMENT OF
Qtvtsntcs, at. ai. FEES AND AFFIDAVIT
Defendant(s) gi _ jr Hf
CASE NUMBER: U i *3 6
I, RAYMOND L . BRUTON declare that I am the (check appropriate box)
Q Petitioner/Plaintiff/Movant E Other TS1:,T,,¤ieAeei-- --iA~ —A »- ~—=~=——~—q
. v »> li
in the above—entit1ed proceeding; that in support of my request to proceed without preiiaymiiiitiofifees or costs
28 USC §l9l5, I declare that I am unable to pay the costs of these proceedings andifthat Iiainieptitledyt mhpgrelipf
sought in the complaint/petition/motion. ·* "’ LU U T L `
In Support of this application, I answer the following questions under penalty of perjuiy:- Q‘..Z....§;u,,4
l. Are you currently incarcerated? E Yes EI No (If "No" go to Question 2)
If "YES" state the place of your incarceration B R y C I
Inmate Identification Number (Required): 5 B I g Q 6 9 gg 5
Are you employed at the institution? X Do you receive any payment from the institution? U 0
\ Attach a [edgy er sheet @0111 the institution of your incarceration Showing at least the gas! sbc 1nonths’
" transactions
2. Are you currently employed? El Yes E No
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.
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. v
3. In the past l2 twelve months have you received any money from any of the following sources?
a. Business, profession or other self—emp1oyment El Yes El No
b. Rent payments, interest or dividends El Yes E No
c. Pensions, annuities or life insurance payments El Yes K1 No
d. Disability or workers compensation payments El Yes E No
e. Gifts or inheritances El Yes K1 No
f. Any other sources El Yes il No
If the answer to any of the 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—OO736-SLR Document 1 Filed 12/O4/2006 Page 2 of 2
AO 240 Reverse (Rev. t0f03) I
DELAWARE (Rev. 41'O52
4. D0 you have any cash or checking or savings accounts? El Yes @’T\lo
If "Yes" state the total amount $
5. Do you own any real estate, stocks, bonds, securities, other financial instruments, automobiles or other
valuable property?
EL Yes El No
lf "Yes" describe the property and state its value. ..... ’ ~ ‘ _
__i_ Lao?. o l7d)%·‘£, Laoéiaci QI?-I
QW5 A/· Umjoufcsy /Q`5oQ_
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.
l declare under penalty of perjury that the above infomation is true and correct.
f x'
xfraazaé QMWWQ J. @~.t.z$t,»
DATE SIGNATURE OF APPLICANT
NOTE TO PRISONER: A Prisoner seeking to proceed without prepayment of fees shall submit an
affidavit stating all assets. In addition, a prisoner must attach a statement certified by the appropriate
institutional officer 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 certified statement of each account.

Case 1:06-cv-00736-SLR Document 1-2 Filed 12/O4/2006 Page 1 of 2
STATE OF DELAWARE
DEPARTMENT OF CORRECTION
BUREAU OF ADULT CORRECTION
HOWARD R. YOUNG CORRECTIONAL INSTITUTION
P.O. BOX 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
OITICE. HBFB is y0l1l‘ l‘€SId€Ilt 2lCC0llIlt hlSt0l‘y p€l‘ y0lll‘ l‘(-3ql1€SlZ.
U 6 ~- ? 3 6
§,,-,-..,..-.. A 2..;.?»,;e.x =—=¤‘="*· 3
Y DMZ UAEUQS 1
Q v,.,,.,_, ,...·» ,,»,, - 1
, ' *f§?¥ 1:*;,., F 7
%·(d

Case 1 :O6—cv—OO736-SLR Document 1-2 Filed 12/04/2006 Page 2 of 2
RESIDENT HISTORY REPORT Page 1 of 1
HRYCI
11/27/06 12:52
ST 007 / OPR JMH
SEI : 069025
Resident Name : BRUTON, RAYMOND
Time Frame : 06/05/2006 13:29 - 11/27/2006 12:52
Date Time Type ST DPR Receipt # Amount Balance
06/05/2006 13:29 Add 4 SEA D48889 70.00 70.10
06/12/2006 14:43 Rec Payment 10 hep J3814 0.75 69.35
06/13/2006 08:16 Order 2 DDT B119336 45.43 23.92
06/14/2006 14:47 Rec Payment 10 bsp JBBB4 0.23 23.69
06/20/2006 08:36 Order 2 DDT B120316 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 B121394 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 B123741 3.90 25.20
07/20/2006 06:05 Order 2 DDT B124813 2.82 22.38
07/27/2006 09:17 Rec Payment 7 jmh G106B7 4.00 18.38
08/08/2006 13:32 Order 2 WLH B127672 5.61 12.77
08/08/2006 13:56 Order 2 WLH B127709 10.16 2.61
08/15/2006 13:31 Order 2 DDT B128708 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 bef H24006 100.00 105.96
09/08/2006 11:03 Order 2 WLH B131906 40.64 65.32
09/12/2006 10:01 Order 2 WLH B132347 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 B133287 9.75 3.23
10/04/2006 05:47 Order 2 DDT B135556 3.23 0.00
10/14/2006 09:10 Add 8 elj H24992 200.00 200.00
10/16/2006 10:04 Order 2 DDT E137l68 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 B138286 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 B140212 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 B142304 25.37 51.79
11/27/2006 10:49 Order 2 WLH B143481 31.51 20.28