Free Mail Returned - District Court of California - California

Case 4:O7—ov—O2405—SBA Document 7; Filed O7/O5/2007 Page 1 of 4
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· ·· Case 4:O7—cv—O2405—SBA Document 7 Filed O7/O5/2007 Page 2 of 4
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5 Prisoner Number 2 I @{:2 Q __ gféii E" _
6 IHSiilUIiO1'1aI Address SI ` SO r\;.g=E>
8 ·—·-“··——.._·:* .;__ ; .———‘ ‘ V
9 UNITED STATESDISTRICT COURT I
- NORTHERN DISTRICT OF CALIFORNIA
1 0 t 1
. Ykeres- Z. Ly me Emyc also- 1 I
I I {Enter the full name ofplaintiff in this action.) gf'; 2 4 0 V l
I2 l vs. ) Case No. I s _ _. _ _
_ ·} * if ` ) (To be rbvid ‘d _b the lerk fc un) _
1 E I3 ~·~-2 n ii ncbi ° 0 g
O _ ‘ ) s COMPLAINT UNDER THE -
14 -.C{5\, Qbr D 1 Q (Dept-. e ) crvnrucrrrsncr,
_ j - - . . - _ t · ‘ _ ) 42 U.S.C §§ 1983 { _ Y
I5 gt; .;Q_y;;gg·¥rg;; ¥.{2gI¤nL,1\.5.,,4..,..\·g )
I6 _ PF\R©\ 2. Ug_Qg rl-`rv\·.2vt`I )· ` l · . i
- __ (Enter the full name ofthe defen‘dant{s) in this action)) ·
I'? .. . ` . . . .. '
_ P I3 [A H guesrivns on this complain! form must be answered in vrderfvryqur action-in proceed.} l
s · 1§_’ 1. 'Exhausmm of Administrative_Remedies - I . · ` _ -
}O EO. [Note: Youlmust exhausts your administrative remedies before. your claimtecan go l
e e 2].: _ forward. The court will dismiss any unexhausted claims.] ·
22 A. Place of present coniinement SQ Q Q jg I ng (**3 & \ E
l Z3" B. Is there a grievance procedure in this institution? = ‘ -i -- · e · * H
‘ 24 Yes bef NO ( jr I _
Q 25 C. Did you present the facts in your complaint for review through the grievmice
` 26 procedure? ‘ _ .-. . . . . . s
. -23 · D. If your answer is YES, list the aprieal nurnber theedate and result- of the
_- COMPLAINI I - 1 — I

Case 4:O7—cv—O2405—SBA Document 7 Filed O7/O5/2007 Page 3 of 4
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3 FILED
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AY 3 2007
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6 OHTHEHN DISTRICTISET COURT
_ CALIFORNIA (
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8 UNITED STATES DISTRICT COURT ·
t NORTHERN DISTRICT OF CALIFORNIA
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t i . . > ·t· » 0
ll ” is -‘ Plaintiff, ) CASE NO.
"” - )
rz _ vs_ ·s l *'T<$’~@&7}, ..&¤YCE°— ) Pnrsomnnts
. ‘ . it ) APPLICATION TO PROCEED
s is _ = A- R¤ ¥>¥>,·,*‘1£—’· M ?¤~‘¤c>*€ ’°¤I¢"*"`) uv roiuvm. r·AuPnms S
CCt.L•F"€3>eg>t~oF·C0rrgC·l·¤hf ) g _
l4‘ ` - _ “ _ = · .‘Defendant. ) ' ‘ `
g `IT6 ` l, Tit";} Q Q if .- C`. Q . , declare, under penalty ofpe1jury that lam the
17 plaintilfin the above entitled case and that the infomation l offer throughout this application
` l 18 is true and correct. l offer this application in support of my request to proceed without being
_ T }`9 required to pt—spay·t1tt· Hall amount of fees, costs or give security. lgstate that because of my ‘ }
l ‘ 20- poverty I ani-unable to psy the costs of this action or give security, and that I believe that I am ,
2] entitled to reliefi T p ‘ U e
_i 22. In support of this application, I provide the following infonnationzi l
if `23 l, are you presently employed? Yes I No K l F _
if C 24 lfyour answer is "yes," state both your gross and net salary or wages per month, and give the
T 25 name and address of your employer; T `
p 26 Gross: . e . - - . Net: t . _i ___ o
27 Employer:. l - O -- 2 - - t · l li ,-.` C `
28 t . ‘ C -s ‘ - `
L -
QP?. TO PR . `IN FORMA PAUPERIS, Case N0. - - tl - ` _ .

· P 4 of 4
Case 4:O7—cv—O2405—SBA Document 7 Fnled O7/O5/2007 age
~ » UNITED STATES DISTRICT COURT; . * - fi-;·~ R
_ T R- FOR THE NORTHERN DISTRICT • - K .- "‘ I _ e
R -a it
. V R H _ _ ·;;T{'Q 0 · I - V .
Dear GI' Madam: . I E Q 9 7 te.-: 4 9 5
I Yourncomplaint has been Eled as civil case number · I . R I A I i _ · n
Your complaint is deticient because: ` F - A I ` t ) I I
L 1. - R _ You did not pay the appropriate filing fee of $350.00. Ifyou are unable to pay the entire _ _
- iiling fee at this time, you must sign and complete this court’s P1isoner’s In Forma Pauperis _
Appl entirety. R _ R R · ` · I _
n 2. - The In Fonna Paup eris Application you submitted-is insuihcient because: n I Q I
_ R You did not use the correct form. You must submit this court’s current Prisoner’s ·
. In Forma Pauperis Application. _ R _ R { `
I · Your In Forma Pauperis Application was not completed in its entirety. no R _ -
_ _ 1 ‘ You did not sign your In Foga Pang- eri-s Application. -- I
I - n You ‘ °d not submit a Certificate of Funds in Prisoner’s Account completed and n . J
‘ sign uthorized oflicer at the prisonQ · -· · -
I ‘ I You did not attach a copy of your prisoner trust account statement showing _ ·
_ . · -· transactions for the last six months. E R ‘ _‘ - ‘
Enclosed you will End this court’s _c1u·rent P1isoner’s In Forma Pauperis Application, which n
· ` includes a Certificate of Funds iI1'PI`i_SDI1€I"S Account form, and a return envelope for your
· convenience. . _ ‘ _ i - R .
.Warning:y If you do not respond within THIRTY DAYS from the- iilingdate stamped _
‘ ‘ above, your action willabe dismissed and theifile closed. Ifyou submit the applicationyyou .
will automatically be liable for the full iiling fee, regardless of your present ability to pay . R -
· the full amount of the fee. _ ` " _ " R
` Deputy Clerk
rv. 4/9/{i6 ` l l

Case 4:07-cv-02405-SBA

Document 7

Filed 07/05/2007

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Case 4:07-cv-02405-SBA

Document 7

Filed 07/05/2007

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Case 4:07-cv-02405-SBA

Document 7

Filed 07/05/2007

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Case 4:07-cv-02405-SBA

Document 7

Filed 07/05/2007

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