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

L » Casei:07-cv-00845-GIVIS D0cument6 Filed 01/22/2008 Page10f2
Case 1:07-cv-00845-***-LPS D0cument5 Filed 01/03/2008 Page40f 4
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF DELAWARE
JEFFREY L. GRUWELL, )
l
Plaintiff, )
)
v. } Civil Action No. 07—845—***—LPS
l
CORRECTIONAL MEDICAL SERVICES,)
DEPARTMENT OF CORRECTIONS, )
)
Defendants. )
AUTHORIZATION
I, Jeffrey L. Gruwell, SBI # 233532 request and authorize
the agency holding me in custody to disburse to the Clerk of the
Court all payments pursuant to 28 U.S.C. § I9I5(b) and required
by the Court’s order dated ;EQmgQi% Qff , 200g?
V {
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 transferred.
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Date; 5/4,,3,,,].,,3; 3 , 200 .
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Case 1:07-cv-00845-GMS

Document 6

Filed 01/22/2008

Page 1 of 2

Case 1:07-cv-00845-GMS

Document 6

Filed 01/22/2008

Page 2 of 2