Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_15-cv-01109/USCOURTS-azd-2_15-cv-01109-0/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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WO 

IN THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF ARIZONA 

Charles Laverne Alexander, II, 

Plaintiff, 

 v. 

Charles L. Ryan, et al., 

Defendants. 

No. CV 15-1109-PHX-SMM (BSB) 

 O R D E R 

On June 16, 2015, Plaintiff Charles Laverne Alexander, II, who is confined in the 

Arizona State Prison Complex-Eyman in Florence, Arizona, filed a pro se civil rights 

Complaint pursuant to 42 U.S.C. § 1983. Plaintiff did not pay the $350.00 civil action 

filing fee and $50.00 administrative fee or file an Application to Proceed In Forma 

Pauperis. The Court will give Plaintiff 30 days to pay the filing and administrative fees 

or file a complete Application to Proceed In Forma Pauperis. 

I. Payment of Filing Fee

 When bringing an action, a prisoner must either pay the $350.00 filing fee and a 

$50.00 administrative fee in a lump sum or, if granted the privilege of proceeding in 

forma pauperis, pay the $350.00 filing fee incrementally as set forth in 28 U.S.C. 

§ 1915(b)(1). An application to proceed in forma pauperis requires an affidavit of 

indigence and a certified copy of the inmate’s trust account statement for the six months 

preceding the filing of the Complaint. 28 U.S.C. § 1915(a)(2). An inmate must submit 

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statements from each institution where he was confined during the six-month period. Id. 

To assist prisoners in meeting these requirements, the Court requires use of a form 

application. LRCiv 3.4. 

 If a prisoner is granted leave to proceed in forma pauperis, the Court will assess an 

initial partial filing fee of 20% of either the average monthly deposits or the average 

monthly balance in Plaintiff’s account, whichever is greater. 28 U.S.C. § 1915(b)(1). An 

initial partial filing fee will only be collected when funds exist. 28 U.S.C. § 1915(b)(4). 

The balance of the $350.00 filing fee will be collected in monthly payments of 20% of 

the preceding month’s income credited to an inmate’s account, each time the amount in 

the account exceeds $10.00. 28 U.S.C. § 1915(b)(2). 

 Because Plaintiff has not paid the $400.00 filing and administrative fees or filed an 

Application to Proceed In Forma Pauperis, Plaintiff will be permitted 30 days from the 

filing date of this Order to submit a properly executed and certified Application to 

Proceed In Forma Pauperis, using the form included with this Order, or pay the $400.00 

filing and administrative fees. 

II. Warnings

A. Address Changes

 Plaintiff must file and serve a notice of a change of address in accordance with 

Rule 83.3(d) of the Local Rules of Civil Procedure. Plaintiff must not include a motion 

for other relief with a notice of change of address. Failure to comply may result in 

dismissal of this action. 

B. Copies

 Because Plaintiff is currently confined in an Arizona Department of Corrections 

unit subject to General Order 14-17, Plaintiff is not required to submit an additional copy 

of every filing for use by the Court, as would ordinarily be required by Local Rule of 

Civil Procedure 5.4. If Plaintiff is transferred to a unit other than one subject to General 

Order 14-17, he will be notified of the requirements regarding copies for the Court that 

are required for inmates whose cases are not subject to General Order 14-17. 

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C. Possible Dismissal

 If Plaintiff fails to timely comply with every provision of this Order, including 

these warnings, the Court may dismiss this action without further notice. See Ferdik v. 

Bonzelet, 963 F.2d 1258, 1260-61 (9th Cir. 1992) (a district court may dismiss an action 

for failure to comply with any order of the Court). 

IT IS ORDERED:

 (1) Within 30 days of the date this Order is filed, Plaintiff must either pay the 

$350.00 filing fee and $50.00 administrative fee or file a complete Application to 

Proceed In Forma Pauperis and a certified six-month trust account statement. 

 (2) If Plaintiff fails to either pay the $350.00 filing fee and $50.00 

administrative fee or file a complete Application to Proceed In Forma Pauperis within 30 

days, the Clerk of Court must enter a judgment of dismissal of this action without 

prejudice and without further notice to Plaintiff. 

 (3) The Clerk of Court must mail Plaintiff a court-approved form for filing an 

Application to Proceed In Forma Pauperis (Non-Habeas). 

 DATED this 30th day of June, 2015. 

Honorable Stephen M. McNamee

Senior United States District Judge

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Revised 5/1/2013

Instructions for Prisoners Applying for Leave to Proceed in Forma Pauperis

Pursuant to 28 U.S.C. § 1915 in a Civil Action (Non-habeas) in Federal Court

You must pay the $350.00 filing fee plus the $50.00 administrative fees for a civil action.

If you later file an appeal, you will be obligated to pay the $455.00 filing fee for the appeal.

If you have enough money to pay the full $400.00 filing and administrative fees, you should

send a cashier’s check or money order payable to the Clerk of the Court with your complaint.

