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

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IN THE UNITED STATES DISTRICT COURT §`iK(@/\®<\N
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IVAN L MENDEz 3 %\X§;§`& Q§ ia 4
Plaintiff, g A\qx\» ¤·
v. ) Civil Action No. 08—364—JJF
RUTH MATRUDER SMYTHE, JANE ; @8.. V\0\§x(Nx\\%\°t W\(*\$’l°(_§ Q\Q\©N\ $@5%) \i((“¢$\
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DIIFENDERS OFITICE OF DELAWARE, )f;O>gQ\\Q\\}`Q`%$)\$(q&%\{°‘COQM \7¤?<~)“\mi¤'(O‘/W‘L
,2%; ii Q9m<<;mN\ \Nx\xmNN rs<.mMn0A Defendants. ) \®°*’\§' b°§\‘\\{<·N\\— ,W¤m?\ QRQ1i(·1·;\,{QQ,%’\0 W; QIQR
AUTHORfz\§·I· §§%Y`;%`L(0V\\N> .
I, Ivan L. Mendez, SBI #453351, requestLaE§&gu§gor;2e the `
agency holding me in custody to disburse to the Clerk of the
Court all payments pursuant to 28 U.S.C. § 19l5(b) and required
by the Court’s order dated , 2008.
This authorization is furnished to the Clerk of Court in
connection with the filing of a civil action, and I understand
that the filing 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 int wneS §;§Qe§y°hi
I may be transferred. Augilzznwg E
Date: KWQQX! Uggfg , 2008. ,
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KQKEV (MM Ulm k,\s\\\ QKM Signature of Plaintiff
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Case 1:08-cv-00364-JJF

Document 8

Filed 08/12/2008

Page 1 of 1