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

‘ Case 1:05-cv-00815-SLR Document 4 Filed O1/18/2006 Page1 of3
IN THE UNITED STATES DISTRICT COURT i
FOR THE DISTRICT OF DELAWARE _ I
STEVEN D. CRAWFORD, ) I
Plaintiff, ) 5
v. g Civ. No. O5—8l5—SLR 1
THOMAS CARROLL (WARDEN), g 2
JANE BRADY (ATTORNEY GENERAL), ) h
CAPT. HAZZARD, LT. FLOYD DIXON,) . _, _, rrr .... i.-.LM.,
`MIKE MCMAHON (COUNSELOR), and ) ¥ '"Ai A ilmiii §;;§_j>§§ { )
SGT. MARVIN CREASEY, ) ; Y w{“;aLa;.4“»»g é I
Defendants. - g i v E ? Jgy qc §“f E 5 E
’ =’- ll
AUTHORIZATION- in ‘-.= wwLhJMwNK·i nlllh innn Wi·` U }
I, Steven D. Crawford, SBI #00229825, request and authorize
the agency holding me in custody to disburse to the Clerk of the
yCourt the initial partial filing fee of $10.17 and the subsequent
payments pursuant to 28 U.S.C. § l9l5(b) and required by the
Court's order dated /Léyg/%s‘ , 2005.
This authorization is furnished in connection with the
filing of a civil action, and I understand that the filing fee
for the complaint is $250.00. 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

* Case 1:05-cv-00815-SLR Document 4 Filed O1/18/2006 Page 2 of 3
U to any other agency into whose custody I may be transferred.
Date: {L {jj;/gg , 2005.
- Signature g? Plaintiff
' 2

Case 1:05-cv-00815-SLR Document 4 Filed O1/18/2006 Page 3 of 3
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