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

r - Case1:07—cv-00505-SLR D0cument6 Filed O9/21/2007 Page10ff2
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF DELAWARE
KEVIN A. APGAR, )
Plaintiff, g
v_ U g Cj_vj_]_ Actio i·. s F _ _'
WARDEN RAPI-LAEL WILLIAMS, g U _ _i
Eis§I§‘§??§H?MS‘ MD g ss zi my
- ‘ E ..,._ . .,,4 zi
Defendants. ) 1- U
AUTHORIZATION RQ .re..,n A I `
I, Kevin A. Apgar, SBI #302981, request and authorize the
agency holding me in custody to disburse to the Clerk of the
Court the initial partial filing fee of $11.81 and the subsequent
payments pursuant to 28 U.S.C. § 19l5(b) and required by the
Court's order dated igifgghétr 3[$?L , 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.
nate; Sgfoméw [§?H•, 2007.

Case 1:07-cv-00505-SLR Document 6 Filed O9/21/2007 Page 2 of 2
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Case 1:07-cv-00505-SLR

Document 6

Filed 09/21/2007

Page 1 of 2

Case 1:07-cv-00505-SLR

Document 6

Filed 09/21/2007

Page 2 of 2