Stribling v. E. Wilson et al

Filing 9

ORDER Granting 2 Motion to Proceed IFP; ORDER Directing Payment of Inmate Filing Fee by California Department of Corrections signed by Magistrate Judge Barbara A. McAuliffe on 09/27/2017. (Attachments: # 1 IFP Application) (Flores, E)

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SEP 18 201T~ UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA ~y17 -~~~~~~~~c CASE NUMBER 1~,~~~ 1~~►t~t~~~~ ~- ~ LJ, lS~~ ~ PRI SONER/PLAINTIFF, v. DEFENDANT(S). REQUEST TO PROCEED WITHOUT PREPAYMENT OF FILING FEES WITH DECLARATION IN SUPPORT ~. ~ R 1, ~(;~~~'`{ ~ ~~ ~~~ ~ ~ ~ ,declare under penalty of perjury, that the following is true and correct; that I am the prisoner-plaintiff in the above entitled case; that in support of my request to proceed without prepayment of fees under 28 U.S.C. Section 1915, [declare that because of my poverty [ am unable to pay the full costs of said proceedings or to give security therefore and that I am entitled to redress. i runner cieciare under penalty of perjury that tine responses which [have made to the questions and instructions below are true, correct and complete. 1. Are you presently employed in prison? ❑Yes fANo a. If the answer is yes, state the number of hours you work per week and the hourly rate of pay: State the place of your incarceration ''' /1 '_~' Have the institution fill out the Certificate portion f this application and attach a certified copy of your prison trust account stateme~lt showing transactions for the past six months. 2 Have you received, within the past twelve months, any money from any of the following sources? . a. Business, profession or form of self-employment? ❑Yes E~]No b. Rent payments, interest or dividends? ❑Yes GC7No c. Pensions, annuities or life insurance payments? ❑Yes [~No d. Gifts or inheritances? ❑Yes ~No e. Any other income (other than listed above)? ❑Yes I~No f Loans? . ❑Yes GdNo If the answer to any of the above is yes, describe such source of money and state the amount received from each source during the past twelve (12) months: RF,QUF.ST 7'O NROCEF',D WITHOL''C PRF,NAYMENT OF FILING E'EES ~~'[TH DECLARA"I'fOfV IN SUPPORT CV-60P (04/06) Page 1 of 3 3. Do you own any cash, or do you have money in a checking or savings account? (Include any funds in prison accounts, if applicable.) ❑Yes ~l No if the answer is yes, identify each account and separately state the amount of money held in each account for each of the six (6) months prior to the date of this declaration. 4. Do you own any real estate, stocks, bonds, notes, automobiles, or other valuable property (excluding ordinary household furnishings and clothing)? ❑Yes ~I No [f the answer is yes, describe the property and state it approximate value: 5. In what year did you last file an Income Tax Return? Approximately how much income did. your last tax return reflect? 6. List the persons who are dependent upon your for support, state your relationship to those persons, and indicate how much you contribute toward their support: 1 understand that a false statement or answer to any question in this declaration will subject me to penalties for perjury. i fu~her u7derstand that per;ur; is ~ani~hable by a tens of im~ri~orm~nt of up to five (5) years and/or a fine of $250,000(18 U.S.C. Sections 1621, 3571). 1 ! 