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

’ Case1:06—cv-00632-JJF Document 12 Filed 11/28/2006 Page 1 of 2
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-IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF DELAWARE
IVAN smrrn l >
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Plaintiff, )
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v. } Civil Action No. 06*632 JJF
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CITY OF WILMINGTON, )
UNNAMED WPD DETECTIVE, ) - @~;¢ij:;·M"""_ ·“·· ‘-‘‘
UNNAMED AUSA FOR DISTRICT OF DE, ) *l_i_V L _
DISTRICT COURT OF DE, ) . _ _ .`“*ft‘”*#“ ```‘ _
UNNAMED ATFE AGENT, ) "
US MARSHAL, ` ) ` J NOV 28 20% ` Q
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Defendants . > F u. u r n counr
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AU·1·H0R::zA·1·1:o1q B1? SFCLDUMV
I, Ivan Smith, SBI #204884, request and authorize the agency
holding me in custody to disburse to the Clerk of the Court the
initial partial filing fee of $35.14 and the subsequent payments
pursuant to 28 U.S.C. § l9l5(b) and required by the Court’s order
*, .
dated Jyhwrnhéi ii! , 2006.
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: i\iD\f€·D”}·iZz.¢Z|j , 2006.
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Signature of Plaintiff
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"···`____________________.,.-...........e._n_______-_.~_L"`\i——-—

A Case 1:06-cv-00632-JJF Document 12 Filed 11/28/2006 Page 2 of 2
MRS. JOYCE S. MASSEY, CSW.
Director of Social Rehabilitation &
. ‘ Deputy Work Release Administrator
SALEM COUNTY CORRECTIONAL FACILITY
l25 Cemetery Road
Woodstown, NJ 08098
(856) 7694300 Ext. 730
Fax. (856) 769-3578 c
DATE: NOVEMBER 2Vl, 2006
TO: DISTRICT COURT CLERK `
SUBJECT: FINANCIAL STATEMENT (
Inmate Ivan Smith, DOB -1975, who has been incarcerated here at
Salem County Correctional Facility since O9/28/2005 presently has on his account $2.61
(two dollars and sixty—one cents).
Any questions or concerns regarding this matter should be directed to ine. "
Thank you. ·
I Sincerely, I
· _ (Mrs.) Joyce S. Massey, CSW A
Director of Social Rehabilitation V