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

Case 1:05-cv-00465-GIVIS Document 4 Filed 07/26/2005 Page 1 of 2
IN THE UNITED STATES DISTRICT COUR° ·~·
FOR THE DISTRICT OF DELAWARE it 0 _ _A(_ _ ___ _
JENNIFER POWELL ) d_ %#,_@w,y Zl, _;]_
' >
figs ,=;§i$; .g;>*;E;:a$¤rF#¤#s%~#
Plaintiff, ) %r%r*·¥~**
)
v. ) Civ. No. 05—465»GMS
)
STANLEY TAYLOR, PAUL HOWARD, )
WARDEN GEORGE, and PHS, )
)
Defendants. )
AUTHORIZATION
I, Jennifer Powell, SBI # 253480, request and authorize the
agency holding me in custody to disburse to the Clerk of the
Court the initial partial filing fee of $1.86 and the subsequent
payments pursuant to 28 U.S.C. § l9l5(b) and required by the
,‘.§ w_ I
Court's order date•ju;$%§g =__ I , 2005. {
This authoriza“¥bn is furnished in connection with the Q
filing of a civil action, and I understand that the filing fee l
for the complaint is $250.00. I also understand that the entire i
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. E
Date: {[-95 `GQ , 2005.
Jégéifer Pgéell ;
lu
5
1
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Case 1:05-cv-00465-GIVIS I }[?0rcurpent4 Filed 07/26/2005 Page 20f2
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