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Janda v. Dar

United States District Court, W.D. Wisconsin

May 9, 2017

KIRSTEN JANDA, Plaintiff,
v.
ELLEN DAR, M.D., et al. Defendants.

          ORDER

          PETER OPPENEER Magistrate Judge

         Plaintiff Kirsten Janda has filed a proposed civil complaint. Plaintiff has not paid the $400 filing fee nor asked for leave to proceed without prepayment of fees or costs. In the event that plaintiff wishes to proceed without prepayment of the filing fee, the enclosed petition and affidavit must be completed to determine whether plaintiff qualifies as indigent.

         ORDER

         IT IS ORDERED that plaintiff Kirsten Janda may have until June 7, 2017, in which to either pay the $400 filing fee or to submit an affidavit of indigency and return it to the court. If, by June 7, 2017, plaintiff fails to respond to this order, I will assume that plaintiff wishes to withdraw this action voluntarily. In that event, the case will be closed without prejudice to plaintiff filing the case at a later date.

         NON-PRISONER REQUEST TO PROCEED IN DISTRICT COURT WITHOUT PREPAYING THE FILING FEE

         Answer the following questions to the best of your ability.

         Note: If you do not tell the truth, the court may dismiss your lawsuit.

         I. Personal Information

         1) Are you employed? [ ]Yes [ ] No

         2) Are you married? [ ] Yes [ ] No

         If “Yes, ” is your spouse employed? [ ] Yes [ ] No

         3) Do you have any dependents that you are responsible for supporting? [ ] Yes [ ] No

         If “Yes, ” list them below:

Name or initials (for minor children only)

Relationship to You

Age

Amount of Support Provided per Month

$

$

$


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