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

y Case 1 :08-cv-00198-GIVIS Document 1 . Filed 04/07/2008 Page 1 of 2 4
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L DELAWARE gev. 4£05 .
; UNITED STATES DISTRICT COURT
E DISTRICT OF DELAWARE
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1 , Plaintiff APPLICATION TO PROCEED
V. WITHOUT PREPAYMEN T OF
- , C we ode nf . . at ri , ill i; KL isil l ky FEES AND AFFIDAVIT
V Defendant(s) l' l . 6
CASE NUMBER: O (I" CI gl
I, l ii-is will I `;P’` R le. ei fi: {Ci declare that I am the (check appropriate box)
° ° Petitioner/Plaintiffflviovant ° ° Other
inthe above-entitled proceeding; that in support of my request to proceed without : ..=-o =.=.-.__· . ,_ _p_p__pK_ __:
28 USC §l9l5, I declare that I am unable to pay the costs of these proceedings LQ d th t aiEe§t@le§t@1e relief
sought in the complaintfpetitionJ’motion. l I ```' ` A``
APH ·~— I Zlllllii ·
In support of this application, I answer the followin uestions under enal of . I
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l. Are you currentl incarcerated? ° s ° °No If "No" to ‘ _ ___s
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If "YES“ state the place of your incarceration UIL. . \l_ — :1. TLELQ. mn`. I =fv"i ltlalii- t I ""l"¤?.»fY. l
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Inmate Identification Number (Required); T”1l"i l.~»`°°i`5 all level `
Are you employed at the institution? lll Do you receive any ayment from the institution? lol l
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Attach a ledger sheet Qom the institution of your incarceration showing at least the past six montl1s’
transactions
2. Are you currently employed? ° ° Yes ° No
a. If the answer is "YES" state the amount of your talce—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.
3. In the past 12 twelve months have you received any money from any of the following sources?
a. Business, profession or other self-employment • • Yes · • Neg
b. Rent payments, interest or dividends ’ • Yes • • No/T
c. Pensions, annuities or life insurance payments • • Yes · • Noz-
d. Disability or workers compensation payments • · Yes • • No/}——/-E
e. Gifts or inheritances j · Yes • • No
f. Any other sources • • No
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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, —-3;- \·€~<..LJ,,L\\ kk CJ", H =. I
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e Case 1:08—cv—00198-Gl\/IS Document 1 Filed 04/07/2008 Page 2 of 2 ··
AO 240 Reverse (Rev. ‘l.EI/D3]
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i 4. Do you have any cash or checking or savings accounts? • • Yes l • ·No
If "Yes" state the total amount $ - `
5. Do you own any real estate, stocks, bonds, securities, other financial instruments, automobiles or other
valuable property? ’ *=·== r-=»—~—=~··-y
p • · Yes i • ·No J
If "Yes" describe the property and state its value.
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.
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I declare under penalty of perjury that the above information is true and correct.
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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 certiiied by the appropriate institutional
ofticer showing all receipts, expenditures, and balances duringthe last six months in your institutional accounts.
lf you have multiple accounts, perhaps because you have been in multiple institutions, attach one certitied
statement of each account.

Case 1:08-cv-OO198—GI\/IS Document 1-2 Filed O4/07/2008 Page 1 of 2
STATE OF DELAWARE
DEPARTMENT OF CORRECTION
BUREAU OF ADULT CORRECTION
HOWARD R. YoUNc CORRECTIONAL INSTITUTION
Ro. Box 9279
WILMINGTON DE 19801
(BUSINESS ADDRESS)
2 Men1orandum
To: O’Neil Thompson, SBI # 280639, 2Y, S
From: Business Office ‘_
Date: April 1, 2008 I
Re: Response to your letter.
Mr. Thompson,
Here is a copy of your 6 months history and balance.

