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


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Date: September 1, 2005
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State: Delaware
Category: District Court of Delaware
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_ , Case 1:04-cv—00922—SLR Document 15 Filed 08/30/2005 Page 1pof 3
IN THE UNITED STATES DISTRICT COURT V gm
FOR THE DISTRICT OF DELAWARE /d"’°/ C"*~E/@1
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LAWRENCE R. COLLINGWOOD,
Plaintiff, )
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v. ) Civil Action No. O4-922-SLR
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STAN TAYLOR, PAUL HOWARD, ) A W ,_, _
KATHY ENGLISH, ROBERT SNYDER, ) VU
THOMAS CARROLL LAWRENCE ) J 53
MCGUIGEN, ELIZABETH BURRIS, ) ,,_ ’ · M ’ ‘ {
JOE HUDSON, JOHN DOE ONE, ) I V
CHARLES C'UN’NINGFAM, MAJOR ) I . ___ i_
Hotmzm, JOSEPH EALLENGER, ) ¥$‘·"Y*" gg
LARRY SAVAGE, MIKE WELCOME, ) .. iq Y 6,
PAUL HARVEY, BRIAN HUMPREYSI ) . .* ,,/— - 4 ·,
DARNELL SCOTT, LELAND SWANSON,) V . _ 8/{ ,
ROBERT YOUNG, BRANDY WYNN, ) ‘~'~ V“` ‘i ‘ C f
HAZZARD BAYNARD, MCGEE ) , , _,Q@§ “§]/07) Q
LLOYD, RAMON, JIM SIMMS: KEVIN) » li Y G p
HoEEEc1 . DRAKE, 1.1sE MERSON, Jox-LN DOE ) ‘ ,, _ _, _ .
TWO, EMILY STEVENSON, CHARLES ) - 71 _ ,451:45 E
PORTER, MERRISSA MCFADDEN, ) A ___ K, F; ',f_ I rr Q I
TODD KRAMER, FRANCINE KOPUS, /0 W'? ,» AI M ,.
MIKE LITTLE, ED JOHNSON, MARIA)
TIMOTHY MARTIN, BRIAN ENGRAMS,) 0 ’,,I I I V
and osMAR SAMANDER, ‘ ) , ,, Em #1% ,. I II L J cii,i’ ‘ I ‘`i‘ ’ [ ‘’‘/
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D?¢%¤%%L$%',E2§§£MrsnC R. csmngwssd, JI., request and authorize the ~§@‘<··-» ~
agency holding me in custody to disburse to the Clerk of the A
Court the initial partial filing fee of $8.24 and the subsequent
payments pursuant to 28 U.S.C. § 1915 (b) and required by the @6/I0 W A
c<>ur1;·s order dated Q!;§f,gf:Qé , 2004. `
This authorization is furnished in connection with the if di l o t
filing of a civil action, and I understand that the filing fee i
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~ · · · Case 1:04-cv—00922—SLR Document 15 Filed 08/30/2005 Page 2 of 3
for the complaint is $150.00. 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. /44,2 uy; /9, 2_·;>c.§"
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a______ / Lawrence R. Collingwood; Jr, ' ’·
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