Order to Proceed Without Prepaying Fees or Costs

The Pursuant to 28 U.S.C. § 1915 application is prepaying fees is either granted, granted conditionally and denied.

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AO 240A  (Rev. 01/09)  Order to Proceed Without Prepaying Fees or Costs	
U	NITED 	S	TATES 	D	ISTRICT 	C	OURT	
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