Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_15-cv-02579/USCOURTS-caed-2_15-cv-02579-0/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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UNITED STATES DISTRICT COURT 

FOR THE EASTERN DISTRICT OF CALIFORNIA 

EDWARD BRIDGEMAN, 

Plaintiff, 

v. 

DEPARTMENT OF CALIFORNIA 

CORRECTION, et al., 

Defendants. 

No. 2:15-cv-2579 AC P 

ORDER 

 Plaintiff, a state prisoner proceeding pro se, has filed a civil rights action pursuant to 42 

U.S.C. § 1983, together with a request for leave to proceed in forma pauperis pursuant to 28 

U.S.C. § 1915. However, the certificate portion of the request, which must be completed by 

plaintiff’s institution of incarceration, has not been filled out. Also, plaintiff has not filed a 

certified copy of his prison trust account statement for the six-month period immediately 

preceding the filing of the complaint. See 28 U.S.C. § 1915(a)(2). Plaintiff will be provided the 

opportunity to submit a completed in forma pauperis application and a certified copy of his prison 

trust account statement in support thereof. 

 In addition, plaintiff has signed and filed a proposed “Order Re. Consent or Request for 

Reassignment,” which improperly indicates that plaintiff both consents to, and declines, the 

jurisdiction of the undersigned magistrate judge for all purposes pursuant to 28 U.S.C. § 636(c). 

Plaintiff will be provided the opportunity to submit a new form containing his signature and 

Case 2:15-cv-02579-JAM-AC Document 5 Filed 12/29/15 Page 1 of 2
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assent to only one of these options. Failure to submit a new form will result in the assignment of 

a district judge and referral to the undersigned magistrate judge for performance of the duties set 

forth in 28 U.S.C. § 636(b). 

 In accordance with the above, IT IS HEREBY ORDERED that: 

 1. Plaintiff shall, within thirty days after the filing date of this order, submit a completed 

affidavit in support of his request to proceed in forma pauperis on the form provided by the Clerk 

of Court, including completion of the certificate by an authorized prison official, and a certified 

copy of his prison trust account statement for the six-month period immediately preceding the 

filing of the complaint. 

 2. Plaintiff shall also, within thirty days after the filing date of this order, submit a 

completed Order Re. Consent or Request for Reassignment, which clearly indicates whether 

plaintiff consents to, or declines, the jurisdiction of the undersigned magistrate judge for all 

purposes. 

 3. The Clerk of the Court is directed to send plaintiff a new Application to Proceed In 

Forma Pauperis By a Prisoner, and a new Order Re. Consent or Request for Reassignment. 

 4. Plaintiff’s failure to comply with this order may result in a recommendation that this 

action be dismissed without prejudice. 

DATED: December 28, 2015 

Case 2:15-cv-02579-JAM-AC Document 5 Filed 12/29/15 Page 2 of 2