Baker v. Brady

Full title: JERRY W. BAKER, Plaintiff, v. JOSH BRADY, et al., Defendants

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

Date published: Jul 26, 2010

No. 2:10-cv-1811 KJN P (E.D. Cal. Jul. 26, 2010)

Opinion

No. 2:10-cv-1811 KJN P.

July 26, 2010

ORDER

KENDALL NEWMAN, Magistrate Judge

Plaintiff, a county inmate proceeding without counsel, has filed a civil rights action pursuant to 42 U.S.C. § 1983. Plaintiff has not, however, filed an in forma pauperis affidavit or paid the required filing fee. See 28 U.S.C. §§ 1914(a), 1915(a). Plaintiff will be provided the opportunity either to submit the appropriate affidavit in support of a request to proceed in forma pauperis or to submit the appropriate filing fee.

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

1. Plaintiff shall submit, within thirty days from the date of this order, an affidavit in support of his request to proceed in forma pauperis on the form provided by the Clerk of Court, or the appropriate filing fee; plaintiff's failure to comply with this order may 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.

SUBMISSION OF IFP or FILING FEE

Plaintiff hereby submits the following document in compliance with the court's order filed __________________:

____________ IFP affidavit ____________ The appropriate filing fee DATED: ______________________________ Plaintiff

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