Brown v. Blinken

UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF NEW YORK

KENNETH ANDERSON BROWN,

Plaintiff,

22-CV-9205 (LTS)

-against-

ORDER DIRECTING PAYMENT OF FEES

ANTONY JOHN BLINKEN, JANET LOUISE OR IFP APPLICATION

YELLEN, ET AL

Defendants.

LAURA TAYLOR SWAIN, Chief United States District Judge:

Plaintiff brings this action pro se. To proceed with a civil action in this Court, a plaintiff

must either pay $402.00 in fees – a $350.00 filing fee plus a $52.00 administrative fee – or, to

request authorization to proceed in forma pauperis (IFP), that is, without prepayment of fees,

submit a signed IFP application. See 28 U.S.C. §§ 1914, 1915.

Plaintiff submitted the complaint without the filing fees or an IFP application. Within

thirty days of the date of this order, Plaintiff must either pay the $402.00 in fees or submit the

attached IFP application. If Plaintiff submits the IFP application, it should be labeled with docket

number 22-CV-9205 (LTS). If the Court grants the IFP application, Plaintiff will be permitted to

proceed without prepayment of fees. See 28 U.S.C. § 1915(a)(1).

No summons shall issue at this time. If Plaintiff complies with this order, the case shall be

processed in accordance with the procedures of the Clerk’s Office. If Plaintiff fails to comply

with this order within the time allowed, the action will be dismissed.

The Court certifies under 28 U.S.C. § 1915(a)(3) that any appeal from this order would

not be taken in good faith, and therefore IFP status is denied for the purpose of an appeal. Cf.

Coppedge v. United States, 369 U.S. 438, 444–45 (1962) (holding that appellant demonstrates

good faith when seeking review of a nonfrivolous issue).

SO ORDERED.

Dated: October 28, 2022

New York, New York

/s/ Laura Taylor Swain

LAURA TAYLOR SWAIN

Chief United States District Judge

UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF NEW YORK

(full name of the plaintiff or petitioner applying (each person

must submit a separate application))

CV ( ) ( )

-against- (Provide docket number, if available; if filing this with

your complaint, you will not yet have a docket number.)

(full name(s) of the defendant(s)/respondent(s))

APPLICATION TO PROCEED WITHOUT PREPAYING FEES OR COSTS

I am a plaintiff/petitioner in this case and declare that I am unable to pay the costs of these proceedings

and I believe that I am entitled to the relief requested in this action. In support of this application to

proceed in forma pauperis (IFP) (without prepaying fees or costs), I declare that the responses below are

true:

1. Are you incarcerated? Yes No (If “No,” go to Question 2.)

I am being held at:

Do you receive any payment from this institution? Yes No

Monthly amount:

If I am a prisoner, see 28 U.S.C. § 1915(h), I have attached to this document a “Prisoner Authorization”

directing the facility where I am incarcerated to deduct the filing fee from my account in installments

and to send to the Court certified copies of my account statements for the past six months. See 28

U.S.C. § 1915(a)(2), (b). I understand that this means that I will be required to pay the full filing fee.

2. Are you presently employed? Yes No

If “yes,” my employer’s name and address are:

Gross monthly pay or wages:

If “no,” what was your last date of employment?

Gross monthly wages at the time:

3. In addition to your income stated above (which you should not repeat here), have you or anyone else

living at the same residence as you received more than $200 in the past 12 months from any of the

following sources? Check all that apply.

(a) Business, profession, or other self-employment Yes No

(b) Rent payments, interest, or dividends Yes No

(c) Pension, annuity, or life insurance payments Yes No

(d) Disability or worker’s compensation payments Yes No

(e) Gifts or inheritances Yes No

(f) Any other public benefits (unemployment, social security,

Yes No

food stamps, veteran’s, etc.)

(g) Any other sources Yes No

If you answered “Yes” to any question above, describe below or on separate pages each source of

money and state the amount that you received and what you expect to receive in the future.

If you answered “No” to all of the questions above, explain how you are paying your expenses:

4. How much money do you have in cash or in a checking, savings, or inmate account?

5. Do you own any automobile, real estate, stock, bond, security, trust, jewelry, art work, or other

financial instrument or thing of value, including any item of value held in someone else’s name? If so,

describe the property and its approximate value:

6. Do you have any housing, transportation, utilities, or loan payments, or other regular monthly

expenses? If so, describe and provide the amount of the monthly expense:

7. List all people who are dependent on you for support, your relationship with each person, and how

much you contribute to their support (only provide initials for minors under 18):

8. Do you have any debts or financial obligations not described above? If so, describe the amounts owed

and to whom they are payable:

Declaration: I declare under penalty of perjury that the above information is true. I understand that a false

statement may result in a dismissal of my claims.

Dated Signature

Name (Last, First, MI) Prison Identification # (if incarcerated)

Address City State Zip Code

Telephone Number E-mail Address (if available)