Free Motion for Leave to Proceed in forma pauperis - District Court of Delaware - Delaware

c, Case 1 :06-cv—00743-SLR Document 1 Filed 12/07/2006 Page 1 of 2 _ A
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_ __ DELAWARE!§ev. QD5) . ` - ` .
UNITED STATES DISTRICT COURT -
DISTRICT OF DELAWARE
RAYMOND L . BRUTONEE
c rmtmnrr APPLICATION TO PROCEED
V. VVITHOUT PREPAYMENT OF
DOUGH PETIFORD,?·ét 31 ·· FEES ANI) AFFIDAVIT l
Defendant(s) s O in __
CASE NUMBER: O T 4 3
I, R 3 Y m 0 H d L · B I U li 0 H · declare that I am the (check appropriate box)
° qi Petitioner/Plaintift)’lvIovant ° ° Other _
in the above-entitled proceeding; that in support of my request to proceed without prepayment of fees or costs under
28 USC §1915, I declare that I am unable to pay the costs of these proceedings and that I am entitled to the relief
sought in the complaint/petition/motion.
EIT? 1 ·‘·‘·
In support of this application, I answer the following questions under penalty of perjury:
1. Are you currently incarcerated? ° Yes ° °No (If "No" go to Question 2)
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- If "YES" state the place of your incarceration H - R · Y · C · I y "J
· ‘
Inmate Identification Number (Required): S B I ii O 6 9 O Z5
Are you employed at the institution? D O Do you receive any payment from the institution? HC? if `
Attach a ledger sheet Qom the institution of your incarceration showing atleast the gust sbt mont/:s’
transactions .
2. Are you currently employed? ° ° Yes ° Mo
a. If the answer is "YES" state the amount of your take-home salary or wages and pay period a
and give the name and address of your employer.
b. If the answer is "NO" state the date of your last employment, the amount of your take-home
salary or wages and pay period and the name and address of your last employer.
3. In the past 12 twelve months have you received any money from any of the following sources?
a. Business, profession or other self—employment • • Yes · •XNo
b. Rent payments, interest or dividends · • Yes · JN0
c. Pensions, annuities or life insurance payments ` • • Yes • •XNo
d. Disability or workers compensation payments • • Yes • ·,,No
e. Gifts or inheritances · · Yes • •;No
f . Any other sources • • Yes • •}g\lo
If the answer to any of the above is "YES" describe each source of money and state the amount
received AND what you expect you will continue to receive.

Case 1 :06-cv—00743-SLR Document 1 Filed 12/07/2006 Page 2 of 2
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` AO 240 Reverse (Rev. 10/D3) -
osrawass gw. 4 pg V .
n 4. Do you have any cash or checking or savings accounts? • • Yes _ • ·>No .
If "Yes" state the total amount $ ' .._.
S. Do you own any real estate, stocks, bonds, securities, other financial instruments, automobiles or other
_ valuable property? ’
_ • ·gYes · •No
‘ If"Yes" describe the property and state its value. I have a home located at .
i 2718 N. Vanburen Sf.19802
6. List the persons who are dependent on you for support, state your relationship to each person and
indicate how much you contribute to their support, OR state NOAE if applicable.
None
I declare under penalty of perjury that the above information is true and correct.
aw~%»a sw i
DATE · SIGNATURE OF APPLICANT
NOTE TO PRISONER: A Prisoner seeking to proceed without prepayment of fees shall submit an affidavit
stating all assets. In addition, a prisoner must attach a statement certified by the appropriate institutional
officer showing all receipts, expenditures, and balances during the last six months in your institutional accounts.
If you have multiple accounts, perhaps because you have been in multiple institutions, attach one certified
statement of each account.

