Free Letter - District Court of Delaware - Delaware

Case 1:07-cv-001384-SLR ent 11 Filed O4/30/2007 Page 1 of 2
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Case 1:07-qv-00084-SLR - Document 41 Filed O4/30/2007 Page 2A-ref? ‘ _
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Case 1:O7—cv4OOO84-SLR Document 11-2 Filed O4/30/2007 Page 1 of 2
NOTICE TO PRISONER: You are directed to complete the following form. The top
portion of the form must be returned to the Clerk. The lower portion of the completed
form shall be returned to the prison ofiicial in charge of the prisoner account.
L QQ ;%/ {/{Z5/.Y_
(Name of Prisoner and Registered Number if
applicable) ·
authorize the Clerk of the Court to obtain, nom the agency having custody over me,
infomation about my institutional account, including balances, deposits, and
withdrawals. The Clerk may obtain such information until the fee and any other payments
owed the Court are paid. I also authorize the agency having custody ova me to withdraw
ftmds from my account and forward payments to the appropriate Clerk of Court in accordance
_ with 28 U.S.C. §19l5 (April 26, 1996).
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Si ture of Prisoner
Date: Q QQ gozfyd 2
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(Name of Prisoner and Registered Number if
applicable)
authorize the Clerk ofthe Court to obtain, from the agency having custody over me, information about
my institutional account, including balances, deposits, and withdrawals. The Clerk may
obtain such information tmtil the fee and any other payments owed the Cotut are paid I also authorize the
agency having custody over me to withdraw funds from my account and forward payments to the
appropriate Clerk of Cotut in accordance with 28 U.S.C. §1915 (April 26, 1996).
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Case 1:07-cy-00084-SLR Document 1*122 Filed O4/30/2007 Page 2` 0f`2e _
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