Opinion
No. CIV S-08-2261 DAD P.
October 2, 2008
ORDER
Plaintiff, a state prisoner proceeding pro se, has filed a civil rights action pursuant to 42 U.S.C. § 1983, together with a request for leave to proceed in forma pauperis pursuant to 28 U.S.C. § 1915. However, the certificate portion of the in forma pauperis application has not been filled out and signed by an authorized prison official. See 28 U.S.C. § 1915(a)(2). Plaintiff will be provided another opportunity to submit a fully completed application to proceed in forma pauperis.
Accordingly, IT IS HEREBY ORDERED that:
1. Plaintiff's September 25, 2008 application to proceed in forma pauperis (Doc. No. 2) is denied without prejudice;
2. Plaintiff shall submit, within thirty days from the date of this order a properly completed in forma pauperis application that includes a certified copy of plaintiff's prison trust account statement for the six-month period immediately preceding the filing of the complaint in this action and a prison official's certification; plaintiff is cautioned that failure to comply with this order or seek an extension of time to do so will result in a recommendation that this action be dismissed without prejudice; and
3. The Clerk of the Court is directed to send plaintiff an Application to Proceed In Forma Pauperis By a Prisoner for use in a civil rights action. APPLICATION TO PROCEED WITHOUT PREPAYMENT OF FEES AND AFFIDAVIT 28 USC § 1915
UNITED STATES DISTRICT COURT Eastern District of California Plaintiff, v. CASE NUMBER: Defendant. I, ___________________________________________________, declare that I am the (check appropriate box) petitioner/plaintiff/movant other in the above-entitled proceeding: that in support of my request to proceed without prepayment of fees or costs under I declare that I am unable to pay the costs of these proceedings and that I am entitled to the relief sought in the complaint/petition/motion. In support of this application, I answer the following questions under penalty of perjury: 1. Are you currently incarcerated? Yes No (If "No," go to Part 2) If "Yes," state the place of your incarceration ____________________________________________________ Are you employed at the institution? __________ Do you receive any payment from the institution? _________ Attach a ledger sheet from the institution(s) of your incarceration showing at least the past six months' transactions. 2. Are you currently employed? Yes No a. If the answer is "Yes," state the amount of your take-home salary or wages and pay period and give the name and address of your employer. 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 12 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, on the following page, each source of money and state the amount received and what you expect you will continue to receive. 4. Do you have any 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 any other thing of value? Yes No 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. I declare under penalty of perjury that the above information is true and correct. ________________________ _______________________________________________________ Date Signature of Applicant NOTICE 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 certififed 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 certified statement of each account.