Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-4_16-cv-00268/USCOURTS-cand-4_16-cv-00268-0/pdf.json

Nature of Suit Code: 555
Nature of Suit: Prisoner - Prison Condition
Cause of Action: 42:1983 Prisoner Civil Rights

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United States District Court 

Northern District of Californi

a

UNITED STATES DISTRICT COURT 

NORTHERN DISTRICT OF CALIFORNIA 

In re ROGER CLARK, 

Plaintiff, 

Case No. 16-cv-00268-DMR (PR) 

ORDER GRANTING PLAINTIFF 

EXTENSION OF TIME TO FILE 

COMPLAINT, IN FORMA PAUPERIS 

APPLICATION, AND 

CONSENT/DECLINATION FORM 

Plaintiff, who is currently in custody at the California Medical Center, filed with the Court 

a letter addressed to the Honorable Thelton E. Henderson. The Clerk of the Court construed the 

letter from Plaintiff as a request to file a pro se prisoner complaint under 42 U.S.C. § 1983. 

On January 15, 2016, the Clerk sent Plaintiff a notice directing him to file a complaint 

along with an application to proceed in forma pauperis (“IFP”) within twenty-eight days. He was 

warned that the failure to do so within the twenty-eight-day deadline would result in the dismissal 

of this action without prejudice. To date, Plaintiff has neither filed his complaint nor his IFP 

application, and the deadline for doing so as passed. 

On January 21, 2016, this case was assigned to the undersigned Magistrate Judge. Plaintiff 

was directed to file a completed consent/declination form within fourteen days. The fourteen-day 

deadline has passed, and Plaintiff has not yet filed his completed consent/declination form. 

Before the Court is Plaintiff’s request for an extension of time to file his complaint, IFP 

application, and his consent/declination form. Dkt. 6. 

Good cause appearing, the request is GRANTED. No later than fourteen (14) days from 

the date of this Order, Plaintiff shall file a completed consent/declination form. No later than 

twenty-eight (28) days from the date of this Order, Plaintiff shall file his complaint and a 

completed IFP application along with his trust account statement and certificate of funds. The 

failure to do so on or by the twenty-eight-day deadline will result in the dismissal of this action 

without prejudice. 

Case 4:16-cv-00268-DMR Document 7 Filed 02/18/16 Page 1 of 3
United States District Court 

Northern District of Californi

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app

Da

The Cle

plication form

This Or

IT IS S

ated: Februa

erk shall sen

m, and a bla

rder termina

O ORDERE

ary 18, 2016

nd Plaintiff a

ank consent/d

tes Docket N

ED. 

6 

2

a blank civil 

declination f

No. 6. 

___

DO

Un

rights comp

form along w

 

__________

ONNA M. R

nited States M

laint form, a

with a copy o

___________

RYU 

Magistrate Ju

a blank priso

of this Order

__________

udge 

oner IFP 

r. 

________ 

Case 4:16-cv-00268-DMR Document 7 Filed 02/18/16 Page 2 of 3
United States District Court 

Northern District of Californi

a

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R

U

Dis

Ext

For

and

add

pla

Da

OGER CLA

v. 

UNKNOWN,

I, the un

strict Court, 

That on

tension of T

rm together 

d a Blank Co

dressed to th

acing said co

Roger 

Californ

P.O. Bo

Vacavil

ated: 2/18/20

ARK, 

Plaintiff, 

,

Defendant.

ndersigned, 

Northern Di

n 2/18/2016, 

Time to File C

with Blank C

onsent/Decli

he person(s) 

opy(ies) into 

Clark ID: G

nia Medical 

ox 2000 

lle, CA 9569

016 

UNITED

NORTHER

.

hereby certi

istrict of Cal

I SERVED 

Complaint, I

Civil Rights

ination Form

hereinafter l

an inter-offi

G-48164

Facility

96 

D STATES D

RN DISTRIC

fy that I am 

lifornia. 

a true and c

In Forma Pau

 Complaint 

m by placing 

listed, by dep

fice delivery 

Su

Cl

By

Iv

H

DISTRICT C

CT OF CALI

Case No. 4

CERTIFIC

an employe

correct copy(

auperis Appli

Form, Blank

said copy(ie

positing said

receptacle lo

usan Y. Soon

lerk, United

y:_________

vy Lerma Ga

Honorable DO

COURT 

IFORNIA 

4:16-cv-0026

CATE OF S

ee in the Offi

(ies) of the O

ication, and 

k Prisoner IF

es) in a posta

d envelope in

ocated in the

ng 

d States Distr

___________

arcia, Deputy

ONNA M. R

68-DMR 

SERVICE 

ice of the Cl

Order Granti

Consent/De

FP Applicati

age paid env

n the U.S. M

e Clerk's off

rict Court 

_______ 

y Clerk to th

RYU 

erk, U.S. 

ing Plaintiff 

eclination 

ion Form, 

velope 

Mail, or by 

fice. 

he 

Case 4:16-cv-00268-DMR Document 7 Filed 02/18/16 Page 3 of 3