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Consent To Collection Of Fees From Trust Account - Official Federal Forms
| Consent To Collection Of Fees From Trust Account Form. This is a national form and can be used in DC Circuit Court Of Appeals Circuit Court Of Appeals . |
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United States Court of Appeals FOR THE DISTRICT OF COLUMBIA CIRCUIT Appellant/Petitioner v. Case No: Appellee/Respondent CONSENT TO COLLECTION OF FEES FROM TRUST ACCOUNT I, , Registration # , hereby consent for the appropriate prison officials to withhold from my prison account and pay to the [ ] Clerk, U.S. District Court or [ ] Clerk, U.S. Court of Appeals an initial payment of 20% of the greater of: (a) the average monthly deposits to my account for the six-month period immediately preceding the filing of my notice of appeal; or (b) the average monthly balance in my account for the six-month period immediately preceding the filing of my note of appeal. I further consent for the appropriate prison officials to collect from my account on a continuing basis each month, an amount equal to 20 per cent of each month's income. Each time the amount in the account reaches $10, the Trust Officer shall forward the interim payment to the [ ] Clerk, U.S. District Court or [ ] Clerk, U.S. Court of Appeals, until such time as the [ ] $450 or [ ] $455 filing fee is paid in full. By executing this document, I also authorize collection on a continuing basis of any additional fees, costs, and sanctions imposed by the Court of Appeals. SIGNATURE OF APPELLANT/PETITIONER cnsnt.ifp rev. 4/9/06 American LegalNet, Inc. www.USCourtForms.com
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