Cruz v. Savioe

Filing 7

ORDER Granting 6 Motion to Proceed IFP, signed by Magistrate Judge Barbara A. McAuliffe on 11/20/17. (Attachments: # 1 Motion for IFP) (Gonzalez, R)

i. .."

1"'--,1

Case 1:17-cv-01474-DAD-BAM Document 6 Filed 11/13/17 Page 1 of 7
CDC No: rtII".,q""·Z9?Y

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NOV 13 2017
CLERI<.

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NOV 13 2011

u.s. DISTRICT COURT

~..I(". 7.r~tf> <::'4"..r~"- c.;rv, C'""e. ~~N DISTRICT OF CALIFORNIA.
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D

BY

CL
!:A.ST~~rWrIAjfI

OEPUTY CLERK

UNITED STATES DISTRICT CO URT
EASTERN DISTRICT OF CALIFORNIA
·'NG,..;9

...._~"'.tI.£~_ ...

CASE NUMBER:

_;;t..,,~".tI.L'" CA";Jt./

l'J1"C;V- 0/ LI7l{- ftI1rr7

Plaintiff/Petitioner,

v.

APPLlCATION TO PROCEED
IN FORMA PAUPERIS
BY A PRISONER
Defendants/Respondent.

----------------------------~/
I, c_.r"'.t.4'"~_ .. ~u.2F~ c~.,,~, declare that I am the plaintiff in the above-entitled proceeding;
that, in support of my request to proceed without prepayment of fees under 28 U.S.c. § 1915, I declare that I
am unable to pay the fees for these proceedings or give security therefor and that I am entitled to the relief
sought in the complaint.

In support of this application, I answer the following questions under penalty of perj ury:

1.

Are you currel:ltly incarcerated?

vYes

_No

(Tf"no" DO NCilT USE THIS FORM)

State the place of your incarceration. C'FL.i-.r~ 4HY J,QrrF,;?Ah..,.."

2.

Are you currently employed (includes prison employment)?

a.
3.

~o

Yes

If the answer is "yes" state the amount of your pay. _ _ _...::.?'
_______

Hav.e you received any money from the following sources over the last twelvemonths?
a.

b.
c.
d.
e.
f.

Business, profession, or other self-employment:
Rent payments, interest or dividends:
Pensions, annuities or life insurance payments:
Disability or workers compensation payments:
Re Gifts or inheritances:
Any other sources:

-

Yes
Yes
Yes
Yes
Yes
Yes

,./' No
~o

vNo
vNo
vNo
vNo·

If the answer to any of the above is "yes," describe by that item each source of money, state the

amount received, as well as what you expect you will continue to receive (attach an additional sheet if

necessary).

;...." .J--.•

Case 1:17-cv-01474-DAD-BAM Document 6 Filed 11/13/17 Page 2 of 7

Do you have cash (includes balance of checking or savings accounts)?

4.

Yes

/No

If "yes" state the total amount: _ _~j1I'c-- _ _ __
Do you own any real estate, stocks, bonds, securities, other financial instruments, autof!}obiles or
_Yes
_V"N_,0
other valuable property?
"

5.

If "yes" describe the property and state its value:

v'No

Yes

Do you have any other assets?

6.

If "yes," list the asset(s) and .state the value of each asset listed: ___
N_tlr_""'_E _ _ _ _ __
_
7.

List all persons dependent on you for support, stating your relationship to each person listed and
how much you contribute to their support.

This form must be dated and signed below for the court to consider your application.
I hereby authorize the agency having custody of me to provide a certified copy of my trust account
statement for activity covering the last six months to the Court. Additionally, once eligibility is established, I
further authorize the agency having custody of me to collect from my trust account and forward to the Clerk
of the United States District Court payments in accorda~u.s.c. § 1915(b)(2).

IC)- 2"1- 2017
DATE

.

