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

· ‘ Case 1:07-cv-00448-G|\/IS Document 10 Filed 08/06/2007 Page 1 of 2
1 I n IN THE UNITED STATES DISTRICT COURT-
FOR THE DISTRICT OF DELAWARE
RUSSELL STEEDLEY, )
Plaintiff, g
l v. g Civil Action No. 07—448-***
CORRECTIONAL MEDICAL SERVICES, g
UNKNOWN EMPLOYEES, AND ) ‘·~· r·i- »»»;»t,,;s,,¤im- R ....
CORRECTIONAL MEDICAL SERVICES ) _ F § @
Reston, J _ C "
Defendants. g t Q AUG ”€l2H¤? g i
AUTHORIZATION p 6éJé
I,Russell Steedley, SBI #249572 , request and authorize theQ§p$
agency holding me in custody to disburse to the Clerk of the ~
Court the initial partial filing fee of $12.63 and the subsequent
payments pursuant to 28 U.S.C. § l9l5(b) and required by the
Court’s order dated '§U\w LAT" , 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; AIS N" , 2007.
Signature of Plaintiff

Case 1:07-cg/$0 * MS Document 10 Filed 08/06/2007 Page 2 0f 2
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