Jason Allan Singer v. Matthew Braman et al

Filing 10

ORDER GRANTING In Forma Pauperis Application; ORDER DIRECTING Payment of Inmate Filing Fee by the California Department of Corrections 2 , signed by Magistrate Judge Erica P. Grosjean on 5/31/17. (Attachments: # 1 IFP Application, # 2 Trust Account Statement)(Hellings, J)

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"-FILE
6~.&h!( U.S (M~T~iICT
COUh1'

Case 1:17-cv-00725-EPG Document 2 Filed 05/18/17 Page 1 of 3

~IA'Y I -8 2017
~M1i D18TRICT Of

C V1~ _ ~3~ 6~.~~CSG~

5,~~~
Petitioner

Respondent(sJ

I, ~q~,_i

C+1LltC1flN1A
DEPIJTy

DECLARATION IN SUPPORT
OF REQUEST
TO PROCEED
IN FORMA PAUPERIS

~ t. ~i L .

,declare that I am the petitioner in the above entitled case;

~ ~ ~~--~~~~ i<

that in support of my motion to proceed without being required to prepay tees, costs or gi~~e security therefor, I state that
because of my' poverty I am unable to pay the costs of said proceeding or to give security therefor; that I believe I am
entitled to relief.

1. Are you presently employed? ^1"es `~ No

a. If the ans~ti~er is ~•es, state the amount oY ~~our salary or ~~ages per month, and gi~~e the flame anti address of your
en~plo~~er.

b. If the answer is no, state the date of last employment and the amount of the salar~~ and wages per month which
you received.

2. Have you received, within the past twelve months, an}~ money from any of the following sources?
❑Yes

~No

b. Rent payments, interest or di~~idends%

❑Yes

~.I~'o

c. Pensions, annuities or life insurance pa~~ments?

❑Yes

~,1 No

Yes

u No

❑Yes

'~ No

a.

Business, profession or forn~ of self-employment?

d. Gifts or inheritances?
e.

Any other sources?

if the answer to any of the above is ~-es, describe each source of money and state the an~ount received from each
during the past t~vel~~e months: ~ia
~} Cat" I Il-I'S
/

(~` ~" E Y1 ~ f(7~r• ;,il:"Y's

~~

;~V~ } ~~ ,~

-~ r

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(~~? L~ C ~ j

3. Do you own any cash, or do you ha~~e mone}' in a checking or sa~-ings account? (Include ~~~~i~ttin~ds rn prison nccounts)
u Yes

(0,%L ~1

~o

PE'I~ITI01 f'OR WRIT OF HABEAS CORPUS BY A PERSON I'~' STATE CUSTODY (28 C.S.0 § 21;-1)

Page

Case 1:17-cv-00725-EPG Document 2 Filed 05/18/17 Page 2 of 3
If the ans~ti~er is ~-es, state the total ~~alue of the items o~ti~ned:

4. Do you o~+'n any real estate, stocks, bonds, noCes, automobiles, or other valuable propert}'? ('Excluding ordinary
householdfisrnishrr~gs nr~d clothing) ❑Yes `~io
If the answer is yes, describe the propert}' and state its approximate ealue:

5. List the persons who are dependent upon you for support, state your relationship to those persons, and indicate how
m uch you contribute toward their support: ~ ~,

I, declare (or certifi~, verity- or state) under penalty of e ; y that the forea ~
Executed on `
J

is true and correct.

~'
~ Signature of Petitioner

Z.
to

CERTIFICATE
I hereby certify that the Petitioner herein has the sum of $

on account to his credit

at the

institution where he is

confined. I further certif~~ that Petitioner like~~-ise has the follo~+~ing securities to his credit according to the records of said
institution:

Date

CV-69 (OS/l2)

Authori<ed Orficer ofIr~stitutiort/Title of O~{icer
-

PETITION FOR WRIT OF H,~BEAS CORPUS BY A PERSON IN STATE CliSTODl'(28 ti.S.0 4 2254)

Page I1 of 11

Verified:
CDCR
Case 1:17-cv-00725-EPG Document 2 Filed 05/18/17 Page 3 of 3
Inmate Statement Report

Date\Time: 4/10/201710:45:41 AM
Institution: SATE
CDCR#

Inmate/Group Name

Institution

Unit

Cell/Bed

V85028

SINGER, JASON

SATF

E 001 1

119001

$0.01

Current Available Balance:
Transaction List
Transaction
Institution
Date

Source Doc#

Transaction Type

01/01/2017

SATF
SATF

TRACS TRANSFER IN

TX02232017

03/20/2017

SATF

SALES

04/06/2017

SATF

SALES

Amount

BEGINNING BALANCE

02/23/2017

Receipt#/Check#

Account Balance
$0.00

$12.16

$12.16

6

($11.80)

$0.36

21

($0.35)

$0.01

Encumbrance List
Transaction Date

Encumbrance Type

Amount

*
"No information was found for the given criteria.''*
Obligation List

Court Case#

Obligation Type

Sum of Tx for Date
Range for Oblg

Original Owed Balance

Current Balance

*
'No information was found for the given criteria.**
Restitution List
Sum of Tx for Date
Range for Oblg

Current Balance

$0.00

$0.00

$0.00

$200.00

$0.00

$0.00

$200.00

Active

$200.00

$0.00

$0.00

$200.00

PA046931

Fulfilled

$250.00

$0.00

$0.00

$0.00

DIRECT
ORDER

62140281

Active

$1,657.81

$0.00

$0.00

$1,657.81

RESTITUTION
FINE

62140281

Active

$6,000.00

$0.00

$0.00

$6,000.00

Original Owed Balance Interest Accrued

Restitution

Court Case#

Status

RESTITUTION
FINE

PA046542

Fulfilled

$200.00

FINE PC
1202.45

PA046542

Active

FINE PC
1202.45

PA046931

RESTITUTION
FINE

30