Free Order (PLRA) Missing Documents - District Court of Delaware - Delaware

Case 1:08-cv—00539-G|\/IS Document 7 Filed 09/05/2008 Page1 0f4
· IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF DELAWARE
JOHN C. JOHNSON, )
WILLIAM GREGORY, DAYMIEN J. )
ROBERTS, BAYANT BANKS, )
RONALD F. BROOKS, CARLOS )
JACKSON, FENEL BAINE, JOHN )
FOLKS, BRANDON OWENS, CHRIS )
ROGERS, MICHAEL L. JONES, )
AND JAMES CAULK, )
Plaintiffs, )
v. ) Civil Action No. 08-539-GMS
CARL DANBERG, af. af. )
Defendants. )
ORDER
I. The plaintiffs, pro ao litigants who are presently
incarcerated, have filed this action pursuant to 42 U.S.C. § 1983
without prepayment of the filing fee or a request to proceed fo
forma pauperis.
2. The plaintiffs are jointly and severally liable for
the $350.00 filing fee. Pursuant to 28 U.S.C. § I9I5(b), the
plaintiffs shall be assessed the filing fee of $350.00.
3. Pursuant to the requirements of 28 U.S.C.
§ l9I5(a)(l) and (2), and in order to determine the schedule of
payment of the filing fee, each plaintiff shall submit a request
to proceed fm forma oauperis (AO Form 240 — Application to
Proceed Without Prepayment of Fees). Furthermore, each plaintiff
shall submit to the Clerk of Court, a certified copy of his trust

Case 1:08-cv—OO539-G|\/IS D0cument7 Filed O9/05/2008 Page20f4
Y · fund account statement (memorandum or institutional equivalent,
with attachments) showing all deposits, expenditures and balances
during the six—month period, immediately preceding the filing of
the complaint, obtained from the appropriate official at the
institution at which the plaintiff is confined. FAILURE OF A
PLAINTIFF TO RETURN THE REQUESTED INFORMATION WITHIN 30 DAYS FROM
THE DATE THIS ORDER IS SENT SHALL RESULT THE E·LAINTIFF’S
DISMISSAL FROM THIS ACTION WITHOUT PREJUDICE. NOTWITHSTANDING
ANY PAYMENT MADE OR REQUIRED, THE COURT SHALL DISMISS THE CASE IF
THE COURT DETERMINES THAT THE ACTION IS FRIVOLOUS OR MALICIOUS,
FAILS TO STATE A CLAIM UPON WHICH RELIEF MAY BE GRANTED, OR SEEKS
MDNETARY RELIEF AGAINST A DEFENDANT WHO IS IMMMNE FROM SUCH
RELIEF.
4. Pursuant to 28 U.S.C. § l915(g), if a plaintiff has
had three or more actions dismissed by the Court on the grounds
that they were frivolous, malicious, or failed to state a claim
upon which relief may be granted, then the Court shall deny the
plaintiff leave to proceed in forma pauperis in all future suits
filed without prepayment of the filing fee, unless the Court
determines that the plaintiff is under imminent danger of serious
physical injury.
DATED: é.@\5 Uni ed States
2

Case 1 :08-cv—OO539-GIVIS Document 7 Filed O9/05/2008 Page 3 of 4
AO 240 (Rev. l0/0])
DELAWARE [Rev. 5/06)
UNITED STATES DISTRICT COlURT
DISTRICT OF DELAWARE
Piaimirr APPLICATION TO PROCEED
V. WITHOUT PREPAYMENT OF
FEES AND AFFIDAVIT
Defendant(s)
CASE NUMBER: 08-539-GMS
I, declare that I am the (check appropriate box)
El Petitioner/Plaintiff/Movant El Other
in the above-entitled proceeding; that in support of my request to proceed without prepayment of fees or costs under
28 USC §l9l5, I declare that I am unable to pay the costs of these proceedirigs and that I am entitled to the relief
sought in the complaint/petition/motion.
In support of this application, I answer the following questions under penalty of perjury:
l. Are you currently incarcerated? El Yes El No (If "No" go to Question 2)
If "YES" state the place of your incarceration
Inmate Identification Number (Required):
Are you employed at the institution? Do you receive any payment from the institution?
Attach a ledger sheet [rom the institution o[ your incarceration detailing all transactions over the gast
six months.
2. Are you currently employed? El Yes El No
a. If the answer is "YES" state the amount of your take-home saary or wages and pay period
and give the name and address of your employer.
b. If the answer is "NO" state the date of your last employment, the amount of your take-home
salary or wages and pay period and the name and address of your last employer.
3. In the past 12 twelve months have you received any money from any of the following sources?
a. Business, profession or other self-employment E1 Yes El No
b. Rent payments, interest or dividends D Yes D No
c. Pensions, annuities or life insurance payments D Yes D No
d. Disability or workers compensation payments D Yes Cl No
e. Gifts or inheritances E1 Yes E1 No
f. Any other sources El Yes D No
If the answer to any of the above is "YES" describe each source of money and state the amount
received AND what you expect you will continue to receive.

Case 1:08-cv—OO539-Gl\/IS Document 7 Filed O9/05/2008 Page 4 of 4
AO 240 Reverse (Rev, 10/O3)
DELAWARE Rev 5/06Z
4. Do you have any cash or checking or savings accounts? El Yes E1 No
If "Yes" state the total amount $
5. Do you own any real estate, stocks, bonds, securities, other financial instruments, automobiles or other
valuable property?
E1 Yes E1 No
If` "Yes" describe the property and state its value.
6. List the persons who are dependent on you for support, state your relationship to each person and
indicate how much you contribute to their support, OR state NONE if applicable.
I declare under penalty of perjury that the above information is true and correct.
DATE SIGNATURE OF APPLICANT
NOTE TO PRISONER: A Prisoner seeking to proceed without prepayment of fees shall submit an affidavit
stating all assets. In addition, a prisoner must attach a statement certified by the appropriate institutional
officer showing all receipts, expenditures, and balances during the last six months in your institutional accounts.
If you have multiple accounts, perhaps because you have been in multiple institutions, attach one certified
statement of each account.

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