Rogers v. Governor of California

Full title: GERMAINE ROGERS, Plaintiff, v. GOVERNOR OF CALIFORNIA, Defendant

Court: United States District Court, E.D. California

Date published: Jan 16, 2008

No. CIV S-08-0026 FCD DAD P (E.D. Cal. Jan. 16, 2008)

Opinion

No. CIV S-08-0026 FCD DAD P.

January 16, 2008

ORDER

DALE DROZD, Magistrate Judge

Plaintiff, a state prisoner proceeding pro se, has filed a civil rights action pursuant to 42 U.S.C. § 1983. Plaintiff has not, however, filed a proper in forma pauperis affidavit. See 28 U.S.C. §§ 1914(a), 1915(a). Plaintiff does indicate that he had income from business, profession or other self-employment, pension, annuity or life insurance, and disability or workers compensation. However, plaintiff has not described the source of such money or state the amount received. Also, the certificate portion of the form was not completed by the authorized staff at the correctional facility, and plaintiff did not submit a certified copy of his inmate trust account statements for the last six months. Plaintiff will be provided the opportunity to submit a new application and the trust account statements.

In accordance with the above, IT IS HEREBY ORDERED that:

1. Plaintiff shall submit, within thirty days from the date of this order, a new application requesting leave to proceed in forma pauperis on the form provided by the Clerk of Court; plaintiff must answer each question and the certificate portion of the form must be completed by the authorized prison official; plaintiff must provide a certified copy of his inmate trust account statement for the six months preceding the filing of his complaint; plaintiff's failure to comply with this order will result in the dismissal of this action; and

2. The Clerk of the Court is directed to send plaintiff a new Application to Proceed In Forma Pauperis By a Prisoner.

APPLICATION TO PROCEED IN FORMA PAUPERIS BY A PRISONER

I, ______________________________, declare that I am the plaintiff in the above-entitled proceeding; that, in support of my request to proceed without prepayment of fees under 28 U.S.C. § 1915, I declare that I am unable to pay the fees for these proceedings or give security therefor and that I am entitled to the relief sought in the complaint.

In support of this application, I answer the following questions under penalty of perjury: Have the institution fill out the Certificate portion of this application and attach a certified copy of your prison trust account statement showing transactions for the past six months. and

1. Are you currently incarcerated: Yes No (If "No" DO NOT USE THIS FORM) If "Yes" state the place of your incarceration. ______________________________ 2. Are you currently employed? Yes No a. If the answer is "Yes" state the amount of your pay. b. If the 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 twelve months have you received any money from any of the following sources? a. Business, profession or other self-employment Yes No b. Rent payments, interest or dividends Yes No c. Pensions, annuities or life insurance payments Yes No d. Disability or workers compensation payments Yes No e. Gifts or inheritances Yes No f. Any other sources Yes No If the answer to any of the above is "Yes" describe by that item each source of money and state the amount received what you expect you will continue to receive. Please attach an additional sheet if necessary. 4. Do you have cash or checking or savings accounts? Yes 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? Yes No If "Yes" describe the property and state its value. ______________________________ 6. Do you have any other assets? Yes No If "Yes" list the asset(s) and state the value of each asset listed. 7. 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. I hereby authorize the agency having custody of me to collect from my trust account and forward to the Clerk of the United States District Court payments in accordance with 28 U.S.C. § 1915(b)(2).

I declare under penalty of perjury that the above information is true and correct.

_______________ __________________________________________________ DATE SIGNATURE OF APPLICANT

CERTIFICATE (To be completed by the institution of incarceration)

I certify that the applicant named herein has the sum of $__________ on account to his/her credit at ______________________________ (name of institution). I further certify that during the past six months the applicant's average monthly balance was $__________. I further certify that during the past six months the average of monthly deposits to the applicant's account was $__________.

(Please attach a certified copy of the applicant's trust account statement showing transactions for the past six months.)

_______________ __________________________________________________ DATE SIGNATURE OF AUTHORIZED OFFICER