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PLRA Consent To Collection Of Fees (Payable To District Court For Appeals) - Official Federal Forms
| PLRA Consent To Collection Of Fees (Payable To District Court For Appeals) Form. This is a national form and can be used in 4th Circuit Court Of Appeals Circuit Court Of Appeals . |
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UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT 1100 East Main Street, Suite 501 Richmond, Virginia 23219-3517 www.ca4.uscourts.gov ____________________________ CONSENT TO COLLECTION OF FEES FROM TRUST ACCOUNT FOR APPEAL ____________________________ No. __________, _________________v.____________________________ ______________________________ (lower court case no.) FEE AMOUNT: $455 PAYABLE TO: Clerk, U.S. District Court I, _________________________, # _________________________, hereby consent for the appropriate prison officials to assess and, when funds exist, collect an initial partial filing fee of 20 percent of the greater of: (a) the average monthly deposits to my account for the six-month period immediately preceding the filing of my petition; or (b) the average monthly balance in my account for the six-month period immediately preceding the filing of my petition. I further consent for the appropriate prison officials to collect: monthly payments of 20 percent of my preceding month's income and forward the payments to the Clerk, U.S. District Court, each time the amount in the account exceeds $10 until the filing fee has been paid in full. I understand that by signing this consent I agree to payment of the full filing fee from my trust account regardless of whether I later choose to dismiss my appeal or the court decides my appeal before the entire amount has been paid. I understand that once consent to the collection of fees has been given it cannot be withdrawn. Signature _____________________ Date ____________________ 09/12/2011 SCC American LegalNet, Inc. www.FormsWorkFlow.com
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