Free Order (PLRA) Missing Documents - District Court of Delaware - Delaware

Case 1:07-cv—00466-G|\/IS D0cument4 Filed 08/07/2007 Page1 0f4
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF DELAWARE
JOHN H. WIMBLEY, )
Plaintiff, i
v. 3 Civil Action No. O7—466 GMS
CANDACE (CMS Nurse), 3
Defendant. 3
ORDER
l. The plaintiff John H. Wimbley, SBI #l65l36, a oro
ao litigant who is presently incarcerated, has filed this action
pursuant to 42 U.S.C. § l983 without prepayment of the filing fee
or a complete request to proceed ro forma oauoeris application.
The Court received a copy of plaintiff’s Resident History Report
or trust account summary, and an incomplete IFP Application to
Proceed Without Prepayment of Fees.
2. Pursuant to 28 U.S.C. § l9l5(b), the plaintiff
shall be assessed the filing fee of $350.00.
3. Pursuant to the requirements of 28 U.S.C.
§ l9l5(a)(l) and (2), and in order to determine the schedule of
payment of the filinq fee, the plaintiff shall submit to the
Clerk of Court, a complete Application to Proceed Without
Prepayment of Fees form in order to proceed fa forma pauperis.
FAILURE OF THE PLAINTIFF TO RETURN THE REQUESTED INFORMATION
WITHIN 30 DAYS FROM THE DATE THIS ORDER IS SENT SHALL RESULT IN

Case 1:07-cv—00466-G|\/IS Document 4 Filed 08/07/2007 Page 2 of 4
DISMISSAL OF THIS ACTION WITHOUT PREJUDICE.
4. Unless the Court determines from the plaintiff’s
financial information that he has no assets whatsoever, an
initial partial filing fee of 2O percent (20%) of the greater of
the plaintiff’s average monthly deposit or average monthly
balance in the trust fund account shall be required to paid
before the court reviews the complaint. NOTWITHSTANDING ANY
PAYMENT MADE OR REQUIRED, THE COURT SHALL DIsMIss THE CASE IF THE
COURT DETERMINES THAT THE ACTION IS FRIVOLOUS OR MALIcIous, FAILS
TO STATE A CLAIM UPON WHICH RELIEF MAY BE GRANTED, OR sEEI MoNETARY RELIEF AGAINST A DEEENDANT wHo IS IMMUNE FROM SUCH
RELIEF.
5. Pursuant to 28 U.S.C. § l9l5(g), if the plaintiff
has had three or more actions dismissed by the Court on the
grounds that they were frivolous, malicious, or failed to state a
claim upon which relief may be granted, then the Court shall deny
the plaintiff leave to proceed in forma pauperis in all future
suits filed without prepayment of the filing fee, unless the
Court determines that the plaintiff is under imminent danger of
serious physical injury.
DATED % GYM y`
F I L E D
2
AUG ..7 2007
U.S. DISTRICT COURT
DISTRICT OF DELAWARE

Case 1:07-cv—00466-Gl\/IS Document 4 Filed 08/07/2007 Page 3 of 4
AO 240 (Rev lO/03)
DELAWARE Rev. 5/06)
UNITED STATES DISTRICT COURT
DISTRICT OF DELAWARE
Plaintiff APPLICATION TO PROCEED
V. WITHOUT PREPAYMENT OF
FEES AND AFFIDAVIT
Defendant(s)
CASE NUMBER: 07-466 GMS
I, gg Ygggg declare that I am the (check appropriate box)
El Petitioner/Plaintiff/Movant El Other
in the above—entit|ed proceeding; that in support of my request to proceed without prepayment of fees or costs under
28 USC §l915, I declare that I am unable to pay the costs of these proceedings and thatl 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:
l. Are you currently incarcerated? El Yes El No (If "No" go to Question 2)
If "YES" state the place of your incarceration
Inmate Identiiication Number (Required): _
Are you employed at the institution? Do you receive any payment from the institution?
Attach a ledger sheet [rom the institution of your incarceration detailing all transactions over the gas!
szlv months.
2. Are you currently employed? Cl Yes El No
a. Ifthe answer is "YES" state the amount ofyour take-home salary or wages and pay period
and give the name and address of your employer.
b. Ifthe 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 last employer.
3. In the past l2 twelve months have you received any money from any ofthe following sources?
a. Business, profession or other self-employment El Yes E1 No
b. Rent payments, interest or dividends El Yes El No
c. Pensions, annuities or life insurance payments E1 Yes E1 No
d. Disability or workers compensation payments E1 Yes E1 No
e. Gifts or inheritances D Yes E No
f. Any other sources D Yes D No
Ifthe answer to any ofthe above is "YES" describe each source of money and state the amount
received AND what you expect you will continue to receive.

Case 1:07-cv—00466-Gl\/IS Document 4 Filed 08/07/2007 Page 4 of 4
AO 240 Reverse (Rev 10/O3)
DELAWARE Rev S/06]
4. D0 you have any cash or checking or savings accounts? E1 Yes El No
If"Yes" state the total amount $
5. Do you own any real estate, stocks, bonds, securities, other financial instruments, automobiles or other
valuable property?
El Yes E1 No
It "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.
T DATE _AMiT SIGNATURE OF APPLICANT _ U _
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.