If you do not have enough money to pay the full $400.00 filing and administrative fees, you

can file the action without prepaying the fees. However, the court will assess an initial partial filing

fee. The initial partial filing fee will be the greater of 20% of the average monthly deposits or 20%

of the average monthly balance in your prison or jail account for the six months immediately

preceding the filing of the lawsuit. The court will order the agency that has custody of you to

withdraw the initial partial filing fee from your prison or jail account as soon as funds are available

and to forward the money to the court.

After the initial partial filing fee has been paid, you will owe the balance of the $350.00

filing fee (you will not be required to pay the $50.00 administrative fee). Until the filing fee is paid

in full, each month you will owe 20% of your preceding month's income. The agency that holds you

in custody will collect that money and forward it to the court any time the amount in your account

exceeds $10.00. The balance of the filing fee may be collected even if the action is later dismissed,

summary judgment is granted against you, or you fail to prevail at trial.

To file an action without prepaying the filing fee, and to proceed with an action in forma

pauperis, you must complete the attached form and return it to the court with your complaint. You

must have a prison or jail official complete the certificate on the bottom of the form and attach a

certified copy of your prison or jail account statement for the last six months. If you were

incarcerated in a different institution during any part of the past six months, you must attach a

certificate and a certified copy of your account statement from each institution at which you were

confined. If you submit an incomplete form or do not submit a prison or jail account statement with

the form, your request to proceed in forma pauperis will be denied.

Even if some or all of the filing fee has been paid, the court is required to dismiss your action

if: (1) your allegation of poverty is untrue; (2) the action is frivolous or malicious; (3) your

complaint does not state a claim upon which relief can be granted; or (4) your complaint makes a

claim against a defendant for money damages and that defendant is immune from liability for money

damages.

If you file more than three actions or appeals which are dismissed as frivolous or malicious

or for failure to state a claim on which relief can be granted, you will be prohibited from filing any

other action in forma pauperis unless you are in imminent danger of serious physical injury.

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Revised 5/1/2013 1

Name and Prisoner/Booking Number

Place of Confinement

Mailing Address

City, State, Zip Code

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

)

 , ) CASE NO. 

Plaintiff, )

)

 vs. ) APPLICATION TO PROCEED

) IN FORMA PAUPERIS 

 , ) BY A PRISONER

Defendant(s). ) CIVIL (NON-HABEAS)

)

I, , declare, in support of my request to proceed in the above

entitled case without prepayment of fees under 28 U.S.C. § 1915, that I am unable to pay the fees for these

proceedings or to give security therefor and that I believe I am entitled to relief.

In support of this application, I answer the following questions under penalty of perjury:

1. Have you ever before brought an action or appeal in a federal court while you were incarcerated or detained?

GYes GNo If "Yes," how many have you filed? .

Were any of the actions or appeals dismissed because they were frivolous, malicious, or failed to state a claim

upon which relief may be granted? GYes GNo If "Yes," how many of them? .

2. Are you currently employed at the institution where you are confined? GYes GNo

If "Yes," state the amount of your pay and where you work. 

3. Do you receive any other payments from the institution where you are confined? GYes GNo

If "Yes," state the source and amount of the payments. 

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Revised 5/1/2013 2

4. Do you have any other sources of income, savings, or assets either inside or outside of the institution where

you are confined? GYes GNo

If "Yes," state the sources and amounts of the income, savings, or assets. 

I declare under penalty of perjury that the above information is true and correct.

DATE SIGNATURE OF APPLICANT

CONSENT TO COLLECTION OF FEES FROM TRUST ACCOUNT

I, , hereby consent to having the designated correctional officials at this

institution release to the Court my trust account information. I further consent to having the designated correctional

officials at this institution withdraw from my trust account the funds required to comply with the order of this Court

for the payment of filing fees in accordance with 28 U.S.C. § 1915(b).

My consent includes withdrawal from my account by correctional officials of partial initial payments to this

Court equal to 20% of the greater of:

(A) the average monthly deposits to my account for the six-month period preceding my filing of this

action, or

(B) the average monthly balance in my account for the six-month period preceding my filing of this

action.

My consent also includes monthly withdrawals from my account by correctional officials of an amount equal

to 20% of each month’s income. Whenever the amount in my account reaches $10.00, correctional officials will

withdraw that amount and forward it to the Court until the required filing fee is paid in full. I understand that I am

liable for paying the entire fee, even if my case is dismissed by the Court before the fee is fully paid.

DATE SIGNATURE OF APPLICANT

CERTIFICATE OF CORRECTIONAL OFFICIAL

AS TO STATUS OF APPLICANT’S TRUST ACCOUNT

I, , certify that as of the date applicant signed this application:

(Printed name of official)

The applicant’s trust account balance at this institution is: $

The applicant’s average monthly deposits during the prior six months is: $

The applicant’s average monthly balance during the prior six months is: $

The attached certified account statement accurately reflects the status of the applicant’s account.

DATE AUTHORIZED SIGNATURE TITLE/ID NUMBER INSTITUTION 

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