Case 1:06-cv-00743-SLR Document 1-2 Filed 12/07/2006 Page 1 012
STATE OF DELAWARE
DEPARTMENT OF CORRECTION
BUREAU OF ADULT CORRECTION y
HOWARD R. YOUNG CORRECTIONAL INSTITUTION
1>.o. Box 9279
WILMINGTON DE 19801
(Business ADDRESS)
Memorandum
To: Raymond Bnuton — Pod -2Q
From: Ms. Hill (Business Office)
Date: November 27, 2006
Re: Response to your letter.
Mr. Bruton,
Please provide your SBI# on ALL letters sent to the Business
Office. Here is your resident account history per your request.
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Case 1 :06—cv—00743-SLR Document 1-2 Filed 12/07/2006 Page 2 012
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RE`S1D“ENT HISTORY REPORT Page 1 0f 1
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11/27/06 12:52
sw 007 / ope Jim
SEI : 069025
Resident Name : BRUTON, RAYMOND
Time Frame : 06/05/2006 13:29 — 11/27/2006 12:52
Date Time Type ST OPR Receipt # Amount Balance
06/05/2006 13:29 Add 4 SEA D48889 70.00 70.1O
06/12/2006 14:43 Rec Payment 10 bep J3B14 0.75 69.35
06/13/2006 08:16 Order 2 DDT B119336 45.43 23.92
06/14/2006 14:47 ReC Payment 10 bsp J3884 0.23 23.69
06/20/2006 08:36 Order 2 DDT B120316 3.14 20.55
06/21/2006 11:38 Add 4 SEA. D49924 80.00 100.55
06/27/2006 10:43 Order 2 DDT E121394 48.24 52.31
06/28/2006 08:51 Credit 3 WLH C13011 0.91 53.22
06/2B/2006 15:24 Rec Payment 10 bsp J4014 1.25 51.97
07/04/2006 08:49 Order 2 DDT B122384 22.87 29.10
07/11/2006 13:41 Order 2 IAK B123741 3.90 25.20
07/20/2006 06:05 Order 2 DDT B124813 2.82 22.38
07/27/2006 09:17 Rec Payment 7 jmh (310687 4.00 18.38
08/08/2006 13:32 Order 2 WLH B127672 5.61 12.77
08/08/2006* 13:56 Order 2 WLH B127709 10.16 2.61
08/15/2006 13:31 Order 2 DDT 8128708 2.57 0.04
08/31/2006 12:14 Add 4 SED D53766 25.00 25.04
09/01/2006 11:26 Order 2 WLH B131035 19.0B 5.96
09/07/2006 11:10 Add 8 bsf H24006 100.00 105.96
09/08/2006 11:03 Order 2 WLH B131906 40.64 65.32
09/12/2006 10:01 Order 2 WLH B132347 56.12 9.20
09/13/2006 13:11 Credit 3 WLH C14603 3.78 12.98
09/19/2006 05:49 Order 2 WLH B133287 9.75 3.23
10/04/2006 05:47 Order 2 DDT B135556 3.23 0.00
10/14/2006 09:10 Add 8 elj H24992 200.00 200.00
10/16/2006 10:04 Order 2 DDT B137168 158.86 41.14
10/16/2006 12:47 Credit 3 WLH C15531 99.00 140.14
10/16/2006 12:54 Credit 3 WLH C15535 6.58 146.72
10/23/2006 08:16 Order 2 DDT B138286 32.79 113.93
10/26/2006 11:31 Add 4 SED D57101 50.00 163.93
10/30/2006 13:04 Order 3 WLH C15896 51.34 112.59
11/06/2006 06:51 Order _ 2 WLH B140212 11.82 100.77
11/09/2006 11:39 Add 4 SED D57962 237.00 337.77
11/13/2006 07:04 Order 2 WLH B141300 V 48.61 289.16
11/14/2006 14:20 Add 4 SED D58192 25.00 314.16
11/16/2006 08:36 Order 2 WLH B142090 237.00 77.16
11/20/2006 05:54 Order 2 WLH B142304 25.37 51.79
11/27/2006 10:49 Order 2 WLH B143481 31.51 20.28