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

Case 1:08-cv-00482-SLR Document 6 Filed 08/29/2008 Page 1 of 1
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF DELAWARE
MICHAEL HENRY, )
Plaintiff, g
v. g Civ. No. 08-482-SLR
THOMAS D. DONOVAN, g
Defendant. g
AUTHORIZATION
I, Michael Henry, SBI #582000, request and authorize the agency holding me in
custody to disburse to the Clerk of the Court the initial partial tiling fee of $13.83 and the
subsequent paym ts pursuant to 28 U.S.C. § 1915(b) and required by the Court’s
order dated , 20tQl/)
This authorization is furnished to the Clerk of Court in connection with the filing
of a civil action, and I understand that the tiling fee for the complaint is $350.00. 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 agency
Into whose custody I may be transferred.
Date: g , 2008.
= /

Case 1:08-cv-00482-SLR

Document 6

Filed 08/29/2008

Page 1 of 1