Smith v. Lasanta et al

Filing 3

ORDER DIRECTING PRISONER AUTHORIZATION: Plaintiff is directed to submit a completed and signed Prisoner Authorization Form to this Court's Pro Se Office within thirty (30) days of the date of this Order. The Clerk of Court is directed to assign this matter to my docket. The Court certifies, pursuant to 28 U.S.C. 1915(a)(3), that any appeal from this Order would not be taken in good faith, and therefore in forma pauperis status is denied for the purpose of an appeal. See Coppedge v. United States, 369 U.S. 438, 444-45 (1962). Prisoner Authorization Form due by 12/17/2021. (Signed by Judge Laura Taylor Swain on 11/17/2021) (Attachments: #1 Supplement Prisoner authorization) (scn) Transmission to Docket Assistant Clerk for processing.

U NITED S TATES D ISTRICT C OURT
S OUTHERN D ISTRICT OF N EW Y ORK

(full name of the plaintiff/petitioner)

CV

-against-

(

)(

(full name(s) of the defendant(s)/respondent(s))

PRISONER AUTHORIZATION
By signing below, I acknowledge that:
(1) because I filed this action as a prisoner, 1 I am required by statute (28 U.S.C. § 1915) to pay
the full filing fees for this case, even if I am granted the right to proceed in forma pauperis
(IFP), that is, without prepayment of fees;
(2) if I am granted IFP status, the full $350 filing fee will be deducted in installments from my
prison account, even if my case is dismissed or I voluntarily withdraw it.
I authorize the agency holding me in custody to:
(1) send a certified copy of my prison trust fund account statement for the past six months
(from my current institution or any institution in which I was incarcerated during the past
six months);
(2) calculate the amounts specified by 28 U.S.C. § 1915(b), deduct those amounts from my
prison trust fund, and disburse those amounts to the Court.
This authorization applies to any agency into whose custody I may be transferred and to any
other district court to which my case may be transferred.

Date

Signature

Prison Identification #

Name (Last, First, MI)

Address

1

City

State

Zip Code

A “prisoner” is “any person incarcerated or detained in any facility who is accused of, convicted of,
sentenced for, or adjudicated delinquent for, violations of criminal law or the terms or conditions of
parole, probation, pretrial release, or diversionary program.” 28 U.S.C. § 1915(h).
SDNY Rev. 8/5/15

)

(Provide docket number, if available; if filing this with your
complaint, you will not yet have a docket number.)