Gilbert, Carl et al v. State of Wisconsin - Department of Health Services et al

Filing 3

ORDER that plaintiffs are to submit the $400 filing fee or motions to proceed without prepayment along with a resident account statement by 11/30/2016. Signed by Magistrate Judge Peter A. Oppeneer on 11/8/2016. (jef),(ps)

IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF WISCONSIN
CARL C. GILBERT, II AND JERRED
WASHINGTON,

v.

Plaintiffs,

ORDER
Case No. 16-cv-729-jdp

STATE OF WISCONSIN-DEPARTMENT
OF HEALTH SERVICES, et al.
Defendants.

Plaintiffs Carl C. Gilbert, II and Jerred Washington, patients at Sand Ridge Secure
Treatment Center in Mauston, Wisconsin, have filed a proposed complaint under
42 U.S.C. § 1983, alleging constitutional rights violations. Plaintiffs have not paid the
filing fee nor requested leave to proceed without prepayment. For this case to proceed,
plaintiffs must pay the $400 filing fee or submit a properly supported motion for leave to
proceed without prepayment of the filing fee no later than November 30, 2016.
This court uses one method for determining the indigent status of all
institutionalized persons, even those like plaintiffs who are not subject to the 1996
Prisoner Litigation Reform Act. This method requires each plaintiff to submit a certified
copy of a resident account statement for the six-month period immediately preceding the
filing of the complaint
A motion for leave to proceed without prepayment of the filing fee must be
accompanied by a certified copy of plaintiff’s resident account statement (or institutional

equivalent) for the six-month period immediately preceding the date of the complaint.
28 U.S.C. § 1915(a)(2).

ORDER
IT IS ORDERED that plaintiffs Carl C. Gilbert, II and Jerred Washington may
have until November 30, 2016 to submit the $400 filing fee or motions for leave to
proceed without prepayment along with certified copies of their resident account
statements for the period beginning approximately May 7, 2016 and ending
approximately November 7, 2016. If, by November 30, 2016, either plaintiff fails to
respond to this order, I will assume that plaintiff wishes to withdraw from this action
voluntarily.

Entered this 8th day of November, 2016.
BY THE COURT:

/s/
PETER OPPENEER
Magistrate Judge

UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF WISCONSIN
CARL C. GILBERT, II AND JERRED WASHINGTON,

Plaintiffs,

ORDER

v.
Case No. 16-cv-729-jdp
STATE OF WISCONSIN-DEPARTMENT OF HEALTH
SERVICES, et al.

Defendants.
REQUEST TO PROCEED IN DISTRICT COURT
WITHOUT PREPAYING THE FULL FILING FEE
Answer the following questions to the best of your ability.
Note: If you do not tell the truth, the court may dismiss your lawsuit.
I.

Personal Information

1)

Your name: ___________________________________________________________
(a)

State the place of your residency and provide your identification
number if applicable:

_______________________________________
(place)

_____________________________
(number)

(b)

Are you employed at the institution?

□Yes

□ No

(c)

Do you receive any payment from the institution?

□Yes

□ No

Attach a printout of your resident account statement showing transactions for the six-month period
immediately preceding the filing of this request and showing the current balance of your account.
2)

Do you have any dependents that you are responsible for supporting?
□ Yes

□ No

If “yes,” list them below.
Name or initials (for
minor children only)

Relationship to You

Age

Amount of Support
Provided per Month

________________________ _________________ ________

$____________

________________________ _________________ ________

$____________

________________________ _________________ ________

$____________

II.

Property or Assets: - If you are married, your answers must include your spouse's property.

1)

Do you own a car?
□ Yes

□ No

If “yes,” list the car(s) below:

Make and Model

Year

Approximate Current Value

_______________________________________________

__________

$________________

_______________________________________________

__________

$________________

2)

Do you own your home(s)?

□ Yes

□ No

If “Yes,” state the approximate value(s).

$ ____________________

What is the amount of equity (assessed value of residence minus outstanding
mortgage balance) in the home(s)? $ ____________________
3)

Do you have any cash or checking, savings, or other similar accounts?
□ Yes □ No
If “Yes,” state the total of such sums.

4)

$ ____________________

Do you own any other property of value, such as real estate, stocks, bonds, trusts, or individual retirement
accounts (e.g., IRA, 401 k), artwork, or jewelry?
□ Yes

□ No

If “Yes,” describe the property and the approximate value(s).
______________________________________________________________________
______________________________________________________________________
III.

Litigation History

For each federal lawsuit that you recall having filed, list as much of the following information that you
remember about each case: The name of the case (that is, the plaintiffs and the defendants), the case number or year
of filing, and the federal district in which you filed the case. Use more paper if needed.
Case Name
(Plaintiffs and defendants)

Case number
(or year of filing)

Federal district

________________________

____________________ _______________________

________________________

____________________ _______________________

________________________

____________________ _______________________

________________________

____________________ _______________________

IV.

Other Circumstances - Describe any other financial circumstance(s) that you would like the court to
consider when reviewing this petition.

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

I, ____________________, declare that I am the plaintiff bringing this complaint. I declare that I am unable to
prepay the full filing fee and that I am entitled to the relief sought in the complaint.
___________________________
Date

_________________________________________
Signature - Signed Under Penalty of Perjury