Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_12-cv-01869/USCOURTS-azd-2_12-cv-01869-1/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

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Anthony Jackson, 

Plaintiff, 

vs.

Charles L. Ryan, et al., 

Defendants. 

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No. CV 12-1869 PHX RCB (LOA)

O R D E R

On September 4, 2012, Plaintiff Anthony Jackson, who is confined in the Arizona

State Prison Complex-Lewis in Buckeye, Arizona, filed a pro se civil rights Complaint

pursuant to 42 U.S.C. § 1983 and an Application to Proceed In Forma Pauperis. On

September 24, 2012, he filed a Notice of First Amended Complaint. In an October 12, 2012

Order, the Court denied the deficient Application to Proceed and gave Plaintiff 30 days to

either pay the fee or file a complete Application to Proceed In Forma Pauperis.

On October 29, 2012, Plaintiff filed an Application for Appointment of Counsel. On

November 5, 2012, he filed a second Application to Proceed In Forma Pauperis (Doc. 8).

I. Payment of Filing Fee

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

sum or, if granted the privilege of proceeding in forma pauperis, pay the 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

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JDDL - 2 -

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(a).

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 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). 

II. Second Application Fails to Comply With Statute

Plaintiff has used the court-approved form, but he has not signed and dated the

“Consent to Collection of Fees from Trust Account” section of the Application to Proceed.

This part of the in forma pauperis application must be filled out, signed, and dated. The

“Certificate of Correctional Official as to Status of Applicant’s Trust Account” section is also

not completed. In light of these deficiencies, the Court will deny the second Application to

Proceed In Forma Pauperis. The Court will give Plaintiff 30 days to either pay the $350.00

filing fee or file a complete Application to Proceed In Forma Pauperis.

III. 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 notice

to Plaintiff.

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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) Plaintiff’s second Application to Proceed In Forma Pauperis (Doc. 8) is

denied without prejudice.

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

$350.00 filing fee or file a complete Application to Proceed In Forma Pauperis and a

certified six-month trust account statement from the ADOC’s Central Office. 

(3) If Plaintiff fails to either pay the $350.00 filing 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.

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

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

DATED this 4th day of December, 2012.

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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

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Petitioner, ) CASE NO. 

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 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. 

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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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