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

IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF DELAWARE
IVAN L. MENDEZ, )
Plaintiff, g
v. ; Civ. No. 05—305—J ,;%$$; ____A;_ zgxqy
DELAWARE STATE, 5 - ,
Defendant. ;
AUTHORIZATION
I, Ivan L. Mendez, SBI #453351, request and authorize the
agency holding me in custody to disburse to the Clerk of the
Court all payments pursuant to 28 U.S.C. § l9l5{b) and required
by the Court’s order dated OZ|`¤‘—,5;·£§; , 2005.
This authorization is furnished in connection with the Q
filing of a civil action, and I understand that the filing fee 1
for the complaint is $250.00. I also understand that the entire l
filing fee may be deducted from my trust account regardless of '
the outcome of my civil action. This authorization shall apply I
to any other agency into whose custody I may be transferred.
Date: , 2005-
Jyan“`."{én•ezU" W
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77 C%1··:05-cv-00305-JJF D0cument7 Fnled 07/27/2005 * _
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