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

Case 1:08—cv—00077-GI\/IS Document 1 Filed 02/05/2008 Page 1 of 4
FORM TO BE USED BY A PRISONER FILING AN .
. APPL ICA TION TO PROCEED IN FORMA PA UPERIS
IN A 42 U. S. C. § 7983 CIVIL RIGHTS ACTION M
IN THE UNITED STA TES DISTRICT COURT , O 8 ·- T '{ ae ‘ I
FOR THE EASTERN DISTRICT OF ‘ ·
. I. CAPTION I ‘
GBEKE MICHAEL. AWALA,
{Enter the full name oi plaintiff or
plaintiffs}
v. I
CIRCUIT JUDGE HARDIMANQ1; al. . . _‘ .
{Enter the Full name of defendant or " " ‘‘ ’ ` l l ` E'J'
defendants} i F .
. OQ * FEB —·5 ZQUB
Instructions: " _
The Cap mn el this application should be identical to the caption of *2 e =.E
separate applica tion must be completed by each plaintiff listed in the -‘_. !‘ .1 ‘ ...c.,
full name ih the first line of the declaration below. Provide all information requested.
Il. DECLARATION ·
GBEKE MICHAEL AWALA _ _ _ _
l, lyour name} , declare that l am the plaintiff in
the abo ve—captioneEl 42 U. S. C. € ISE? civrll rights action, and that l am entitled to proceed
in forma gaugeris pursuant to 28 U.S. C. § 7.915 because of my inability to prepay the full
fee to file this action or give security therefor. l understand that the granting of Q forma
gaugeris status does not waive payment of the full filling fee.
ln further support of this application, l provide the following tinformation:
1. Do you presently have prison employment? yes I } no %(l -
2. lf you are not employed do you have other income? yes ( } no yr"
.3, lf "yes " to either of above, state source of monthly income and amount,
source amount
4. lf "no, " state date and place of last employment and amount of monthly income.
date and place amount
5. Do you have money in a prison account? yes l l no ( } amount
6. Do you have money at a bank account? yes l l no { J amount
7, Do you own or have an interest in valuable property such an automobile
real estate, stocks, or bonds? yes l Jno { )
ll "yes, "describe property value

Case 1:08—cv—00077¥iGiI\/IS Document 1 Filed 02/05/2008 Page 2 of 4
8. List the persons who depend on you for support, state ther? relationship to you, and
how much you contribute toward ther? support. . `
N * V
.9. State whether you have received within the past i 2 months any money from any of
' the followrng s0ur¢6S.‘ . - / .
a, Business, profession or other form of self-employment yes ( } no y
b. Fient pa yments; interest or dividends yes I J no J
c. Pensions, annuities or life insurance payments yes ( no (
d. Gifts or inheritances ~ yes ( I no I J
e. Any other sources ‘ yes ( I nl y/I
If the answer to any of the above is "yes, " describe each source of money
and state the amount received from each source during the past 12 months.

III. DE CLA RA TION AND SIGNA TURE
I declare under, penalty of perjury that the Jforegoing is true and correct.
· J L_
Ig !"”t$' A _ I- 2.2. ·— cage
_ SIGNA UR OF PLAINTIFF DA TE
IV. CEHLTIFICA TION _
Instructions: i J _ I
Request that an appropriate prison official provide: 1) the information below concerning
your inmate trust fund account balances; and 2} a certified copy of your inmate trust fund
account statement showing all deposits and withdrawals for the pri ,pan‘0d_
r
Icertify that the appIican§nanp{edCli rr;»of S rb on account
to his credit at The Q) " ` ` ‘ institution where he is
confined.
i runner certify that dugnyhe last six months the applicants average month/y account
balance v9 ‘ and that the average monthly deposits during tha au,-ing
the ia I " . *5 · ·/ »
A-·*—— -- · ‘ "" `\ ·<’.z.f1»·
SIGNA ' AND TITLE O · r a · ZED OFFICIAL A TE
- Page 2

Case 1 :08—cv—00077-GI\/IS Document 1 Filed 02/05/2008 Page 3 of 4
INMATE VISITOR LIST TURNER] D AVID ALLEN


General Information l Account Balances | Commissgy Histoq | Commissagy Restrictions | Comments
General Information _
Administrative Hold Indicator: No
No Power ofAttorney: No `
Never Waive NSF Fee; No
Max Allowed Deduction %: 100
PIN: 1374
PAC #: 352244177
FRP Participation Status: ExemptTmp
Arrivcd From: LEW
Transferred To:
Account Creation Date: 4/9/2007
Local Account Activation Date: 4/1 1/2007 3:33:51 AM
Sort Codes: `_____
Last Account Update: 1/13/2008 12:11:36 AM
Account Status: Active
Phonc Balance: $0.00
FRP Plan Information
FRP Plan Type Expected Amount Expected Rate
Account Balances
Account Balaneei $0_(}()
Pre-Release Balance: $0.00
Debt Encumbrance: $0.00
SPO Encumbrance: $0.00
Other Encumbrances: $0.00
Outstanding Negotiable Instruments: $0.00
Administrative Hold Balance: $0.00
Available Balance; $0.00
National 6 Months Deposits: $585.00
National 6 Months Withdrawals: $585.00 l
National 6 Months Avg Daily Balance: $16,78
Local Max. Balance - Prev. 30 Days: $0.00
Average Balance - Prev. 30 Days: $0.00
l11mate Qualities for OTC Medication
(TANA AN T ISP Page 1 nt` 2 04-19-2006 07*39

L~mATL%s§rLbR8Lssi¤¤¤77·GMS ¤¤¤¤m¤¤* 1 F·*¤¤ 02/¤5/Zoassiitsssststie ALLEN
This Inmate is indigent I
Commissary History
Purchases
_ Validation Period Purchases: $0-00 ·
YTD Purchases: $222.20
Last Saies Date: 12/6/2007 5:38:37 PM
SPO Information
SPO‘s this Month: 0
SPO $ this Quarter: $0.00
Spending Limit Info
Spending Limit Override: No
Weekly Revalidationz No
Bi—Weci·;iy Revalidation: No
Spending Limit: $290.00
Expendcd Spending Limit: $0.00
Remaining Spending Limit: $290.00
Commissary Restrictions
Spending Limit Restrictions
Restricted Spending Limit: $0.00
Restricted Expended Amount: $0.00
Restricted Remaining Spending Limit: $0.00
Restriction Start Date: N/A
Restriction End Date; NfA
Item Restrictions
List Name List Type Start Date End Date Active
Comments
Comments:
CANAAN USP Page 2 of 2 04-19-2006 07:39

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