Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_05-cv-01342/USCOURTS-azd-2_05-cv-01342-0/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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JDDL

WO JDN

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Thomas Lillard, 

Plaintiff, 

vs.

Joseph Arpaio, 

Defendant. 

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No. CV 05-1342-PHX-DGC (LOA)

ORDER

Plaintiff, currently confined in the Maricopa County Durango Jail in Phoenix,

Arizona, filed a pro se Comp laint p ursuant to 42 U.S.C. § 1983. He also requested leave to

proceed in forma pauperis. Plaintiff used an outdated form which inst ructed him that the

current filing fee is $150.00. Effective February 7, 2005, the filing fee for a civil rights action

increased to $250.00. See 28 U.S.C. § 1914, amended by, Consolidated Appropriations Act

of 2005, Pub. L. No. 108-447, 118 Stat. 2809, Sec. 307 (December 8, 2004). The local rules of

this Court require Plaintiff to use the current court-approved form. See LRCiv 3.4(a).

Accordingly, the Court will deny Plaintiff’s in forma pauperis application without

prejudice. 

Plaintiff may make a new in forma pauperis application on the current courtapproved form. He must fill out the form completely, including the Consent t o Collection

of Fees From Trust Account and t he Certificate of Correctional Official as to Status of

Case 2:05-cv-01342-DGC--LOA Document 3 Filed 10/21/05 Page 1 of 5
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JDDL - 2 -

Applicant’s Trust Account. Plaintiff must also re-submit his certified six-month trust

account statement. To assist Plaint iff, t he Court will direct the Clerk of Court to send

Plaintiff a current court-approved form for an in forma pauperis application. 

Plaintiff must file his new in forma pauperis application within thirty days. Plaint iff

should take not ice that if he fails to timely comply with every provision of this Order, or

any order entered in this matter, this action will be dismissed pursuant to Rule 41(b) of the

Federal Rules of Civil Procedure. See Ferdik v. Bonzelet, 963 F.2d 1258, 1260-61 (9th Cir.

1992) (district court may dismiss action for failure to comply with any order of the Court).

IT IS THEREFORE ORDERED that: 

(1) Plaintiff’s application to proceed in forma pauperis (Doc. #1) is denied without

prejudice; 

(2) The Clerk of Court shall enter a judgment of dismissal of this action, without

prejudice and without further notice to Plaint iff, if Plaintiff fails to file a new in forma

pauperis application within thirty days of the date this Order is filed; and

(3) The Clerk of Court shall provide t o Plaintiff the current instructions and form

for an Application to Proceed In Forma Pauperis By a Prisoner Civil (Non-Habeas).

DATED this 20th day of October, 2005.

Case 2:05-cv-01342-DGC--LOA Document 3 Filed 10/21/05 Page 2 of 5
Revised 2/7/05

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 full filing fee of $250.00 for a civil action. If you later file an appeal,

you will be obligated to pay the $255.00 filing fee for the appeal.

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

money order payable to the Clerk of the Court with your complaint, petition, or notice of

appeal.

If you do not have enough money to pay the full filing fee, you can file the action without

prepaying the filing fee. 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 filing 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.

Case 2:05-cv-01342-DGC--LOA Document 3 Filed 10/21/05 Page 3 of 5
Revised 2/7/05 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

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 , ) CASE NO. 

Plaintiff, )

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 vs. ) APPLICATION TO PROCEED

) IN FORMA PAUPERIS 

 , ) BY A PRISONER

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

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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. 

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

Case 2:05-cv-01342-DGC--LOA Document 3 Filed 10/21/05 Page 4 of 5
Revised 2/7/05 2

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, 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 

Case 2:05-cv-01342-DGC--LOA Document 3 Filed 10/21/05 Page 5 of 5