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

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Case 1:05-cv-00304-JJF Dincument 7 Filed 07/27/2005 Page1 of 2
JN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF DELAWARE
IVAN L. NENDEZ, )
Plaintiff, g
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DELAWARE LEGAL SYSTEM, ) MvNh”;"hi ''7` V
Defendant. i §@&»§§ $@E
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 23 U.S.C. § l9l5(b) and required
by the Court’s order dated vilyfjvlkjg , 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 y
l filing fee may be deducted from my trust account regardless of I
· the outcome of my civil action. This authorization shall apply
A to any other agency into whose custody I may be transferred. In
i oars; m__Q;[_2_g_{_Q_g, __Â¥4 ___, 2005. if
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ilwgtk §a.o1ga‘02z __r_._ I
Ivan . Mendez V
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