Stewart v. Greenwell et al
MEMORANDUM AND ORDER (See Full Order) IT IS HEREBY ORDERED that Plaintiff's motion to proceed in forma pauperis [ECF No. 2 ] is DENIED. IT IS FURTHER ORDERED that the Clerk is directed to mail to Plaintiff blank copies of the Court's 39;Prisoner Civil Rights Complaint' and 'Application to Proceed in District Court without Prepaying Fees or Costs' forms. IT IS FURTHER ORDERED that Plaintiff must file an amended complaint on the Court form within thirty (30) days o f the date of this Order. IT IS FURTHER ORDERED that Plaintiff must either pay the $402 filing fee or file an application to proceed without prepayment within thirty (30) days of the date of this Order. IT IS FURTHER ORDERED that if Plaintiff files an application to proceed without prepayment, he must also file a certified copy of his inmate account statement for the six-month period preceding the filing of the complaint. IT IS FINALLY ORDERED that if Plaintiff fails to timely comply wi th this Order, the Court will dismiss this action without prejudice and without further notice. ( Amended/Supplemental Pleadings due by 9/1/2022.) Signed by Magistrate Judge Shirley Padmore Mensah on 8/2/2022. (Attachments: # 1 Attachment Prisoner Civil Rights Complaint form, # 2 Attachment Application to Proceed without paying fees)(HMA)
UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
) Civil Case No. _______
APPLICATION TO PROCEED IN DISTRICT COURT WITHOUT PREPAYING FEES OR COSTS
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: $
3. Other Income. In the past 12 months, I have received income from the following sources (check all that apply):
Business, profession, or other self-employment
Rent payments, interest, or dividends
Pension, annuity, or life insurance payments
Disability or worker’s compensation payments
Gifts or inheritances
Any other sources
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.
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
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.
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