Darden v. St. Louis Airport and City Dept. et al, No. 4:2022cv00203 - Document 2 (E.D. Mo. 2022)

Court Description: OPINION MEMORANDUM AND ORDER (See Full Order) IT IS HEREBY ORDERED that the Clerk of Court shall provide plaintiff a blank Prisoner Civil Rights Complaint form and Motion to Proceed in Forma Pauperis Prisoner Cases form. IT IS FURTHER ORDERED that , within twenty-one (21) days of the date of this Order, plaintiff shall file an amended complaint on the Court-provided form and in compliance with the Courts instructions. IT IS FURTHER ORDERED that, within twenty-one (21) days of the date of thi s Order, plaintiff shall either pay the full filing fee of $402 or submit a motion to proceed in forma pauperis on the Court-provided form. If plaintiff files a motion to proceed in forma pauperis, he shall also submit a certified copy of hi s inmate account statement for the six-month period immediately preceding the filing of the complaint. IT IS FURTHER ORDERED that plaintiffs failure to timely comply with this Order shall result in the dismissal of this action, without prejudice and without further notice. (Response to Court due by 3/15/2022) Signed by District Judge Henry Edward Autrey on 2/22/2022. (Attachments: # 1 Form Prisoner Civil Rights Complaint Form, # 2 Form Motion to Proceed In Forma Pauperis)(JEB)

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Darden v. St. Louis Airport and City Dept. et al Doc. 2 Att. 2 Clear Form UNITED STATES DISTRICT COURT EASTERN DISTRICT OF MISSOURI ____________ DIVISION ) ) ) ) ) Case No. _____________________ ) ) ) Petitioner, v. Respondent. MOTION TO PROCEED IN FORMA PAUPERIS AND AFFIDAVIT IN SUPPORT - HABEAS CASES I declare (1) that I am the petitioner in this case; (2) that because of my poverty I am unable to pay the filing fee; and (3) that I believe I am entitled to relief. The nature of my action and the issues are briefly stated as follows. In further support of this application, I answer the following questions: 1. Place of confinement of petitioner: 2. Crime(s) for which you have been convicted, date and sentence on each: 3. Are you presently employed? a. Yes No If the answer is 'yes’ state the amount of your salary or wages per month and give the name and address of your employer. Dockets.Justia.com b. If the answer is 'no’ state the date of last employment and the amount of the salary and wages per month which you received. 4. Have you received within the past twelve (12) months, money from any of the following sources? Yes No Business profession or form of self-employment, Rent payments interest or dividend, Pensions annuities or life insurance payments, Gifts or inheritances, Any other sources. , If the answer to any of the above is 'yes’ describe the source and amount of money received from each during the past twelve (12) months. 5. Do you own any cash or do you have money in a checking or savings account? Include any funds in your prison account. No Yes If the answer is 'yes’ state the total amount of cash owned, and the balance in all checking savings or prison accounts. 6. Do you own real estate stocks bonds notes automobiles,or other valuable property (excluding ordinary household furnishings and clothing) No Yes If the answer is 'yes’ describe the property and state its approximate value. 2 I 7. List the persons who are dependent upon you for support, state your relationship to those persons, and indicate how much you contribute toward their support: I DECLARE UNDER PENALTY OF PERJURY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT. I UNDERSTAND THAT PROVIDING FALSE INFORMATION MAY SUBJECT ME TO CRIMINAL PROSECUTION, IMPOSITION OF A FINE, OR OTHER SANCTION THAT MAY ADVERSELY AFFECT MY ABILITY TO PURSUE THIS CASE OR OTHER CASES. I HAVE REVIEWED MY ANSWERS TO INSURE THEIR ACCURACY. Executed (signed) this day of 20______. (Signature of petitioner) Certificate I certify that the applicant named herein has the sum of on account to his or her $ credit at the institution where he or she is confined. I further certify that the applicant likewise has the following securities to his or her credit according to the records of said institution: Authorized Officer of Institution 3

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