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

{ Case 1:07-cv-OO814—G|\/IS Document 8 Filed O1/O9/2008 Page 1 of 2
` Case 1:07-cv-00814-***-MPT Document? Fiied 01/02/2008 Page 4 of 4
IN THE UNITED STATES DISTRICT COURT .;
FOR THE DISTRICT OF DELAWARE .
CLARENCE EDWARDS, ) .
piainrirf, 3
v. ; Civil Action Nc. 07-814-***-MPT E
KATHLEEN AMALEITANO, g 1
STATE OF DELAWARE, ET AL, )
Defendants. g !
, i
_____ AUTHORIZATION
I, Clarence Edwards, SB1 #158551, request and authorize the l
agency holding me in custody to disburse to the Clerk of the 2
Court the initial partial filing fee of $1.67 and the subsequent E
payments pursuant to 28 U.S.C. § 1915(b) and required by the l
Court' s order dated I/Z~ ,fw 2008. l U l
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 into whose custody
1 may be transferred.
Date: I [ 5/ , 2008.
‘ U U Signature of Plaintiff
JAN 0912008 ,
{gp sma rt

Case 1:07-cv-OO814—G|\/IS DecUF1eHI-IS Filed O1/O9/2008 Page 2 of 2
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Case 1:07-cv-00814-GMS

Document 8

Filed 01/09/2008

Page 1 of 2

Case 1:07-cv-00814-GMS

Document 8

Filed 01/09/2008

Page 2 of 2