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

Case 1:07—cv—00614-GI\/IS Document 6 Filed 10/29/2007 Pagei of2
D L_ Case 1:07-cv-00614-*** Document5 Filed 10/18/2007 F’age4 ofj4 _
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IN THE UNITED STATES DISTRICT COUQ@HUCT2q ?H 3`51
FOR THE DISTRICT OF DELAWARE
ANDREW ANTHONY LONG )
Plaintiff, i
v. i Civil Action No. 07-614-***
WARDEN ROBERT GEORGE, i
DEPUTY WARDEN WILLIAM OETTEL, )
STAFF LT. MIKE COSTELLO, )
STAFF LT. TOM BAKER, J
LT. FRANCIS MONTEE, )
Defendants. i
AUTHORIZATION
I, Andrew Anthony Long, SBI # 169067 request and authorize
_ the agency holding me in custody to disburse to the Clerk of the
Court all payments pursuant to 23 U.S.C. § 1915(b) and required
by the Court’s order dated ii him , 2007.
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.
Date: , 2007.
lp ; 4;./
Signature of Plaintiff‘

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Case 1:07-cv-00614-GMS

Document 6

Filed 10/29/2007

Page 1 of 2

Case 1:07-cv-00614-GMS

Document 6

Filed 10/29/2007

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