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

Case 1:04-cv—00922—SLR Document 16 Filed 08/30/2005 Page1 of3 0
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IN THE UNITED STATES DISTRICT COURT /c’z ’ *‘‘ Q
FOR THE DISTRICT OF DELAWARE “ za /970/
LAWRENCE R. COLLINGWOOD, JR., )
)
Plaintiff, )
)
v. ) Civil Action No. O4-922-SLR
)
STAN TAYLOR, PAUL HOWARD, )
KATHY ENGLISH, ROBERT SNYDER, )
THOMAS CARROLL, LAWRENCE )
MCGUIGEN, ELIZABETH BURRIS, )
JOE HUDSON, JOHN DOE ONE, )
CHARLES CUNNINGHAM, MAJOR )
HOLMAN, JOSEPH BALLENGER, ) _
LARRY SAVAGE, MIKE WELCOME, )
PAUL HARVEY, BRIAN HUMPREYS, )
DARNELL SCOTT, LELAND SWANSON,)
ROBERT YOUNG, BRANDY WYNN, )
HAZZARD, BAYNARD, MCGEE, )
LLOYD, RAMON, JIM SIMMS, KEVIN)
HOFFECKER, CHAVON DOTTINS, RON) J e,.. i;; ·.~· J ...- `
. DRAKE, mss MERSON, JOHN Dos > ;
TWO, EMILY STEVENSON, CHARLES ) “ ` __
PORTER," MERRISSA MCFADDEN, ) g
TODD KRAMER, FRANCINE KOPUS, )
MIKE LITTLE, ED JOHNSON, MARIA) _ A I `’‘0 _
TIMOTHY MARTIN, BRIAN ENGRAMS4,) q V _,, g__j .
and OSMAR sA1v1ANDER, · ) u.s.msm¤ H
) DISTRSCT `
Defendants. )
AUTHORI ZATION
I, Lawrence R. Collingwood, Jr., request and authorize the
agency holding me in custody to disburse to the Clerk of the l
Court the initial partial filing fee of $8.24 and the subsequent J
payments pursuant to 28 U.S.C. § 1915 (b) and required by the
1 Court’s order dated Qhgngt , 2004.
This authorization is furnished in connection with the
filing of a civil action, and I understand that the filing fee

* · · · Case1:04-cv—00922—SLR D0cument__16 Filed 08/30/2005 Page20f3
for the complaint is $150.00. 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
to any other 8.Q’GI'1Cy into whose CLISCOCIY I may be CI`&I'1Sf€I`I`€d.
Date: /q“_,2`¢¢¢*"'{ {qi l<>¤5`"
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_ “ _ § % 0 1:04-cv—00922—SLR' D0cument16. Filed 08/30/2005 Page30f3
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