Reid v. Wilkes et al

Filing 5

ORDER directing the Clerk to serve this Order on Plaintiff's custodian and to include a Prisoner Trust Fund Account Statement with that service copy. The Court directs the Clerk to enclose a copy of the Consent to Collection of Fees form with Plaintiff's service copy of this Order. Compliance due by 4/28/2017. Signed by Magistrate Judge Brian K. Epps on 04/06/2017. (Attachments: # 1 Prisoner Trust Fund Account Statement and Consent to Collection of Fees from Trust Account) (thb)

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Augusta, Brunswick, or Savannah? Augusta RESET FORM This form is to be used ONLY in Judge Barfield cases. UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF GEORGIA Scott L. Poff Clerk (706)849-4400 OFFICE OF THE CLERK P.O. Box 1130 Augusta, Georgia 30903 TRAVION REID, Plaintiff, v. SCOTT WILKES, et al., CASE NUMBER: CV1:17-32 Defendant. PRISONER TRUST FUND ACCOUNT STATEMENT Under the Prison Litigation Reform Act, a prisoner seeking to bring a civil action without prepayment of fees must obtain from the appropriate prison official a certified copy of the prisoner's trust account statement for the six-month period immediately preceding the submission of the complaint to the Court. The plaintiff in this case has been instructed by the Court to furnish this form to the trust officer of each institution where he has been confined for the last six months. Please complete this form, attach the supporting ledger sheets, and return these documents to the prisoner for mailing to this Court. DATE COMPLAINT RECEIVED: 03/14/2017 __________________________________ AVERAGE MONTHLY DEPOSITS during the six months prior to receipt of the complaint: __________________________________ AVERAGE MONTHLY BALANCE during the six months prior to receipt of the complaint: __________________________________ I certify that the above information accurately states the deposits and balances in the plaintiff's trust account for the period shown and that the attached ledger sheets are true copies of the account records maintained by this institution. __________________________________ Signature of Authorized Officer of Institution __________________________________ Print or type name __________________________________ Date UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF GEORGIA Scott L. Poff Clerk OFFICE OF THE CLERK P.O. Box 1130 Augusta, Georgia 30903 (706)849-4400 TRAVION REID, Plaintiff, v. SCOTT WILKES, et al., CASE NUMBER: CV1:17-32 Defendant. CONSENT TO COLLECTION OF FEES FROM TRUST ACCOUNT As a condition to proceeding with this lawsuit, I hereby consent for the appropriate prison officials to withhold from my prison account and pay to the Court an initial partial filing fee equal to 20 percent of the greater of (a) the average monthly deposits to my account, or (b) the average monthly balance in my account for the six-month period immediately preceding the filing of my complaint. I understand that I may not withdraw any monies from my account until this initial payment has been paid. After the payment of any initial partial filing fee, I further consent for the appropriate prison officials to collect from my account on a continuing basis each month an amount equal to 20 percent of all deposits credited to my account, Each time the set aside amount reaches $10.00, the trust officer shall forward the payment to: Clerk's Office, United States District Court P.O. Box 1130 Augusta, Georgia 30903 until such time as the $350.00 filing fee is paid in full. until such time as the $350.00 filing fee is paid in full. In the event that I file a Notice of Appeal, I also give my consent for the appropriate prison officials to similarly collect from my account the applicable appellate By executing court filing fee. this document, I also authorize collection on a continuing basis of any additional costs which may be imposed by the Court. By executing this document, I also authorize collection on a continuing basis of any additional costs which may be imposed by the Court. Date: ________________ Plaintiff's Signature: ____________________________ Date: ______________________ Plaintiff's Prison No: ____________________________ Plaintiff's Signature: ___________________________ Plaintiff's Prison No: ___________________________

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