Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_05-cv-00573/USCOURTS-caed-2_05-cv-00573-0/pdf.json

Nature of Suit Code: 550
Nature of Suit: Prisoner - Civil Rights (U.S. defendant)
Cause of Action: 42:1983 Prisoner Civil Rights

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IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF CALIFORNIA

GARY HALLFORD,

Plaintiff, No. CIV S-05-0573 FCD DAD P

vs.

CALIFORNIA DEPARTMENT 

OF CORRECTIONS, et al.,

Defendants. ORDER

 /

Plaintiff is a state prisoner proceeding pro se with this civil rights action. 

Plaintiff’s informal request for waiver of the filing fee was denied. Plaintiff was provided with

an appropriate application form and was granted thirty days to submit a properly completed

application with a trust account statement covering the six-month period immediately preceding

the filing of this action. No in forma pauperis application has been received to date.

In a letter received on April 26, 2005, plaintiff informed the court that he

submitted the application form to the trust account office on April 4, 2005. In a letter received

on May 23, 2005, plaintiff informed the court that he had received no response from the trust

account office. Plaintiff must make further inquiries concerning his application and, if

appropriate, file an inmate appeal. Plaintiff will be provided with an additional form in the event

that he wishes to submit a new form to prison officials along with a copy of this order.

Case 2:05-cv-00573-FCD-DAD Document 13 Filed 10/03/05 Page 1 of 6
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In his May 23, 2005 letter, plaintiff requested that the court serve his complaint on

defendants. On August 5, 2005, the court received plaintiff’s “Supplement to Complaint Under 

42 U.S.C. § 1983,” in which he provides information described as supplemental. On September

9, 2005, the court received plaintiff’s declaration and request for service of that declaration on

defendants. On September 28, 2005, the court received an additional declaration in which

plaintiff describes recent events.

After a properly completed in forma pauperis application is submitted, the court

will screen plaintiff’s complaint and determine whether it states cognizable claims against any

defendant. If the complaint states cognizable claims, the court will instruct plaintiff to provide

documents required for service by the United States Marshal. Plaintiff is advised that his

complaint consists solely of the nine-page pleading filed on March 24, 2005. Supplements,

updates, and declarations will be disregarded. If plaintiff wishes to amend his complaint, he may

do so by submitting an amended complaint that is complete in itself. Plaintiff is cautioned that

an amended complaint should not include new allegations or claims unless administrative

remedies were exhausted with regard to those claims prior to March 24, 2005, when this action

was commenced. If this action proceeds, every document submitted for filing by plaintiff must

be served by plaintiff on defendants’ counsel. The Clerk of the Court does not serve documents

on behalf of the parties.

Accordingly, IT IS HEREBY ORDERED that:

1. Plaintiff shall submit, within thirty days from the date of this order, a properly

completed application to proceed in forma pauperis; the completed form must be certified by a

prison official and must be accompanied by a copy of plaintiff’s trust account statement for the

six-month period immediately preceding the filing of this action; plaintiff’s failure to comply

with this order or seek an extension of time to do so will result in a recommendation that this

action be dismissed without prejudice;

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2. Plaintiff’s May 23, 2005 request for service of his complaint on defendants is

denied;

3. Plaintiff’s August 5, 2005 supplement to complaint will be disregarded;

4. Plaintiff’s September 9, 2005 declaration will be disregarded;

5. Plaintiff’s September 9, 2005 request for service is denied; and

6. Plaintiff’s September 28, 2005 declaration will be disregarded.

DATED: September 30, 2005.

DAD:13

hall0573.3s

Case 2:05-cv-00573-FCD-DAD Document 13 Filed 10/03/05 Page 3 of 6
UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF CALIFORNIA

GARY HALLFORD, APPLICATION TO PROCEED

Plaintiff, IN FORMA PAUPERIS 

vs. BY A PRISONER

CALIFORNIA DEPARTMENT

OF CORRECTIONS, et al.,

Defendants. CASE NUMBER: CIV S-05-0573 FCD DAD P

I, , declare that I am the plaintiff in the above-entitled

proceeding; that, in support of my request to proceed without prepayment of fees under 28 U.S.C. § 1915, 

I declare that I am unable to pay the fees for these proceedings or give security therefor and that I am entitled to

the relief sought in the complaint. 

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

1. Are you currently incarcerated: 9 Yes 9 No (If “No” DO NOT USE THIS FORM) 

 If “Yes” state the place of your incarceration. 