1 State I, ~~~'~~ ~ ~~ ~~~~~~► ~ . ~I Coun y (ar City) ,declare under penalty of perjury that the foregoing is true and correct. i f,6 ~/ ~~ Dater r' Prisoner/P ai '' ~gnature) REQUEST TO NROCGED WITHOUT PRF,PAYNiENT OF FLING FEF,S WITH DECLARA'f[ON IN SL`PPORT C V-60P (04/06) Page 2 of 3 PRISONER AUTHORIZATION If my request to proceed without prepayment of filing fees is granted, l understand that I am required by statute to pay the full amount of the filing fees for this case, regardless of my forma pauperis status and the disposition of this case. I further authorize the prison officials at this institution to assess, collect and forward to the Court the full amount of these fees, in monthly payments based on the average of deposits to or balance in my prison trust account in accordance with 28 U.S.C. Section 1915. Prisoner- i ff(Signature) CERTIFICATE OF AUTHORIZED OFFICER I hereby certify that the Prisoner-Plaintiff herein has credit in the sum of$ on account at the institution where Prisoner-Plaintiff is confined. I further certify that during the past six months the applicant's average monthly balance was $ certify that during the past six months the average of monthly deposits to the applicant's account was$ I further A certified copy of tl~e prisoner-plaintiffs trust acco~~nt statement for the last six (6) months is attached. Date Authorized Officer of Institution (Signature) REQUEST TO PROCEED WITHOUT PREPAYMENT OF FILING FEES WITH DECLARATION IN SUPPORT CV-60P (04/06) Page 3 of 3 Verified: ___ CDCR Inmate Statement Report Date\Time: 8/11 /2017 1:27:47 PM Institution: PBSP CDCR# InmatelGroup Name Institution Unit Cell/Bed G40745 STRIBLING, AARON PBSP Z 001 1 129001 $0.00 Current Available Balance: .Transaction List ! Transaction Institution Date Receipt#1/Check# Source Doc# Transaction Type Amount Acco,;nt Ealance * 'No information was found for the given criteria." (Encumbrance List Amount Transaction Date Encumbrance Type ` *No information was found for the given criteria.' ~.----------... .._ L_Obligation List r _~._-_ -- -...__~_..-------- ---_-_..--- --....__.__..__.~.. __,..._._.._ Original Owed Balance Sum of Tx for Date Range for Oblg Current Balance CELL WINDOW $183.00 $0.00 $183.00 PLRA 4:15-CV-03336-YGR $350.00 $0.00 $330.00 PLRA 4:15-CV-03337-YGR $350.00 $0.00 $335.00 PLRA 4 15-CV-03199-YGR $350.00 $0.00 $350.00 PLRA 2:16-CV-00400-CKD $350.00 $0.00 $350.00 PLRA 2:16-CV00399-MCEEFB $350.00 $0.00 $350.00 PLRA 2:16-CV-01438-EFB $350.00 $0.00 $350.00 COPY CHARGES COPIES 7/17/16 $0.40 $0.00 $0.40 PLRA 4:16-CV-01277-YGR $350.00 $0.00 $350.00 PLRA APPEAL2: 16CV00400CKD $505.00 $0.00 $505.00 PLRA APPEAL2: 16CV00399EF6 $505.00 $0.00 $505.00 COPY CHARGES COPIES 03/13/17 $0.20 $0.00 $0.20 PLRA APPEAL4: 15CV03199YGR $505.00 $0.00 $505.00 PLRA APPEAL4: 15CV03336YGR $505.00 $0.00 $505.00 MEDICAL COPAY 8/9/17M 830233273 $5.00 $0.00 ~ $5.00 Obligation Type Court Case# DAMAGES -STATE PROPERTY Restitution List _ ~ Original Owed Balance Interest Accrued Sum of Tx for Date Range for Oblg Current Balance $200.00 $0.00 $0.00 $200.00 Active $3,650.00 $0.00 $0.00 $3,550.00 Active $200.00 $0.00 $0.00 $200.00 Restitution Court Case# Status RESTITUTION FINE 07F03385 Active DIRECT ORDER 07F03385 RESTITUTION FINE 08F00946 30 ~~~l ~_ E ~~ ~,~~h~ ~~1 r ~~~~ ~~~ ~ ~ I .~ . / r ~ ~ ~ 1 ~ ~ ~ ~- ~ ~ ~c ~ ,_ ~ ~~~. ~r ~ ~ ~ ~~ 1 ~ ~. ~ : r , _ { ~~ ~~~x~~ ~~~ 4 C ~ ~~ , r ~ ~" ~-~ -~ ~~n 1I~ U ~ ~ )_ ~ ~ ~~. i ~ _~ C ~; ~~ ~, ~ ti e~ ~ ~ C I ~ ~ .- Jj ~ r ~~~~/ ~e~-~ a~~~~ ~ r w~i f a 1 STATEOFCALIFORNIA GA-0022(Rev 2013-10) DATE ,~ f~ ~ ~ C ~i DEPARTMENTOFCORRECTIONS.&REHABILIATION INMATE R~~~E FOR INTERVIEW ~~ ~`~ O HOUSING ROM (LAST NAME) BED NUMBER CDCR NUMBER WORK ASSIGNMENT JOB NUMBER FROM OTHEP,ASSIGNMENT(SCHO L, THERAPY, ETC.) TO ASSlGNtNENT HOURS FROM TO Clearly state your reason for requesting this interview. You will be called in for interview in the near future if the matter cannot be handled by correspondence. A ~ 1 • ~ t ~t I t - L! '. U i s 1~ L

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