AO 240A (Rev. 01/09) Order to Proceed Without Prepaying Fees or Costs
UNITED STATES DISTRICT COURT
for the
__________ District of __________
)
)
)
)
)
Plaintiff
v. Civil Action No.
Defendant
ORDER TO PROCEED WITHOUT PREPAYING FEES OR COSTS
IT IS ORDERED: The plaintiff’s application under 28 U.S.C. § 1915 to proceed without prepaying fees or
costs is:
’
Granted:
The clerk is ordered to file the complaint and issue a summons. The United States marshal is ordered to serve
the summons with a copy of the complaint and this order on the defendant(s). The United States will advance
the costs of service. Prisoner plaintiffs are responsible for full payment of the filing fee.
’
Granted Conditionally:
The clerk is ordered to file the complaint. Upon receipt of the completed summons and USM-285
form for each
defendant, the clerk will issue a summons. If the completed summons and USM-285 forms are not submitted as
directed, the complaint may be dismissed. The United States marshal is ordered to serve the completed summons
with a copy of the complaint and this order on the defendant(s). The United States will advance the costs of
service. Prisoner plaintiffs are responsible for full payment of the filing fee.
’
Denied:
This application is denied for these reasons:
Date:
Judge’s signature
Printed name and title
