Wall v. Black et al

Filing 38

ORDER that within 20 days of the entry of this order the plaintiff Robert Wall shall file a completed application for leave to proceed in forma pauperis or pay the required appeal filing fee of $455.00, and file a completed and signed affidavit that he signed the notice of appeal 34 in this civil action as well as provide the requested information concerning placement in the Special Housing Unit. Signed by Honorable David C. Bramlette, III on 12/14/09 (PKM)

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IN THE UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF MISSISSIPPI WESTERN DIVISION ROBERT WALL, #13965-052 VERSUS UNKNOWN BLACK, et al. ORDER Upon consideration of the appeal [34] to the United States Court of Appeals for the Fifth Circuit filed by the plaintiff in the above entitled action as well as the motion to proceed in forma pauperis, this Court finds that the plaintiff failed to file the appropriate motion to proceed in forma pauperis with the necessary information needed to evaluate his financial ability to pay the appeal fee. Additionally, this Court is requiring the plaintiff to complete, sign and file the attached affidavit that plaintiff Robert Wall is the individual who signed the notice of appeal [34] and provide the date he entered and was released from Special Housing Unit. Accordingly, it is hereby ORDERED: 1. That within 20 days of the entry of this order the plaintiff Robert Wall shall file a completed application for leave to proceed in forma pauperis or pay the required appeal filing fee of $455.00. If the appeal fee is paid by the plaintiff or someone other than the plaintiff, there must be a written explanation that the money is being submitted as payment of the filing fee in this case (5:08cv274-DCB-MTP) on behalf of the plaintiff, Robert Wall, #13965-052. 2. That the Clerk shall mail the attached in forma pauperis application to the plaintiff Robert Wall at his last known address. PLAINTIFF CIVIL ACTION NO. 5:08cv274-DCB-MTP APPEAL NO. DEFENDANT(S) 3. That within 20 days of the entry of this order the plaintiff Robert Wall shall file a completed and signed affidavit that he signed the notice of appeal [34] in this civil action as well as provide the requested information concerning placement in the Special Housing Unit. 4. That the Clerk shall mail the attached affidavit to the plaintiff Robert Wall at his last known address. 5. That the plaintiff submit the appeal fee and the original signed affidavit to the Clerk, Western Division, P.O. Box 23552, Jackson, MS 39225-3552. Failure to advise this court of a change of address or failure to comply with any order of this Court will be deemed as a purposeful delay and contumacious act by the plaintiff and may result in the denial of in forma pauperis status. THIS the 14th day of December , 2009. s/David Bramlette UNITED STATES DISTRICT JUDGE G:\wp51\forms\prisoners\App Ord-No IFP frm no fee pd req IFP form or pay 2 Rev. 07/02 Form 4 of Federal Rules of Appellate Procedure, as modified by the United States District Court for the Southern District of Mississippi UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF MISSISSIPPI _____________ DIVISION Plaintiff v. CIVIL ACTION NO. ______________ APPEAL NO. ______________ Defendant MOTION TO PROCEED IN FORMA PAUPERIS I, _____________________________________, declare that I am the plaintiff in the above-entitled proceeding; that in support of my request to proceed without prepayment of fees or costs under 28 U.S.C. 1915 I declare that I am unable to pay the costs of these proceedings and that I am entitled to the relief sought in the complaint. Signed:___________________________________ Date:_________________________ -------------------------------------------------------------------------------------------------------------------- INSTRUCTIONS Complete all questions in this application and then sign it. Do not leave any blanks: if the answer to a questions is "0," "none," or "not applicable (N/A)," write in that response. If you need more space to answer a question or to explain your answer, attach a separate sheet of paper identified with you name, your case's docket number, and the question number. AFFIDAVIT IN SUPPORT OF MOTION I swear or affirm under penalty of perjury that, because of my poverty, I cannot prepay the docket fees of my appeal or post a bond for them. I believe I am entitled to redress. I swear or affirm under penalty of perjury under United States laws that my answers on this form are true and correct. (28 U.S.C. 1746; 18 U.S.C. 1621) Signed:______________________________ Date:________________________________ My issues on appeal are: __________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________. 1. For both you and your spouse estimate the average amount of money received from each of the following sources during the past 12 months. Adjust any amount that was received weekly, biweekly, quarterly, semiannually, or annually to show the monthly rate. Use gross amounts, that is, amounts before any deductions for taxes or otherwise. Income source: Average monthly amount during the past 12 months You $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ Amount expected next month You $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ Employment Self-employment Income from real property such as rental income) Interest and dividends Gifts Alimony Child support Retirement (such as social security pensions, annuities, insurance) Disability (such as social security insurance payments) Unemployment payments Public-assistance (such as welfare) Other (specify): _________________ Total monthly income: 2. List your employment history, most recent employer first. (Gross monthly pay is before taxes or other deductions.) DATES OF EMPLOYMENT GROSS MONTHLY PAY EMPLOYER ADDRESS 3. List your spouse's employment history, most recent employer first. (Gross monthly pay is before taxes or other deductions.) DATES OF EMPLOYMENT GROSS MONTHLY PAY EMPLOYER ADDRESS 4. How much cash do you and your spouse have? $________ Below, state any money you or your spouse have in bank accounts or in any other financial institution. FINANCIAL INSTITUTION AMOUNT YOUR SPOUSE HAS TYPE OF ACCOUNT AMOUNT YOU HAVE If you are a prisoner, you must attach a statement certified by the appropriate institutional officer showing all receipts, expenditures, and balances during the last six months in your institutional accounts. If you have multiple accounts, perhaps because you have been in multiple institutions, attach one certified statement of each account. 