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

E Case 1:08-cv-00396-SLR Document 1 Filed 06/30/2008 Page 1 of 2. `
AO 240 {Rev. 10/D3)
DELAWARE {Rev. 4/05
AL UNITED STATES DISTRICT COURT
Q OFNGIN nisriuctr or DELAWARE
Bergarci woods
Piaimirr APPLICATION TO PROCEED
V. WTTHOUT PREPAYMENT OF
FEES AND AFFIDAVIT
Defendant(s) .
CASE NUMBER:
. , O 8 " ‘*~’ “ 6
I, B; [ l) 0, [A N Q 0 rl i declare that I am the (check appropriate box)
° ° Petitioner/Plaintiff/Movant ° ° Other
in the above—entitled proceeding; that in support of my request to proceed without pr • . in - . . — —» » ..
28 USC §l915, I declare that I am unable to pay the costs of these proceedings an that I am gr} , re e f -
sought in the complaint/petition/motion. _ i l “ `W `D I Q
1 JUN it 0 illlltt .
In support of this application, I answer the following questions under penalty of perj 1
1. Are you currently incarcerated? ® ° °No (If "No" go t s ru]
.- _ 6
If "YES" state the place of your incarceration /‘I/4IMm-’{-an i [ll, i‘i3]6"1‘ i fi 5
Inmate Identification Number (Required); Ig Li SOL`} (
Are you employed at the institution? Mc Do you receive any payment from the institution'? lit
Attach rz ledger sheet Qom the institution of your incarceration showing at least the past six months'
transactions
2. Are you currently employed? ° ° Yes Qnjb
a. Ifthe answer is "YES" state the amount of your take-home salary or wages and pay period a
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 lag employer. /J/g,», Quay
(Q]0éyQ;,,· q mpqfh f.[[,}?’¢ /.36/L: ,2}*5//{gt; [,4,6//rr] D5/;%‘7`
3. In the past 12 twelve months have you received any money from any of the following sources?
a. Business, profession or other seltiemployment • • Yes • Not
b. Rent payments, interest or dividends • • Yes •
c. Pensions, annuities or life insurance payments • • Yes @
d. Disability or workers compensation payments • · Yes • `@
e. Gifts or inheritances ·p;_VYes • •,_N
f. Any other sources • • No
If the answer to any ofthe above is "YES" describe each source ofmoney and state the amount
receivec;’AND what you irpect you will continue to receive. M7 mmm ji NX mt SHIGWW5 auU1mm\\_\c!
O kt" r“;A·{"\ TL °t·’ f€"’y"-.1/` * S¢\·"n`(· .5(*_•‘Y\( +‘]y` ( ,
, · . , W C"€"‘J€’“’¢$—jixl
mh] Séoci men $200/·:lI¢·#.s’ •./i1i>*#f~’c'i'¢¢l 5e m—e,‘l’¤Me bart n.:`C OLLQ n_

' Case 1 :08-cv-00396-SLR Document 1 Filed 06/30/2008 Page 2 of 2 _ `I
AO 240 Reverse [Rev. ID/03)
DELAWARE Rev 4/O5l
4. D0 you have any cash or checking or savings accounts? • • Yes
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 Q
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 ofperjury that the above information is true and correct.
,/ ,_ {_
rp /;?f S, .»»/(cw J
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.

Case 1:08-cv—00396-SLR Document 1-2 Filed 06/30/2008 Page 1 of 2
STATE or DELAWARE
DEPARTMENT or CORRECTION
BUREAU OF ADULT CORRECTION
HOWARD R. YOUNG coRREcT1oNAL INSTITUTION
Ro. Box 9279
WILMINGTON DE 19801
(BUSINESS ADDRESS)
Memorandum
To: Bernard Woods, SBI # 215300, lA, 8
From: Business Ofiice
Date: June 6, 2008
Re: Response to your letter.
Mr. Woods,
Here is a copy of your 6 months history and balance.

Case 1 :08-cv—00396-SLR Document 1-2 Filed 06/30/2008 Page 2 of 2
RESIDENT HISTORY REPORT Page 1 ¤f 1
HRYCI ··_‘_’ ‘‘·i:
06/06/08 12:57 ,1.I_ Y {QQ. ;
ST 006/ OPR JNM ·1‘‘ z
SBI : 215300
Resident Name : WOODS, BERNARD
Time Frame : 01/01/2008 12:27 - 06/06/2008 12:57
Date Time Type ST OPR Receipt # Amount: Balance
01/07/2008 07:33 Order 2 DDT B199755 7.67 0.76
01/23/2008 12:06 Add 4 gmw D83016 50.00 50.76
01/28/2008 08:48 Order 2 DDT B202600 38.72 12.04
02/04/2008 08:12 Order 2 AFC B203472 6.80 5.24
02/06/2008 11:36 Add 4 J D83846 50.00 55.24
02/07/2008 12:14 Add 4 J D83955 40.00 95.24
02/08/2008 12:21 Credit 11 AFC K7257 6.80 102.04
02/11/2008 07:28 Order 2 DDT B204385 40.21 61.83
02/25/2008 08:17 Order 2 DDT B206353 42.71 19.12
03/03/2008 07:37 Order 2 AFC B207323 13.69 5.43
03/07/2008 12:04 Add 4 J D85734 50.00 55.43
:03/10/2008 09:14 Order 2 DDT B208409 26.25 29.18_
03/17/2008 08:23 Order 2 DDT B209406 21.78 7.40
03/17/2008 12:08 Add 4 J D86297 20.00 27.40
03/24/2008 08:33 Order 2 DDT B210224 24.20 3.20
03/31/2008 10:42 Order 2 DDT B211295 2.29 0.91
04/10/2008 11:46 Add 4 gmw D87751 70.00 70.91
04/10/2008 12:25 Add 10 bsp J13134 15.00 85.91
04/14/2008 07:46 Order 2 DDT B213005 45.74 40.17
04/14/2008 09:20 Add 4 gmw D87896 7.95 48.12
04/15/2008 10:25 Rec Payment 10 bsp J13159 2.50 45.62
04/15/2008 10:56 Credit 11 WLH K8203 4.33 49.95
04/21/2008 11:42 Add 4 jxs D88258 20.00 69.95
04/22/2008 10:23 Order 2 AFC B214499 31.81 38.14
04/22/2008 12:45 Rec Payment 7 SJW G15628 4.00 34.14
04/29/2008 10:25 Order 2 DDT B215404 18.24 15.90
04/29/2008 13:30 Rec Payment 7 SJW G15797 4.00 11.90
05/06/2008 09:03 Order 2 DDT B216276 11.86 0.04
05/12/2008 15:13 Add 6 JNM F38328 50.00 50.04
05/13/2008 10:59 Order 2 AFC B217232 30.66 19.38
05/14/2008 15:06 Add 10 bsp J13848 21.00 40.38
05/20/2008 08:27 Order 2 DDT B218143 31.22 9.16
05/22/2008 15:17 Rec Payment 10 bsp J13963 1.00 8.16
05/27/2008 09:48 Order 2 DDT B219073 5.70 2.46

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