Stine v. Doe #1 et al

Filing 2

MEMORANDUM OPINION & ORDER: (1) Plas claims are SEVERED into four separate cases. Jeremy Pinson shall remain as sole pla in 7:13-cv-134. (2) Clerk SHALL CREATE three new docket numbers-one for each of other three pla. (3) Plas each fail ed either to pay filing fee or apply for leave to proceed in forma pauperis. By Monday, March 24, 2014, plas must each either pay full filing fee or apply to proceed in forma pauperis using attached forms. If any pla fails to co mply with this order, Court will dismiss his case. a. Clerk SHALL MARK assigned case numbers on a form Civil Rights Complaint [EDKy Form 520]; an Application to Proceed Without Prepayment of Fees and Affidavit [AO Form 240]; and a Certificate of Inmate Account [EDKy Form 523]. Clerk SHALL SEND appropriate documents to each pla. (4) Clerk SHALL FILE in record of each case complaint, R. 1 , and this order. Signed by Judge Amul R. Thapar on 2/20/2014. (Attachments: # 1 EDKy Form 520, # 2 AO Form 240, # 3 EDKy Form 523) (TDA) cc: Stine

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AO 240 (Rev. 07/10) Application to Proceed in District Court Without Prepaying Fees or Costs (Short Form) UNITED STATES DISTRICT COURT for the Eastern District of of __________ __________ District Kentucky ) ) ) ) ) Plaintiff/Petitioner v. Defendant/Respondent Civil Action No. 7:14-cv-19-ART APPLICATION TO PROCEED IN DISTRICT COURT WITHOUT PREPAYING FEES OR COSTS (Short Form) I am a plaintiff or petitioner in this case and declare that I am unable to pay the costs of these proceedings and that I am entitled to the relief requested. In support of this application, I answer the following questions under penalty of perjury: 1. If incarcerated. I am being held at: . If employed there, or have an account in the institution, I have attached to this document a statement certified by the appropriate institutional officer showing all receipts, expenditures, and balances during the last six months for any institutional account in my name. I am also submitting a similar statement from any other institution where I was incarcerated during the last six months. 2. If not incarcerated. If I am employed, my employer’s name and address are: My gross pay or wages are: $ (specify pay period) , and my take-home pay or wages are: $ per . 3. Other Income. In the past 12 months, I have received income from the following sources (check all that apply): (a) Business, profession, or other self-employment (b) Rent payments, interest, or dividends (c) Pension, annuity, or life insurance payments (d) Disability, or worker’s compensation payments (e) Gifts, or inheritances (f) Any other sources u u u u u u Yes Yes Yes Yes Yes Yes u u u u u u No No No No No No If you answered “Yes” to any question above, describe below or on separate pages each source of money and state the amount that you received and what you expect to receive in the future. AO 240 (Rev. 07/10) Application to Proceed in District Court Without Prepaying Fees or Costs (Short Form) 4. Amount of money that I have in cash or in a checking or savings account: $ . 5. Any automobile, real estate, stock, bond, security, trust, jewelry, art work, or other financial instrument or thing of value that I own, including any item of value held in someone else’s name (describe the property and its approximate value): 6. Any housing, transportation, utilities, or loan payments, or other regular monthly expenses (describe and provide the amount of the monthly expense): 7. Names (or, if under 18, initials only) of all persons who are dependent on me for support, my relationship with each person, and how much I contribute to their support: 8. Any debts or financial obligations (describe the amounts owed and to whom they are payable): Declaration: I declare under penalty of perjury that the above information is true and understand that a false statement may result in a dismissal of my claims. Date: Applicant’s signature Printed name

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