Case 1 :08-cv-OO198—GI\/IS Document 1-2 Filed O4/07/2008 Page 2 0f 2
RESIDENT HISTORY REPORT Page 1 0f 1
Haven -;=.==
ST 000 1 0PR mm 7
SBI : 280639
Resident Name : NEIL, THOMPSON
Time Frame . 10/01/2007 13:36 - 04/01/2008 11:20

Date Time Type ST OPP. Receipt # Amount Balance

10/02/2007 11:25 Add 4 gmw D76606 40.00 118.65
10/03/2007 05:57 Order 2 DDT B187188 59.15 59.50
10/04/2007 14:18 Withdrawal 6 SJW F32269 3.00 56.50 -
10/09/2007 10:11 Order 2 DDT B188043 13.08 43.42
10/16/2007 13:30 Order 2 DDT B188959 18.57 24.85
10/17/2007 09:39 Withdrawal-Rev 6 JNM F32563 3.00 27.85
10/23/2007 09:19 Order 2 DDT B189880 24.54 3.31
· 10/30/2007 10:01 Order 2 DDT B190768 1.91 1.40
10/31/2007 10:43 Order 11 AFC K5892 1.05 0.35 “
11/06/2007 11:16 Order 2 DDT B191734 0.26 0.09
11/07/2007 13:25 Credit 2 DDT B191855 0.26 0.35
I 11/07/2007 15:05 Add 10 bsp J1258B 3.75 4.10 *
11/13/2007 09:00 Order 2 AFC B192744 3.28 0.82
11/27/2007 11:04 Order 2 AFC B194610 0.78 0.04
12/09/2007 09:10 Add 8 GLD H35510 30.00 30.04
12/09/2007 09:11 Add 8 GLD H35511 30.00 60.04
12/10/2007 11:19 Add 7 SJW G13436 15.75 75.79
12/11/2007 10:01 Order 2 DDT B196533 58.58 17.21
12/12/2007 09:10 Order 11 WLH K6501 3.15 14.06
12/12/2007 09:11 Credit 11 WLH K6502 3.15 17.21
12/18/2007 10:20 Order 2 AFC B197461 16.91 0.30
01/08/2008 10:26 Order 2 DDT B200283 0.26 0.04
01/10/2008 13:28 Credit 11 AFC K6945 0.26 0.30
01/15/2008 08:31 Add 7 SJW G13838 15.75 16.05
01/15/2000 09:51 Order 2 DDT B201184 15.88 0.17
01/29/2008 08:51 Order 2 DDT B202961 0.13 0.04
02/01/2008 09:20 Credit 3 WLH C25483 0.13 0.17
02/04/2008 09:06 Add 4 J D83663 40.00 40.17
02/05/2000 12:25 Add 4 J D83788 400.00 440.17
02/12/2008 09:35 Order 2 DDT B204911 63.07 377.10
02/14/2008 09:55 Order 3 AFC C25743 39.94 337.16
02/15/2008 15:25 Add 7 SJW G14385 4.50 341.66
02/19/2008 08:58 Order 2 DDT B205869 64.51 277.15
02/20/2008 10:18 Order 2 DDT B206040 185.00 92.15
02/21/2008 14:01 Withdrawal 6 SJW F35580 5.50 86.65
02/21/2008 14:13 Withdrawal 6 SJW F35587 10.00 76.65
02/26/2008 07:22 Order 2 AFC B206896 41.82 34.83
02/28/2008 10:44 Credit 3 AFC C26055 0.68 35.51
02/29/2008 13:42 Rec Payment 10 bsp J12703 2.23 33.28
02/29/2008 14:26 Rec Payment 10 bSp J12732 2.46 30.82
02/29/2008 15:11 ReC Payment 7 SJW G14494 8.00 22.82
03/04/2008 08:29 Order 2 AFC B207718 22.67 0.15
03/13/2008 11:53 Add 4 J D86068 50.00 50.15
03/17/2008 12:44 Order 2 DDT B209795 47.18 2.97
03/20/2008 10:01 Credit 3 WLH C26583 1.99 4.96
04/01/2008 08:43 Order 2 DDT B211484 4.95 0.01

Case 1:08-cv-00198-GMS

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