PLRA Consent To Collection Of Fees (Payable To Court Of Appeals For Mandamus Petitions)

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 ORIGINAL PROCEEDINGS ____________________________ No. _________, _________________v.____________________________ _____________________________ (lower court case no.) FEE AMOUNT: $500 PAYABLE TO: Clerk, U.S. Court of Appeals 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. Court of Appeals, 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 petition or the court decides my petition 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 I understand that once consent to the collection of fees has been given it cannot be withdrawn.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 ____________________ American LegalNet, Inc. www.FormsWorkFlow.com 06/03/2014 SCC