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

Case 1:06-cv-00267-JJF D0cument4 Filed 05/10/2006 Page1 0f2
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF DELAWARE
DEVEARL L. BACON, )
)
Plaintiff. J
`1
v. ) Civil Action No. 06-267-JJF
)
WARDEN CARROLL, J _, _, .. ......._ 2
DEPUTY WARDEN MCGUIGAN, } t ‘‘‘i‘ F § L §
JOE HUDSON, LT. CARROTHERS, ) _ _ ____, .,.., . -A»A- . .;
LT. LEGATES, LT. BOONE, ) g , e
LT. PROFACI, LT. FORBES, ) g
SGT. SNEAD, C.M,S., F.C.M., ) I '
DOCTOR TAMMY KASTRE, ) ;, I .
> ¤· ¤·SE.¤¤T.¤¤¤BI.
Defendants. ) _,__ _ ____ _;_,;c-;_..;...;-.-. ..,. A ~·---—· me I
-p- 5¢a.,nru.e·/
AUTHORIZATION
I, Devearl L. Bacon, SBI #22l242 request and authorize the
agency holding me in custody to disburse to the Clerk of the
Court the initial partial filing fee of $l0.33 and the subsequent
payments pursuant to 28 U.S.C. § l9l5(b) and required by the
\_ -n
Court‘s order dated {Z"?/iq! *5 . 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
authorization shall apply to any other agency into whose custody
I may be t ns ferred. _ _,”_ ,./-··"‘”":'
tj; ,,;, X _.,.¤:i.--.. .....,. .___ M
Date: _ ,.· 1 /..;’ 2006. N
I I I .¤•** I *2; " *·'··“"'*@’4\
` —-——-—·- --~—· .i ,
\ Signature ii
\ an . I J/ .
\ /{//"
‘—·.____\`_ J/·

Case 1 :06-cv-00267-JJF Document 4 Filed 05/10/2006 Page 2 0f 2
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