Corral-Lozano v. Ryan et al
ORDER that within 30 days, petitioner must either pay the $5.00 filing fee or file a completed application to proceed in forma pauperis (ifp). If petitioner fails to either pay the $5.00 filing fee or file a completed application for ifp wi thin 30 days, the Clerk must enter a judgment of dismissal of this action without prejudice and without further notice to petitioner. Special Prisoner Deadline due by 3/13/2009. Signed by Judge Mary H Murguia on 2/12/2009. (Attachments: # 1 Application form) (LAD)
Name and Prisoner/Booking Number
Place of Confinement
City, State, Zip Code
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF ARIZONA
) ,) ) CASE NO. ) ) ) APPLICATION TO PROCEED ,) IN FORMA PAUPERIS ) BY A PRISONER ) (HABEAS)
Petitioner, vs. Respondent(s).
I, , declare, in support of my request to proceed in the above entitled case without prepayment of fees under 28 U.S.C. § 1915, that I am unable to pay the fees for these proceedings or to give security therefor and that I believe I am entitled to relief. In support of this application, I answer the following questions under penalty of perjury: 1. Are you currently employed at the institution where you are confined? If "Yes," state the amount of your pay and where you work.
Do you receive any other payments from the institution where you are confined? If "Yes," state the source and amount of the payments.
98-ifphab Revised 6/98
Do you have any other sources of income, savings, or assets either inside or outside of the institution where you are confined? GYes GNo If "Yes," state the sources and amounts of the income, savings, or assets.
I declare under penalty of perjury that the above information is true and correct.
SIGNATURE OF APPLICANT
CERTIFICATE OF CORRECTIONAL OFFICIAL AS TO STATUS OF APPLICANT'S TRUST ACCOUNT I, (Printed name of official) The applicant's trust account balance at this institution is: $ . , certify that as of the date applicant signed this application:
Disclaimer: Justia Dockets & Filings provides public litigation records from the federal appellate and district courts. These filings and docket sheets should not be considered findings of fact or liability, nor do they necessarily reflect the view of Justia.
Why Is My Information Online?