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

Case 1:07-cv-00791—G|\/IS Document 7 Filed 12/20/2007 Page 1 013
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF DELAWARE
MICHAEL L. JONES, }
)
Plaintiff, )
)
v. ) Civil Action No. 07-791-GMS
)
WARDEN THOMAS CARROLL, )
DEPUTY WARDEN DAVID PIERCE, )— _
HEAD OF SECURITY DAVID HOLMAN, } _
STAFF LIEUTENANT KAREN HAWKINS,)
CORRECTIONAL OFFICER RAYNARD )
JONES, CORRECTIONAL OFFICER ) — -- » -. . ___, _. _ ____,AA_; ____W _
AUDREY EVANS, C/O KESHAW ) · _
TRAVIES, LT. LARRY SAVAGE, AND ) j i ·· s`
FLOYD s. DIXON, > ; § ,—‘ Q
) BEC ZOZUU7 g
Defendants. ) I §mm { S
— C
‘ AUTHORIZATION ·‘ ${:1nné ` li``'` ` C ‘‘‘‘
I, Michael L. Jones, SB1 #417267, request and authorize the
agency holding me in custody to disburse to the Clerk of the
Court the initial partial filing fee of $13.78 and the subsequent
payments pursuant to 28 U.S.C. § 1915(b) and required by the
Court's order dated 2007.
This authorization is furnished to the Clerk of Court in
connection with the filing of a civil action, and 1 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

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authorization shall apply to any other agency into whose custody
I may be transferred.
Date: Qggmbcw. I3 , 2007.
. Signature éff Plaintiff
2

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Case 1:07-cv-00791-GMS

Document 7

Filed 12/20/2007

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Case 1:07-cv-00791-GMS

Document 7

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Case 1:07-cv-00791-GMS

Document 7

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