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

» Case1:O6-cv-00011-SLR D0cument15 Filed O1/18/2006 Page10f2
IN THE UNITED STATES DISTRICT COURT _ .
N ._ _ . EORTHE DISTRICT OF DELAWARE A . =
LEONARD K. BAYLIS,_ U } M · , i
Plaintiff, l g -
v. g Civ. No. 06-11-SLR 1
STAN TAYLOR, THOMAS CARROLL, g `
and CHRIS MALANEY, ) p»-~~»;a»»m~a.aa~mwa. I,. ,¤.»i.,.
Defendants. E { ‘‘‘‘‘f I“““““"“‘*v““T ‘I‘‘ gl
Au1·r—1oR1zAT10N _ JAN l8 2000 g _
I, Leonard K. Baylis, request and authorize the Q
holding me in custody to disburse to the Clerk of the Court all I
I
payments pursuant to 28 U.S.C. § l9l5(b) and required by the n . Q
Court's order dated {ig Cjh»Jv4t¥ , 2006. I
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.
nate; gyapuabf , 2006. 0
i A PC x
ignature of Plainti f

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