5. List the assets, and their values, which you own or your spouse owns. Do not list clothing and ordinary household furnishings. HOME (VALUE) OTHER REAL ESTATE (VALUE) OTHER ASSETS (VALUE) MOTOR VEHICLE # 1 VALUE: ______________________ MAKE & YEAR: ___________________ MODEL: ___________________ REGISTRATION #: ___________________ VALUE: ______________________ MAKE & YEAR: ___________________ MODEL: ___________________ REGISTRATION #: ___________________ MOTOR VEHICLE # 2 6. State every person, business, or organization owing you or your spouse money, and the amount owed. PERSON OWING YOU OR YOUR SPOUSE MONEY AMOUNT OWED TO YOU AMOUNT OWED TO YOUR SPOUSE 7. State the persons who rely on you or your spouse for support. NAME RELATIONSHIP AGE 8. Estimate the average monthly expenses of you and your family. Show separately the amounts paid by your spouse. Adjust any payments that are made weekly, biweekly, quarterly, semiannually, or annually to show the monthly rate. Rent or home-mortgage payment (include lot rented for mobile home) Are real-estate taxes included? Is property insurance included? Utilities (electricity, heating fuel, water, sewer, and Telephone) Home maintenance (repairs and upkeep) Food Clothing Laundry and dry-cleaning Medical and dental expenses Transportation (not including motor vehicle payments) Recreation, entertainment, newspapers, magazines, etc. Insurance (not deducted from wages or included in Mortgage payments) Homeowner's or renter's Life Health Motor Vehicle You $______ Your Spouse $______ [ ] Yes [ ] No [ ] Yes [ ] No $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ Other: __________________________ Taxes (not deducted from wages or included in Mortgage payments) (specify): ______________________ Installment payments Motor Vehicle Credit card (name): ______________ Department store (name): _________ Other: _________________________ Alimony, maintenance, and support paid to others Regular expenses for operation of business, profession, or farm (attach detailed statement) Other (specify): __________________ Total monthly expenses: 9. $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ $______ Do you expect any major changes to your monthly income or expenses or in your assets or liabilities during the next 12 months? [ ] Yes [ ] No If yes, describe on an attached sheet. 10. Have you paid--or will you be paying--an attorney any money for services in connection with this case, including the completion of this form? [ ]Yes [ ] No If yes, how much? $__________ If yes, state the attorney's name, address, and telephone number: _________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Have you paid--or will you be paying--anyone other than an attorney (such as a paralegal or a typist) any money for services in connection with this case, including the completion of this form? [ ] Yes [ ] No If yes, how much? $__________ If yes, state the person's name, address, and telephone number: __________________________________________________________________________ __________________________________________________________________________ 12. Provide any other information that will help explain why you cannot pay the docket fees 11. for your appeal. 13. State the address of your legal residence. __________________________________________________________________________ __________________________________________________________________________ Your daytime phone number: ___ _______________ Your age: ________ Your years of schooling: ________ Signed under penalty of perjury: _________________________________________ Date: ______________________ ----------MUST BE COMPLETED BY PLAINTIFF--------Authorization for Release of Institutional Account Information and Payment of the Appeal Filing Fee I, _________________________________________, __________________________________ (Name of Plaintiff) (Prisoner Number) authorize the Clerk of Court to obtain, from the agency having custody of my person, information about my institutional account, including balances, deposits and withdrawals. The Clerk of Court may obtain my account information from the past six months and in the future, until the appeal filing fee is paid. I also authorize the agency having custody of my person to withdraw funds from my account and forward payments to the Clerk of Court, in accord with 28 U.S.C. Section 1915. ____________________________ (Signature of Plaintiff) _______________________ (Date) IT IS PLAINTIFF'S RESPONSIBILITY TO HAVE THE APPROPRIATE PRISON OFFICIAL COMPLETE AND CERTIFY THE CERTIFICATE BELOW CERTIFICATE TO BE COMPLETED BY AUTHORIZED OFFICER (Prisoner Accounts Only) I certify that the applicant named herein has the sum of $_____________________ on account to his credit at the ___________________________________ institution where he is confined. I further certify that the applicant likewise has the following securities to his credit according to the records of said institution: _____________________________________________________________________________. I further certify that during the last six (6) months the plaintiff's average monthly balance was $__________. I further certify that during the last six (6) months the plaintiff's average monthly deposit was $___________. ______________________ TELEPHONE NUMBER OF OFFICER FOR VERIFICATION ______________________ DATE ____________________________________ AUTHORIZED OFFICER OF INSTITUTION ___________________________________ PRINT NAME OF AUTHORIZED OFFICER RETURN COMPLETED FORM TO: U. S. DISTRICT CLERK P.O. BOX 23552 JACKSON, MS 39225 IN THE UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF MISSISSIPPI WESTERN DIVISION ROBERT WALL VERSUS UNKNOWN BLACK, et al. AFFIDAVIT I, Robert Wall, the plaintiff in the above referenced civil action, declare under penalty of perjury that the notice of appeal [34] filed on November 19, 2009, in the above referenced civil action was signed by Robert Wall, the plaintiff in the instant civil action. I, Robert Wall, the plaintiff in the above referenced civil action, declare under penalty of perjury that I was placed in Special Housing Unit at F.C.I.-Yazoo on __________________________ and will be released from Special Housing Unit at F.C.I.-Yazoo on ______________________. I, Robert Wall, the plaintiff in the above referenced civil action, declare under penalty of perjury that I was incarcerated at F.C.I. - Yazoo with a mailing address of P.O. Box 5000, Yazoo City, Mississippi 39194, at the time the notice of appeal [34] was signed by me. Executed on ________________________. (date) ________________________________________ ROBERT WALL, plaintiff in the above referenced civil action PLAINTIFF CIVIL ACTION NO. 5:08cv274-DCB-MTP APPEAL NO. DEFENDANTS

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