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

A Case 1 :06-cv—00435-GIVIS Document 8 Filed 08/30/2006 Page 1 0f 4
//1 /
v. civn Docket No.1:06-cv-00435-·GMS
VERIFIED COMPLAINT DEMAND A JURY TRIAL (seZ¢[l£°x$thl,lih32@dgQi¢1@) U r
UNITED STATES OF AMERICA
(throught the federal judicial courts)
and
Judge Kent A. Jordan in his official capacity as a Federal Judge
and ,
in His individual capacity.
defendants _
PLANTIFF MOTION FOR LEAVE TO PROCEED IN
F ORMA PAUPERIS AS PER PLAN TIFFS FIRST AMENDMENT TO OUR
UNITED STATES CONSTITUTION THE FEDERAL COURTS ARE A
FEDERAL GOVERNMENT AGENCY UNDER 'I`HE CONTROL OF OUR
UNITED STATESCONGRESS
PLANTIFF REQUEST
That filing fees be waived under a declaration of Oath for lack of funds.
Plantiff is living on fixed incomes and on social security disability.
and can not afford the tiling fee.
Wednesday, August 09, 2006
signed,
Joseph D‘Alessandro
23136 Prince George Drive
Angola Estates
Lewes, Delaware 19958-9342
phone (302)-945-1554

Case 1:06-cv—00435-Gl\/IS Document 8 Filed 08/30/2006 Page 2 of 4
AO 240 (Rev. I0/03) H
DELAWAREtRev. ${06) { ,· ·1 ;- _ ,
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UNITED STATES DISTRICT COURT
DISYFRBOGKDFMHHJAWARE
OIG?/7f D /9J`J`¢IA> O
Plaintiff APPLICATION TO PROCEED
E V. { WITHOUT PREPAYMENT OF
MQTE dir U6 4 We I6? FEES AND AFFIDAVIT
Defendant(s)
CASE NUMBER:
I ' `2 declare that I am the (check appropriate box)
|l?l/ Petitioner/Plaintiff/Movant El Other
in the above-entitled proceeding; that in support of my request to proceed without prepayment offees or costs under
28 USC §19l 5, I declare that I am unable to pay the costs ofthese proceedings and that I am entitled to the relief
sought in the complaint/petition/motion.
In support of this application, I answer the following questions under penalty of perjury:
1. Are you currently incarcerated? E Yes El No (If "No" go to Question 2) ~
If "YES" state the place of your incarceration
Inmate Identification Number (Required):
Are you employed at the institution? Do you receive any payment from the institution?
Attach a ledger sheet [rom the institution 0[ your incarceration detailing all transactions over the gust
six months.
2. Are you currently employed? El Yes Ei No
a. Ifthe answer is "YES" state the amount of your take—home salary or wages and pay period
and give the name and address ofyour employer.
b. If the answer is "NO" state the date ofyour last employment, the amount ofyour take—home
salary or wages and pay period and the name and address of your last employer.
3. In the past l2 twelve months have you received any money from any of the following sources?
a. Business, profession or other self-employment El Yes III No
b. Rent payments, interest or dividends E1 Yes E1 No
c. Pensions, annuities or life insurance payments E/S? III No
d. r workers compensation payments Q es E1 No
e. Gifts or inheritances D Yes D No
f. Any other sources El Yes El No
If the answer to any ofthe 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—00435-Gl\/IS Document 8 Filed 08/30/2006 Page 3 of 4
AO 240 Reverse (Rev. 10/03)
DELAWARE SRev 5/062
4. D0 you have any cash • · savings accounts? El/Ygi D No
If"Yes" state the total amount $ 2 fd
5. Do you own any real estate, stocks, bonds, securities, other financial instruments, automobiles or other
valuable property? h/
Yes U No
If "Yes" describe the property and sge its value.
. I
A-¢ Q " JQ VV`V· JD
C ¢.? - K? rn. 1-0
6. List the persons who are dependent on you for support, state e . Iationship to each person and
indicate how much you contribute to their support, OR sta applicable.
I declare under penalty of perjury that the above information is true and correct.
/ 25 0 { sewn! ip
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—00435-G|\/IS Document 8 Filed 08/30/2006 Page 4 of 4 i
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF DELAWARE
Joseph L. D’Alessandro, )
Olga D'Alessandro, )
>
Plaintiffs, )
>
v. ) Civil Action No. 06-435 GMS
)
State of Delaware, )
l43“ Delaware General )
Assembly, and Sheriff of )
Sussex County, )
)
Defendants. )
ORDER
The plaintiffs, Joseph L. D’Alessandro and Olga
D’Alessandro, pro se litigants, have filed this action together
with a request that they be permitted to proceed in forma
pauperis. The motion (D.I. #3) does not include specific
financial information regarding the plaintiffs.
rh c I
At Wilmington this 27 day of tj , 2006,
IT IS ORDERED that; G
l. Each plaintiff shall complete and submit an
application to proceed without prepayment of fees.
2. Failure to return the requested information within
30 days from the date this order is sent shall result in
dismissal of this action without prejudice.
ll ’ ’ A
J A _
Uni J- S tes Dist , " Judge