Free Order (PLRA) Missing Documents - District Court of Delaware - Delaware

Case 1:06-cv-00405-JJF Document 4 Filed 07/07/2006 Page1 of 2
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF DELAWARE
Daron B. Allen, )
Clifton Demont Hall, )
Plaintiffs, )
v. ) Civil Action No. 06-405-JJF
James Chandler, Warden )
Raphael Williams, Deputy )
Warden Mark Emig, Security )
Chief David Williams, Jay )
Sylvester, )
Defendants. )
ORDER
1. The plaintiffs oro ao litigants presently
incarcerated, have both signed and filed this action pursuant to
42 U.S.C. § 1983 without prepayment of the filing fee or a
request to proceed fo forma pauperis.
2. The plaintiffs are jointly and severally liable for
the $350.00 filing fee. Pursuant to 28 U.S.C. § l9l5(b), the I
plaintiffs shall be assessed the filing fee of $350.00.
3. Pursuant to the requirements of 28 U.S.C. _
§ 19I5(a)(I) and (2), and in order to determine the schedule of Q
payment of the filing fee, each plaintiff shall submit a request
to proceed fo forma oauperis and a certified copy of his prison g
trust fund account statement (or institutional equivalent) for %
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Case1:06-cv-00405-JJF D0cument4 Filed 07/07/2006 Page20f2
the six—month period im ediately preceding the filing of the
complaint, obtained from the appropriate official at each
institution at which each plaintiff is confined. Plaintiff Daron
B. Allen has submitted a request to proceed in forma pauperis
along with the required trust fund account statement. Plaintiff
Clifton Demont Hall has not submitted the required request to
proceed in forma pauperis and trust fund account statement.
FAILURE OF PLAINTIFF HALL TO RETURN THE REQUESTED INFORMATION
WITHIN 30 DAYS FROM THE DATE THIS ORDER IS SENT SHALL RESULT IN
THE PLAINTIFF'S DISMISSAL FROM THIS ACTION WITHOUT PREJUDICE.
NOTWITHSTANDING ANY PAYMENT MADE OR REQUIRED, THE COURT SHALL
DISMISS THE CASE IF THE COURT DETERMINES THAT THE ACTION IS
FRIVOLOUS OR MALICIOUS, FAILS TO STATE A CLAIM UPON WHICH RELIEF
MAY BE GRANTED, OR SEEKS MONETARY RELIEF AGAINST A DEFENDANT WHO
IS IMMUNE FROM SUCH RELIEF.
4. Pursuant to 28 U.S.C. § 19l5(g), if a plaintiff has
had three or more actions dismissed by the Court on the grounds
that they were frivolous, malicious, or failed to state a claim L
upon which relief may be granted, then the Court shall deny the
plaintiff leave to proceed in forma pauperis in all future suits ,
filed without prepayment of the filing fee, unless the Court 1
determines that the plaintiff is under imminent danger of serious Y
physical injury. E
A AMY it
DATED: U ed at Districi Ju ge ;

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Case 1 :06-cv—00405-JJF Document 4-2 Filed 07/07/2006 Page 1 of 2
S.§i.iiEl’¥i;‘ .
UNITED STATES DISTRICT COURT
DISTRICT OF DELAWARE
Piaimarr APPLICATION TO PROCEED
v. WITHOUT PREPAYMENT OF
FEES AND AFFIDAVIT
Defendant(s)
CASE NUMBER:
I, declare that I am the (check appropriate box)
El Petitioner/Plaintiff/Movant El Other
in the above—entitled proceeding; that in support of my request to proceed without prepayment of fees or Costs under
2S USC §l915, 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.
In support of this application, I answer the following questions under penalty of perjury:
I. Are you currently incarcerated? El 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 of your incarceration detailing all transactions over the gust
sir months.
2. Are you currently employed? El Yes El No
a. If the answer is "YES" state the amount ot`your take-home salary or wages and pay period
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 I2 twelve months have you received any money from any ofthe following sources?
a. Business, profession or other self-employment El Yes El No
b. Rent payments, interest or dividends Ei Yes El No
c. Pensions, annuities or life insurance payments El Yes El No
d. Disability or workers compensation payments U Yes El No
e. Gifts or inheritances El Yes U No
f. Any other sources El Yes E1 No
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—00405-JJF Document 4-2 Filed 07/07/2006 Page 2 of 2
AO 240 Rcxtrsc (Rev IU 03)
DF[J\WARE Rev 5*06
4. Do you have any cash or checking or savings accounts? Cl Yes D No
If "Yes" state the total amount S
5. Do you own any real estate, stocks, bonds, securities, other financial instruments, automobiles or other
valuable property?
13 Yes El No
If "Yes" describe the property and state its value.
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 NONE if applicable.
I declare under penalty of perj ury that the above information is true and correct.
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.
lf you have multiple accounts, perhaps because you have been in multiple institutions, attach one certified
statement of each account.