Free Motion for Leave to Proceed in forma pauperis - District Court of Delaware - Delaware

Case 1 :08-cv-00420-SLR Document 1 Filed 07/O9/2008 Page 1 of 2
mv. 4/vn UNITED STATES DISTRICT COURT
DISTRICT OF DELAWARE
f Plaintiff APPLICATION TO PROCEED
( V. _ WITHOUT PREPAYMENT OF
Timo, /\/Q mos 250 qi·{\£>l\ FEES AND AFFIDAVIT
Defendant(s) r,
CASENUMBER: .O¤‘*i2O
I, [Q xg, [ (Q2, gi, 5 gg Q {3 declare that I am the (check appropriate box)
lj Petitioner/Plaintiff/Movant D Other ` _
in the above·entitled proceeding; that in support of my request to proceed without prepayment of fees or costs
under 28 USC §1915, I declare that I am unable to pay the costs of these proceedings 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: {E;
1. Are you currently incarcerated? |jYes El No (If "No" go to Question§;
r·‘ $1 _
If "YES" state the place of your incarceration QQ ,· L gg ;A Q; I ng 2g,Q I
_ _ ’U _
Are you employed at the institution? A[_Q_ Do you receive any payment from the l¤S€It¤(10lX%_&_QL
I! 1 1 1 . !1l V. idll lali h'l! '1' 1 £il!!A !.1{!!!!-1’ "'# 1 '
. 1 .l fi f l. iq! -4f!l !1 1u.1 4’ l! ..4.i 4 ru.! Z u.H 1 !!1!•:! f1 SQL ’! 1‘4
2. Are you currently employed? U Yes dNo
a. If the answer is "YES" state the amount of your take-home salary or wages and pay period and
give the name and address of your employer.
b. If the answer is "N0" 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 ¤ Yes rf No
b. Rent payments, interest or dividends D Yes 51/ No
c. Pensions, annuities or life insurance payments El Yes 5/ No
d. Disability or workers compensation payments D Yes 19/ No
e. Gifts or inheritances D Yes J No
f. Any other sources ¤ Yes J No
If the answer to any of the above is "YES" describe each source of money and state the amount
receivedAND what you expect you will continue to ieceive.

. Case 1 :08-cv-00420-SLR Document 1 Filed 07/O9/2008 Page 2 of 2
4. D0 you have any cash or checking or savings accounts? ¤Yes Ao
i i i If"Yes" state the total amount _$ .-[ .
5. Do you own any real estate, stocks, bonds, securities, other financial instruments, automobiles or other
valuable property?
, ¤Yes N/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.
DA’I`E SIGNATURE OF APPLICANT
· CERTIFICATE
(Incarcerated applicants only) X
I certify that the applicant named herein has the sum of S on account his/her credit at (name
of institution) .
I further certify that the applicant has the following securities to hislher credit:
I further certify that during the past six months the applicant's average monthly balance was S
and the average monthly deposits were S .
Date SIGNATURE OF AUTHORIZED OFFICER
(NOTE THE REQUIREMENTIN ITEM 1 FOR THE INLIATE TO OBTAINANDATTACHLEDGER SHEETS
OF ACCOUNT TRANSACTIONS OVER THE PAST SIX MONTH PERIOD. LEDGER SHEETS ARE NOT
REQUIRED FOR CASES FILED PURSUANT TO 28: USC §2254)

Case 1:08-cv—O0420-SLR Document 1-2 Filed 07/O9/2008 Page 1 of 2
STATE OF DELAWARE
DEPARTMENT OF CORRECTION
BUREAU or ADULT CORRECTION
HOWARD R. YoUNG coRREcT1oNAL INSTITUTION
Ro. Box 9279
WILMINGTON DE 19801
(DUS1NESS ADDRESS)
Memorandum
To: Marquis Robinson, SBI # 495649, 2F, 12
From: Business Office
Date: July 1, 2008
Re: Response to your letter.
Mr. Robinso11,
Here is a copy of your 6 months history and balance.

Case 1 :08-cv—00420-SLR Document 1-2 Filed 07/09/2008 Page 2 of 2
RESIDENT HISTORY REPORT Page 1 Of 1
HRYCI ·’**1 if `'’. ’’aE
07/01/08 13:57 _ . `fji y Q.
ST 006 / OPR JNM IIIEI
SBI : 495649
Resident Name : ROBINSON, MARQUIS
Time Frame : 01/01/2008 12:09 — 07/01/2008 13:57
Date Time Type ST OPR Receipt # Amount Balance
04/25/2008 22:23 Add 5 blr E28583 0.55 3.36
05/05/2008 05:47 Order 2 DDT B215629 3.27 0.09
05/09/2008 11:16 Credit 11 AFC K8652 3.27 3.36
05/12/2008 05:38 Order 2 AFC B216492 2.85 0.51
05/14/2008 12:12 Add 8 bsf H39054 15.00 15.51
05/16/2008 13:41 Close 6 JNM F38420 15.51 0.00
06/09/2008 12:09 Reopen 5 CCB E29440 5.00 5.00
(06/09/2008 12:09 Rec Payment 5 CCB E29441 2.00 3.00
06/16/2008 09:08 Order 2 DDT B221568 2.98 0.02
06/23/2008 11:26 Add 8 bsf H39905 15.00 15.02
06/30/2008 16:50 Rec Payment 10 bsp J14279 3.00 12.02
*07/01/2008 05:59 Order 2 DDT B223384 11.90 0.12

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