~-T""

SIGNATURE OF APPLICANT

Applicant's CDCR Number (Mandatory forCDCR Applicants):

---'#-'---'A-'-'-A_·-=2'-~...;..,..!.." _ _ _ _ __
_

CERTIFICA TION BELO W IS TO BE COll1PLETED BY

NON-CDCR INCARCERA TED PRISONERS ONLY

CERTIFICATE

(To be completed by the institution of incarceration)

(certify that the applicant named herein has the sum of
on account to his/her credit at
_-:-:-_ _ _ _ _ _~:-:--~-:- (name of institution). I further certify that during the past six months the
applicant's average monthly
was $
. I further certify that during the Pflst six months the
average monthly deposits to the applicants account was
'
(Please attach a certified copy of the applicant's trust account statement showing transactions for the past six
months.)

DATE

SIGNATURE OF AUTHORIZED OFFICER

Case 1:17-cv-01474-DAD-BAM Document 6 Filed 11/13/17 Page 3 of 7

CERTIFICATE OF FUNDS

IN

PRISONER'S ACCOUNT

I certify that attached hereto is a true and correct copy the prisoner's trust
account statement showing transactions of:

_Tl<--J<-f_v-,-/..;....,./I,--o _ _
_
I1-,-A---",-;J..-,-cr.!.-7--1-f_ _for the last six months at

KERN VALLEY STATE PRISON where he is confined.

Oq ~~~-<-_~_jl 0 . ~ ~
I further certify that the average- deposits each month -to this prisoner's­
account for the most recent 6-month period were $ (f). ({)C) , and the
average balance in the prisoner's account each for the most recent 6-month
period was $ () ·00 .

Date

Verified: _ _ _ _-'----_ _ _ _ _ _ _ __
AM
COCR
Case 1:17-cv-01474-DAD-BAM Document 6 Filed 11/13/17 Page 4 of 7
Inmate Statement Report

Date\Time: 1117/201710:53:11
Institution: KVSP

CDCR#

Inmate/Group Name

Institution

Unit

Cell/Bed

AA2974

TRUILLO, GUILLERMO

PBSP

B 0021

117001

$0.00

Current Available Balance:

[ransaction List
Transaction
Date
Institution

Transaction Type

Source Doc#

Receipt#/Check#

Amount

Account Balance

**No information was found for the given criteria.**

IEncumbrance List
Encumbrance Type

Transaction Date

Amount

**No information was found for the given criteria.**

I Obligation List
Sum of Tx for Date
Range for Oblg

Current Balance

$0.48

$0.00

$0.48

POST2/9/14EN2/13/1
4

$0.48

$0.00

$0.48

REGULAR MAIL

MAIL 2/9/14ENT2/21

$0.48

$0.00

$0.48

PLRA

CV-00975-GSA

$350.00

$0.00

$350.00

PLRA

CV-00976-0LB

$350.00

$0.00

$350.00

PLRA

CV-01215-GSA

$350.00

$0.00

$350.00

COPY CHARGES

COpy
5/22/14E8/7/14

$1.76

$0.00

$1.76

PLRA

CV-01371-0LB

$350.00

$0.00

$350.00

PLRA

CV-00584-AC

$350.00

$0.00

$350.00

PLRA

CV-01370-0LB

$350.00

$0.00

$350.00

PLRA

1:14-CV-01401-BAM

$350.00

$0.00

$350.00

COPY CHARGES

COPY11/21/14ENT1
2/12

$0.70

$0.00

$0.70

PLRA

1:14-CV-01797-0LB

$350.00

$0.00

$350.00

PLRA

APPEAL 1:
14CV01401 BAM

$505.00

oAA&@.

