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

Case 1:07—cv—00466-Gl\/IS Document 1 Filed 07/26/2007 Page 1 ot 1
AO 240 Reverse (Rev, 10,/ 03)
DELAWARE {Env, {EDS] I .
n ( - ‘ gw 0 '( ·· 4 6 6 Env
l 4. Do you have any cash or checking or savings accounts? · • Yes · ®
If "Yes" state the total amount S ‘
5. Do you own any real estate, stocks, bonds, securities, other financial instruments, automobiles or other
valuable property? ‘ _
p · • Yes ·(No>
7 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/J U A/b
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I I declare under penalty of perjury that the above information is true T s correc . l ` l `
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on a ' » stonaru PLICANT
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 certitied
statement of each account.

Case 1:07-cv-00466-GIVIS Document 1-2 Filed 07/26/2007 Page 1 of 1 A
RESIDENT 1-::cs·1·012Y REPORT PAQE l ¤f 1 a
’ HRYCI .
05/23/07 13:51 ' ’
ST 006 / OPR. KJG
SBI : 165136 ~
Resident Name : WEMBLEY, JOHN
Time Frame : 06/07/2006 17:56 - 05/23/2007 13:51
Date Time Type ST OPR Receipt # Amount Balance
06/07/2006 17:56 Intake 5 BVS E15448 1.00 1.00
06/13/2006 12:11 Add 4 SED D493E!9 30.00 31.00
06/14/2006 09:41 Order 2 DDT B119632 20.08 10.92
06/21/2006 08:36 Order 2 DDT a1z0va2 10.91 0.01
03/26/2007 12.:15 Add 4 CAR D66097 20.00 20.01
03/29/2007 15:47 Rec Payment 6 kjg F27533 0.39 19.62
03/30/2007 09.:10 Rec Payment 10 bsp J9131 19.53 0.09