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

Case 1:06—cv—00061-GI\/IS Document 5 Filed 03/24/2006 Page1 of3
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF DELAWARE
JEFFREY MICKENS, )
)
Plaintiff, )
)
v. ) Civil Action No. 06—06l—GMS
)
LT. KENDALL HICKMAN, )
SGT. BARRY BILES, )
CO. GREG SMITH, )
CO. BILLY JACKSON, ) y _H ___} _____ M _
co. TEANNA BANKS, ) ¥ ",>¥¢_‘ ‘‘‘= il ‘
) ` ,-§§%§¥_g _.... E
Defendants. ) g ? 5
i MAR 24% 2006 l
AUTHORIZATION { 5m~ee~wwm?bum-§ .... g
Uh- ·... I MJUHT .;
c I- -......., ..._
Â¥gC)rroAwA@%
I, Jeffrey Mickens, SBI #203738, request and authorize the
agency holding me in custody to disburse to the Clerk of the
Court the initial partial filing fee of $9.48 and the subsequent
payments pursuant to 28 U.S.C. § l9l5(b) and required by the
Court’s order dated églégdgggl Ci , 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 $250.00. 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.
Date: /{4dfgé , 2006.

Case 1:06-cv-00061—G|\/IS Document 5 Filed 03/24/2006 Page 2 of 3
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/
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Case 1 :06-cv-00061-GIVIS Document 5 Filed 03/24/2006 Page 3 of 3
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