Gordon, Bernard v. Adams County Sheriff Department et al

Filing 3

ORDER on ifp request: Trust Fund Account Statement due 4/23/2024. Signed by Magistrate Judge Andrew R. Wiseman on 3/26/2024. (jef),(ps)

IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF WISCONSIN
BERNARD T. GORDON,
Plaintiff,

ORDER

v.

Case No. 24-cv-193-jdp

ADAMS COUNTY SHERIFF
DEPARTMENT, et al.,
Defendants.

Plaintiff Bernard T. Gordon has filed a proposed civil complaint and has requested leave
to proceed without prepaying the filing fee. To evaluate plaintiff’s request to proceed without
prepayment, I must review a certified copy of plaintiff’s inmate trust fund account statement
(or institutional equivalent) for the six-month period immediately preceding the filing of the
complaint. 28 U.S.C. § 1915(a)(2).
For this case to proceed, plaintiff must submit a certified trust fund account statement
no later than April 23, 2024. If I find that plaintiff is indigent, I will calculate an initial partial
payment of the filing fee that plaintiff must pay before the court can screen the complaint on
the merits under 28 U.S.C. § 1915(e)(2). Thereafter, plaintiff will be required to pay the
balance of the filing fee in installments.

ORDER
IT IS ORDERED that plaintiff Bernard T. Gordon may have until April 23, 2024 to
submit a certified trust fund account statement for the period beginning approximately
September 25, 2023 and ending approximately March 25, 2024. If plaintiff fails to respond
to this order by April 23, 2024, then I will assume that plaintiff wishes to withdraw this action

voluntarily. In that event, the case will be dismissed without prejudice to plaintiff refiling at a
later date.

Entered this 26th day of March, 2024.
BY THE COURT:

/s/
ANDREW R. WISEMAN
United States Magistrate Judge

UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF WISCONSIN
BERNARD T. GORDON,
Plaintiff,

ORDER

v.
ADAMS COUNTY SHERIFF
DEPARTMENT,

Case No. 24-cv-193-jdp

Defendants.

PRISONER 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 incarceration and provide your prisoner identification
number:

_______________________________________
(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 prison trust account statement showing transactions for the sixmonth 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

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

□ No
$ ____________________

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