Davis v. Ryan

Filing 8

ORDER the 1 "Notice of Intent to File Petition" and this action are dismissed without prejudice; the Clerk of Court must enter judgment accordingly. Petitioner's request for appointment of counsel is denied without prejudice. Petitio ner's 3 Application to Proceed In Forma Pauperis is denied as moot. Petitioner's 5 Motion for Clarification and Statutory Tolling is denied. Signed by Judge G Murray Snow on 11/28/11. (Attachments: # 1 2254 Form, # 2 IFP Habeas Form) (ESL)

Name and Prisoner/Booking Number

Place of Confinement

Mailing Address

City, State, Zip Code

IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF ARIZONA

Petitioner,
vs.
Respondent(s).

)
, )
) CASE NO.
)
)
)
APPLICATION TO PROCEED
, )
IN FORMA PAUPERIS
)
BY A PRISONER
)
(HABEAS)

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.

GYes

GNo

2.

Do you receive any other payments from the institution where you are confined?
If "Yes," state the source and amount of the payments.

GYes

GNo

98-ifphab
Revised 6/98

1

3.

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.

DATE

SIGNATURE OF APPLICANT

CERTIFICATE OF CORRECTIONAL OFFICIAL
AS TO STATUS OF APPLICANT’S TRUST ACCOUNT
, certify that as of the date applicant signed this application:

I,
(Printed name of official)

The applicant’s trust account balance at this institution is: $

DATE

AUTHORIZED SIGNATURE

TITLE/ID NUMBER

2

.

INSTITUTION