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

,_· Case 1:07-cv-00245-SLR Document 5 Filed 05/31/2007 Paget of2
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IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF DELAWARE
RUFUS D. ANDERSON, I I
.7 Plaintiff, g l
v. g Civ. No. 07—245—SLR I
y NURSE DIRECTOR GAIL ELLER, g
II/IEDIOAI. DIRECTOR JOHN RUNDIE, ) 7 y g ,
and BUREAU CHIEF PAUL HOWARD, I , I
n Defendants. ) i
MAY 3 I ZUU7
AUTHORIZATION I
misrriicrorrsstriwiiriiq
I, Rufus D. Anderson, SBI #328043, request and authorize the agency holding
me in custody to disburse to the Clerk ofthe Court all payments pursuant to 28 Ll.S.C.
§ 19‘l5(b) and required by the Court's order dated lg ll , 2007.
This authorization is furnished to the Clerk of Court in connection with the filing 2
of a civil action, and I understand that the tiling fee for the complaint is $350.00. i also
understand that the entire tiling fee may be deducted from my trust account regardless I
ofthe outcome of my civil action. This authorization shall apply to any other agency
into Whose custody I may be transferred. 1
Date: a .//Q , 2007. ;

Case1:‘07—cv-00245-SLR D0cument5 Filed 05/31/2007 Page20f2
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