Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_06-cv-01012/USCOURTS-azd-2_06-cv-01012-0/pdf.json

Nature of Suit Code: 530
Nature of Suit: Prisoner Petitions - Habeas Corpus
Cause of Action: 28:2254 Petition for Writ of Habeas Corpus (State)

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28 JDDL

WO KM

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Michael Adam Prostka, 

Petitioner, 

vs.

Dora B. Schriro, et al.,

Respondents.

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No. CV 06-1012-PHX-MHM (LOA)

ORDER

On April 11, 2006, Petitioner Michael Adam Prostka, presently confined in the

Arizona State Prison Complex-Tucson, filed a Petition for Writ of Habeas Corpus by a

Person in State Custody (28 U.S.C. § 2254). Petitioner has not paid the five dollar ($5.00)

filing fee or filed an Application to Proceed In Forma Pauperis by a Prisoner (Habeas)

("Application to Proceed").

Local Rule of Civil Procedure ("LRCiv") 3.5(b) requires that actions filed in forma

pauperis by persons who are incarcerated must be accompanied by an "Application to

Proceed In Forma Pauperis by a Prisoner (Habeas)" that is executed under penalty of perjury

and contains a certification, executed by an authorized officer of the institution regarding any

amount contained in any of the inmate's accounts. Local Rule of Civil Procedure 3.5(b) also

Case 2:06-cv-01012-MHM Document 4 Filed 05/22/06 Page 1 of 5
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 The five dollar ($5.00) filing fee is set pursuant to 28 U.S.C. § 1914(a).

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requires payment of the five dollar ($5.00) filing fee1

 if a petitioner has in excess of

twenty-five dollars ($25.00) in his inmate account. 

Petitioner will be given thirty (30) days to pay the five dollar ($5.00) filing fee, or file

a certified Application to Proceed In Forma Pauperis using the form included with this Order.

If Petitioner fails to pay the five dollar ($5.00) filing fee or file a certified Application to

Proceed In Forma Pauperis within thirty (30) days of the filing date of this Order, the Clerk

of the Court will be directed to enter a judgment of dismissal of this case, without prejudice,

without further notice to Petitioner.

IT IS THEREFORE ORDERED as follows:

1) Petitioner SHALL HAVE thirty (30) days from the filing date of this Order to pay the

five dollar ($5.00) filing fee, or to file with the Court a certified Application to Proceed In

Forma Pauperis using the form included with this Order; 

2) The Clerk of the Court is DIRECTED to enter judgment of dismissal of this action

without prejudice, without further notice to Petitioner, if Petitioner fails to pay the five dollar

($5.00) filing fee, or fails to file a certified Application to Proceed within thirty (30) days

from the date of filing of this Order;

3) A clear and legible copy of every pleading or other document filed shall accompany

each original pleading or other document filed with the Clerk for use by the District Judge

or Magistrate Judge to whom the case is assigned and additional copies for each Judge in

three-judge panel cases. See LRCiv 5.4. Failure to submit a copy along with the original

pleading or document will result in the pleading or document being stricken without

further notice to Petitioner;

4) At all times during the pendency of this action, Petitioner shall immediately advise

the Court of any change of address and its effective date. Such notice shall be captioned

“NOTICE OF CHANGE OF ADDRESS.” The notice shall contain only information

pertaining to the change of address and its effective date, except that if Petitioner has been

Case 2:06-cv-01012-MHM Document 4 Filed 05/22/06 Page 2 of 5
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released from custody, the notice should so indicate. The notice shall not include any

motions for any other relief. Failure to file a NOTICE OF CHANGE OF ADDRESS may

result in the dismissal of the action for failure to prosecute pursuant to Federal Rule of Civil

Procedure 41(b);

5) The Clerk of the Court is DIRECTED to send Plaintiff a form for filing an

"Application to Proceed In Forma Pauperis by a Prisoner (Habeas)".

DATED this 19th day of May, 2006.

Case 2:06-cv-01012-MHM Document 4 Filed 05/22/06 Page 3 of 5
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. 

Case 2:06-cv-01012-MHM Document 4 Filed 05/22/06 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 

Case 2:06-cv-01012-MHM Document 4 Filed 05/22/06 Page 5 of 5