Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_13-cv-01292/USCOURTS-azd-2_13-cv-01292-0/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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IN THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF ARIZONA 

Ramon Manuel Rivera, 

Plaintiff, 

 vs. 

Brennan, et al., 

Defendants. 

No. CV 13-1292-PHX-RCB (JFM) 

 O R D E R 

On June 27, 2013, Plaintiff Ramon Manuel Rivera, who is confined in the 

Maricopa County Fourth Avenue Jail, 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 fee1

 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 

 

1

 Effective May 1, 2013, the Clerks of Court for the United States District Courts 

are required to collect a $50.00 administrative fee for the filing of a civil action, suit, or proceeding in a district court. See Judicial Conference Schedule of Fees, District Court 

Miscellaneous Fee Schedule &14 (effective May 1, 2013), foll. 28 U.S.C. § 1914. 

However, the administrative fee “does not apply to applications for a writ of habeas corpus or to persons granted in forma pauperis status under 28 U.S.C. § 1915.” Id.

Case 2:13-cv-01292-JJT-JFM Document 3 Filed 09/26/13 Page 1 of 5
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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 

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

 Plaintiff must submit an additional copy of every filing for use by the Court. See

LRCiv 5.4. Failure to comply may result in the filing being stricken without further 

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notice to Plaintiff. 

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 

$400.00 filing and administrative fees 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 $400.00 filing and administrative fees 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 25th day of September, 2013. 

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98-ifphab

Revised 6/98 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

)

 , )

Petitioner, ) CASE NO. 

)

 vs. )

) APPLICATION TO PROCEED

 , ) IN FORMA PAUPERIS

Respondent(s). ) BY A PRISONER

) (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. 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. 

2. 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. 

Case 2:13-cv-01292-JJT-JFM Document 3 Filed 09/26/13 Page 4 of 5
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3. 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

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: $ .

DATE AUTHORIZED SIGNATURE TITLE/ID NUMBER INSTITUTION 

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