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

Case 1:08-cv-00195-SLR Document8 Filed 05/21/2008 Page1 of2
IN TI-IE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF DELAWARE
DONALD JEROME THOMPSON, III., )
Plaintiff, g
v. g Civ. No. 08-195-SLR
SCOTT KASPRENSKI, g _v·_ _
E*;I'tk'FDAI.%*é2EI"G* I r"’r‘
DAVID HOLMAN )
E';EIICi.§€5§§&ECT.ONAt I MAY zi M8
CENTER, and DELAWARE ) I {__“_____,_____”,...,.».s.· Q
CORRECTIONAL CENTER ) é
iNsuRANcE PROVIDER, ) I ¤—»»I ¤-»-—~·—~*
Defendants. g
AUTHORIZATION
I, Donald Jerome Thompson, III., SBI #326474, request and authorize the agency
holding me in custody to disburse to the Clerk of the Court the initial partial filing fee of
$22.90 and the subsequent payments pursuant to 28 U.S.C. § 1915(b) and required by
the Courts order dated if Igpi Ig , 2008.
This authorization is furnished to the Clerk of Court in connection with the liling 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 transferred.
Date: img gw I ( , 2 { (,,, >
J Signature of Plaintiff

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Case 1:08-cv-00195-SLR

Document 8

Filed 05/21/2008

Page 1 of 2

Case 1:08-cv-00195-SLR

Document 8

Filed 05/21/2008

Page 2 of 2