Calhoun v. Gomez

Full title: JAMONT L. CALHOUN, Plaintiff, v. GOMEZ, et al., Defendants

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

Date published: Sep 6, 2011

No. CIV S-11-2239 EFB P (E.D. Cal. Sep. 6, 2011)

Opinion

No. CIV S-11-2239 EFB P.

September 6, 2011

ORDER

EDMUND BRENNAN, Magistrate Judge

Plaintiff, a prisoner without counsel, has filed a complaint alleging civil rights violations. See 42 U.S.C. § 1983.

To proceed with a civil action a plaintiff must pay the $350 filing fee required by 28 U.S.C. § 1914(a) or request leave to proceed in forma pauperis and submit the affidavit and trust account statement required by 28 U.S.C. § 1915(a).

Plaintiff has neither paid the fee nor submitted a proper application for leave to proceed in forma pauperis.

Accordingly, plaintiff has 30 days from the date of service of this order to submit either the filing fee or the application required by § 1915(a). The Clerk of the Court is directed to mail to plaintiff a form application for leave to proceed in forma pauperis. Failure to comply with this order will result in a recommendation that this action be dismissed.

So ordered.

APPLICATION TO PROCEED IN FORMA PAUPERIS BY A PRISONER CASE NUMBER:

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF CALIFORNIA Plaintiff vs. Defendant(s) 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.

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 and 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