$505.00

PLRA

1: 15-00859-GSA-PC

REGULAR MAIL

POST8/16/15-8/24/15

COPY CHARGES

COPY8/12/15­
8/24/15

COpy CHARGES

COPY9/1/15"9/11/15

REGULAR MAIL

101615MAIL 1020

PLRA

15SM0192

Obligation Type

Court C~se#

REGULAR MAIL

POST2/9/14EN2/10/1
4

REGULAR MAIL

REGULAR

~AIL

MAIL 2/11/16E21816

Original Owed Balance

THE WITHIN INSTRUMENT IS A
CORRECT COpy OF THE TRUST
ACCOUNT MAINTAINED BY THIS
ATIeST: /1·2:-("7
L

, I

m / f<' -c ~rql1c-. '-()c//e$O~OO

$350.00

CALIFORNIAj1EPMTMENT OF
I
CQRRECTI
SAN REHABI AT~O

$2.52

0.00

$1.60

$2.00

$0.00

$2.00

$0.49

$0.00

$0.49

$30.00

$0.00

$30.00

$0.49

$0.00

$0.49

PLRA

3: 15-CV-2826-JLS­
PCL

$350.00

$0.00

$350.00

PLRA

APPEAL1:
14CV00975SAB

$505.00

$0.00

$505.00

REGULAR MAIL

POST3/27/16-4/20/16

$3.40

$0.00

$3.40

2

Verified: _ _ _ _ _ _ _ _ _ _ _ __

Date\Time: 11/71201710:53:11 AM-.
Institution: KVSP

COCR
Case 1:17-cv-01474-DAD-BAM Document 6 Filed 11/13/17 Page 5 of 7
Inmate Statement Report
Original Owed Balance

Sum of Tx for Date
Range for Oblg

Current Balance

052516MAI L0609

$0.47

$0.00

$0.47

REGULAR MAIL

052516MAIL0609

$0.47

$0.00

$0.47

REGULAR MAIL

052516MAIL0609

$0.68

$0.00

$0.68 .

REGULAR MAIL

061316MAIL0615

$0.47

$0.00

$0.47

REGULAR MAIL

061316MAIL0615

$0.47

$0.00

$0.47

REGULAR MAIL

061316MAIL0615

$2.41

$0.00

$2.41

REGULAR MAIL

062016MAIL0621

$0.47

$0.00

$0.47

REGULAR MAIL

062016MAIL0621

$0.68 .

$0.00

$0.68

REGULAR MAIL

062016MAIL0621

$0.47

$0.00

$0.47

REGULAR MAIL

062216MAIL0623

$1.99

$0.00

$1.99

REGULAR MAIL

062216MAIL0623

$3.04

$0.00

$3.04

REGULAR MAIL

072216MAIL0725

$0.47

$0.00

$0.47

REGULAR MAIL

072216MAIL0725

$0.47

$0.00

$0.47

REGULAR MAIL

072216MAIL0725 .

$0.47

$0.00

$0.47

PLRA

APPEAL1:
14CV00976DLB

$505.00

$0.00

$505.00

PLRA

APPEAL1:
14CV01215SAB

$505.00

$0.00

$505.00

REGULAR MAIL

12/15/16

$0.47

$0.00

$0.47

PLRA

APPEAL1:
14CV01797DLB

$505.00

$0.00

$505.00 .

REGULAR MAIL

POST/E040517

$0.29

THE WITHIN INSTRUMENT IS A $0.00

REGULAR MAIL

POST/E040717

$0.67

CORRECT COPY 0F THE TR
ACCOUNT MAINTAINED BY T

COPY CHARGES

5/14/17

PLRA

APPEAL1:
15CV00859EPG

PLRA

APPEAL1:
14CV01371EPG

PLRA

1:17-CV-00789-GSA

Obligation Type

CourtCase#

REGULAR MAIL

$0.29

E.

