Opinion
No. CIV S-11-2296-CMK-P.
September 22, 2011
ORDER
To: The California Department of Corrections and Rehabilitation 1515 S Street, Sacramento, California 95814:
Plaintiff, a state prisoner proceeding pro se and in forma pauperis, is obligated to pay the full statutory filing fee for this action. In addition to any initial partial filing fee that has been assessed, plaintiff will be obligated to make monthly payments in the amount of twenty percent of the preceding month's income credited to plaintiff's inmate trust account. The agency referenced above is required to send to the Clerk of the Court the initial partial filing fee and thereafter payments from plaintiff's inmate trust account each time the amount in the account exceeds $10.00, until the statutory filing fee of $350.00 is paid in full. See 28 U.S.C. § 1915(b)(2).
Good cause appearing therefor, IT IS HEREBY ORDERED that:
1. If an initial partial filing fee has been assessed by the accompanying order granting in forma pauperis status, the director of the agency referenced above, or a designee, shall collect from plaintiff's prison trust account the amount specified and forward the amount to the Clerk of the Court, such payment to be clearly identified by the name and number assigned to this action;
2. The director of the agency referenced above, or a designee, shall collect from plaintiff's prison trust account the balance of the filing fee by collecting monthly payments from plaintiff's inmate trust account in an amount equal to twenty percent (20%) of the preceding month's income credited to the prisoner's inmate trust account and forwarding payments to the Clerk of the Court each time the amount in the account exceeds $10.00 in accordance with 28 U.S.C. § 1915(b)(2), such payments to be clearly identified by the name and number assigned to this action;
3. The Clerk of the Court is directed to serve a copy of this order, a copy of the court's order granting in forma pauperis status, and a copy of plaintiff's signed in forma pauperis affidavit to the address shown above; and
4. The Clerk of the Court is further directed to serve a copy of this order on the Financial Department of the court. APPLICATION TO PROCEED IN FORMA PAUPERIS BY A PRISONER CASE NUMBER:
UNITED STATES DISTRICT COURT EASTERN DISTRICT OF CALIFORNIA Plaintiff vs. Defendant 2:11-W-2296 CMK I, Terrence L. Davis, 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:High Desert State Prison 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 N/A
1. Are you currently incarcerated: [X] Yes [] No (If "No" DO NOT USE THIS FORM) If "Yes" state the place of your incarceration. 2. Are you currently employed? [] Yes [X] 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. Haven't worked since: 1993. SSI 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 [X] No b. Rent payments, interest or dividends [] Yes [X] No c. Pensions, annuities or life insurance payments [] Yes [X] No d. Disability or workers compensation payments [] Yes [X] No e. Gifts or inheritances [] Yes [X] No f. Any other sources [] Yes [X] 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 [X] 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 [X] No If "Yes" describe the property and state its value. 6. Do you have any other assets? [] Yes [X] 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.8/11/11 Terrence L. Davis
DATE SIGNATURE OF APPLICANTCERTIFICATE (To be completed by the institution of incarceration)
I certify that the applicant named herein has the sum of $0 on account to his/her credit at High Desent State Prison (name of institution). I further certify that during the past six months the applicant's average monthly balance was $0. I further certify that during the past six months the average of monthly deposits to the applicant's account was $0.(Please attach a certified copy of the applicant's trust account Statement showing transactions for the past six months.)
____________________ ___________________________________________________ DATE SIGNATURE OF AUTHORIZED OFFICER Exhibit