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)

SEP 18 201T~

UNITED STATES DISTRICT COURT
CENTRAL DISTRICT OF CALIFORNIA

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CASE NUMBER

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PRI SONER/PLAINTIFF,
v.

DEFENDANT(S).

REQUEST TO PROCEED WITHOUT
PREPAYMENT OF FILING FEES WITH
DECLARATION IN SUPPORT

~.
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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

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1
State

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Coun y (ar City)

,declare under penalty of perjury that the foregoing is true and correct.
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f,6

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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

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STATEOFCALIFORNIA
GA-0022(Rev 2013-10)

DATE

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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.

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