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

· Case 1:07-cv-00539—G|\/IS Document 6 Filed 10/16/2007 Page 1 012
IN THE UNITED STATES DISTRICT COURT I
FOR THE DISTRICT OF DELAWARE
LARRY M. SEXTON 1
Plaintiff, i l E
U U v. g Civil Action l I
STATE OF DELAWARE, 1 M I H I
HRYCL § DCT 1 6 2007 1
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· AUTHORIZATION it .,.,,,,, - ..,, . 2 ,.,.. I.,
I,Larry M. Sexton, SBI #298313, request and authorize the
agency holding me in custody to disburse to the Clerk of the 1
Court the initial partial filing fee of $15.17 and the subsequent
payments pursuant to 28 U.S.C. § 1915(b) and required by the l
Court's order dated i;f£+?M颤 Z1 , 2007. i
This authorization is furnished to the Clerk of Court in
connection with the filing of a civil action, and I understand l
that the filing fee for the complaint is 8350.001 T also
understand that the entire filing fee may be deducted from my
trust account regardless of the outcome of my civil action. This an
authorization shall apply to any other agency into whose custody 1
I may be transferred. E
Date: 2007.

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Case 1:07-cv-00539-GMS

Document 6

Filed 10/16/2007

Page 1 of 2

Case 1:07-cv-00539-GMS

Document 6

Filed 10/16/2007

Page 2 of 2