Have the institution fill out the Certificate portion of this application and attach a certified

copy of your prison trust account statement showing transactions for the past six months.

2. Are you currently employed? 9 Yes 9 No

 a. If the answer is “Yes” state the amount of your pay. 

 b. If the answer is “No” state the date of your last employment, the amount of your take-home salary or

wages and pay period, and the name and address of your last employer.

3. In the past twelve months have you received any money from any of the following sources?

 a. Business, profession or other self-employment 9 Yes 9 No

 b. Rent payments, interest or dividends 9 Yes 9 No

 c. Pensions, annuities or life insurance payments 9 Yes 9 No

 d. Disability or workers compensation payments 9 Yes 9 No

 e. Gifts or inheritances 9 Yes 9 No

 f. Any other sources 9 Yes 9 No

If the answer to any of the above is “Yes” describe by that item each source of money and state the amount

received and what you expect you will continue to receive. Please attach an additional sheet if necessary.

ifpform.non-hab (rev. 7/02)

Case 2:05-cv-00573-FCD-DAD Document 13 Filed 10/03/05 Page 4 of 6
4. Do you have cash or checking or savings accounts? 9 Yes 9 No

 If “Yes” state the total amount: 

5. Do you own any real estate, stocks, bonds, securities, other financial instruments, automobiles or other 

valuable property? 9 Yes 9 No

 If “Yes” describe the property and state its value. 

6. Do you have any other assets? 9 Yes 9 No

 If “Yes” list the asset(s) and state the value of each asset listed.

7. List the persons who are dependent on you for support, state your relationship to each person and indicate

how much you contribute to their support.

I hereby authorize the agency having custody of me to collect from my trust account and forward to the

Clerk of the United States District Court payments in accordance with 28 U.S.C. § 1915(b)(2). 

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

 

 DATE SIGNATURE OF APPLICANT

CERTIFICATE

(To be completed by the institution of incarceration)

I certify that the applicant named herein has the sum of $ on account to his/her credit at 

 (name of institution). I further certify that during the past six months 

the applicant's average monthly balance was $ . I further certify that during the past six months the

average of monthly deposits to the applicant’s account was $ . 

(Please attach a certified copy of the applicant’s trust account statement showing transactions for the past six

months.)

 

 DATE SIGNATURE OF AUTHORIZED OFFICER

ifpform.non-hab (rev. 7/02)

Case 2:05-cv-00573-FCD-DAD Document 13 Filed 10/03/05 Page 5 of 6
INFORMATION TO PRISONERS SEEKING LEAVE TO 

PROCEED WITH A CIVIL ACTION IN FEDERAL COURT

IN FORMA PAUPERIS PURSUANT TO 28 U.S.C. § 1915

In accordance with 1996 amendments to the in forma pauperis (IFP) statute, as a prisoner you will be

obligated to pay the full filing fee of $150.00 for a civil action. If you later file an appeal, the filing fee for the

appeal is $105.00. 

If you have the money to pay the filing fee, you should send a cashier’s check or money order to the

court with your complaint, petition, or notice of appeal and, if appropriate, your IFP application. 

If you do not have enough money to pay the full filing fee when your action is filed, you can file the

action without prepaying the filing fee. However, the court will assess an initial partial filing fee at the time

your action is filed. The initial partial filing fee will be equal to 20 percent of the average monthly deposits to

your prison or jail account for the six months immediately preceding the filing of the lawsuit, or 20 percent of

the average monthly balance in your prison or jail account for that same six month period, whichever is greater. 

The court will order the agency that has custody of you to take that initial partial filing fee out of 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 filing fee. Until the

amount of the filing fee is paid in full, each month you will owe 20 percent of your preceding month’s income

toward the balance. The agency that has custody of you will collect that money and send payments to the court

any time the amount in the 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. 

In order 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 Certification section on

the back of the form and attach to the form a certified copy of your prison or jail account statement for the last

six months. 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.

Regardless of whether some or all of the filing fee has been paid, the court is required to screen your

complaint and to dismiss the complaint if (1) your allegation of poverty is untrue; (2) the action is frivolous or

malicious; (3) your complaint does not state a claim on which relief can be granted; or (4) you sue a defendant

for money damages and that defendant is immune from liability for money damages.

If you file more than three actions or appeals while you are a prisoner which are dismissed as frivolous

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

bringing any other actions in forma pauperis unless you are in imminent danger of serious physical injury.

ifpinfo.rev

Revised 12/96

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