AT);~J~~(f- ~(7' J.. r $0.00
utffC,£.
J.-4'n-e ltJe-·{t;h

CAUFOR
DEPARTMENT OF'$O·OO
CORRECTIO S NO RE BIUTATION
c::tI=--..L'l:O.OO

$350.00

$0.67
$0.30
$505.00
$505.00
$350.00

REGULAR MAIL

101117MAIL1012

$0.69

$0.00

$0.69·

REGULAR MAIL

101117MAIL1012

$0.90

$0.00

$0.90

REGULAR MAIL

101117MAIL 1012

$0.69

$0.00

$.0.69

REGULAR MAIL

101117MAIL1012

$0.49

$0.00

$0.49

REGULAR MAIL

101117MAIL 1012

$.1.61

$0.00

$1.61

REGULAR MAIL

101117MAIL 1012

$3.29

$0.00

$3.29

REGULAR MAIL

101117MAIL 1012

$3.29

$0.00

$3.29

REGULAR MAIL

101317MAIL 1013

$0.49

$0.00

$0.49

Restitution List
Restitution

CourtCase#

Status

RESTITUTION
FINE

SCD219793

Active

Original Owed Balance Interest Accrued

Sum of Tx for Date
Range for Oblg

Current Balance

$0.00

$0.00

$92.05

$200.00

3

Case 1:17-cv-01474-DAD-BAM Document 6 Filed 11/13/17 Page 6 of 7
· .,5-"..z-,U:~~,vt~??Z~~~£o -Cj.:pvJz-~·______

DECLARATION IN SUPPORT

Petitioner

OFREQ~ST

TO PROCEED
IN FORIvtA P A lJPERIS

that in support of my motion

without being required to prepay fees, costs or give security therefor, ] stale thaI

10 proceed

because of my poverty J am unable to pay the costs of said proceeding or 10 give security therefor; thai 1 believe 1 am

entitled to re lief.

1.

Are you presently employcd1 Dyes

a. If the amwer is yes, stale the aIDOunt of yom salary or wages per montb, and give the name and address of your
employer. __~_____ ~_ _ _~~_______ ~~________________~~___~_ _ __

b. If the answer is

DO,

stale the date of last employment and the amount of the salarY and wages per month whicb

you received. ___________________..~~----------------~~------------------..

)

2. Haye you received, withiD the past twelve months, any money from any of the following sources?
;L

Business, profession or fOilll of

self-emplo~nt?·

0 yes}(No

~No

b. Rent payments, interest or dividends?

DYes

c. Pensions, annuities

DYes ~No

Of

d, Gifts or inheritanci:s 7

life msurJDCe payments?

DYes

c. Any odler sources?

~No

DYes

'r

~o

1f the answer to any of the above is yes, describe each source of money. and state the amount received from each
during the past (welvc"-fnooths:

3_

_~_ _ _ _~"'--_ _.__.__~."""_ _~_ _ _ _ _ _ _ _ ._.._______~

Do you own any cash, or do you have· money ina checking or savings account?

(Include any funds in prison

oCCQUnLf)

O,:rcs)fNO,
If U1C answer is yes, slale lite lotal value of Ole ilcTm

QWflCi.t _ _~-'--_ _ _..~_ _ _ _ _ _ _ _ _ _~..__..~_ _ _~

-----_

..- . -..

_

..

4. Do you own 1:17-cv-01474-DAD-BAM Document 6 or other valuable property'! (ErcliuJing ordinary
Case any real estate, stocks, bonds, nOtes, autbmobiles, Filed 11/13/17 Page 7 of 7
ha=clolJfurnishings and dothing)

0 Yes}(No

I f tile answer is yes, descnbe the property and state its approximate value:

_--"7/"--Z!
____________

5_ List Ule persons who are dependent upon you fOT SuppOl;l, state your relationship 10 those persons, and indicate how

mucb you contribute toward their support: - - - - - 7 ' = - - - - - - - - - - - - - - - - - - - - - ­

I, declare (or certify, verify or state) under penalty of perjuryth~the"mg is true and correct.

-EAecuterlO~~-

- -

~~

Dale

Signature ofPetitioner

CERTIFICATE
J hereby certify that the Petitioner herein has the sum of ~_______________ OD account to his credit
at the ___________________________________ . institution where be is
confined. I further certify thai Petitioner likewise has Ibe following secUlities to his credit according to the records of said
institution:

-------

.. -~-.------

A uthorized Officer of jruriturionfTitle of Officer

- - - - - - - - - - - - - - - - - - - - _.._ - - _.._ - - - - - - - - - - - - _ .