UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF NEW YORK HUBERT DUPIGNY, Plaintiff, -against- UNITED STATES OF AMERICA; GEOFFREY S. BERMAN; ELINOR TORLOW; MOLLIE BRACEWELL; JACOB 20-CV-5346 (CM) GUTWILLING; AARON MYSLIWIEC; THEIR OFFICERS AND AGENTS, ORDER SERVANTS, EMPLOYEES, ATTORNEYS, AND ALL OTHERS (INCLUDING SUBSIDIARIES) IN ACTIVE CONCERT OF PARTICIPATION, IN THEIR OFFICIAL AND INDIVIDUAL CAPACITY, Defendants. COLLEEN McMAHON, Chief United States District Judge: Plaintiff, currently detained in the Metropolitan Detention Center in Brooklyn, New York, brings this action pro se. By order dated July 27, 2020, the Court directed Plaintiff, within 30 days, to pay the $400 in fees required to bring an action in this Court or, to proceed without prepayment of fees, that is, in forma pauperis (IFP), to submit an IFP application and prisoner authorization. The Court is in receipt of a letter from Plaintiff requesting an extension of time to comply with the Court’s order and seeking information regarding how to pay the fees. The Court grants Plaintiff’s request for an extension of time and directs Plaintiff to pay the relevant fees or submit an IFP application and prisoner authorization within 30 days of the date of this order. If Plaintiff submits the completed and signed IFP application and prisoner authorization, $350.00 will be deducted from Plaintiff’s prisoner account in monthly installments. If Plaintiff wishes to pay the $400.00 in fees, he may submit payment by certified check or money order, payable to: Clerk of Court — SDNY, and mail the payment to: Cashiers — Room 120, 500 Pearl Street, New York, NY 10007. Any check or money order must include Plaintiff's case number, 20-CV-5346 (CM). The Clerk of Court is directed to mail a copy of this order to Plaintiff and note service on the docket. An IFP application and prisoner authorization are attached to this order for Plaintiff's convenience. The Court certifies under 28 U.S.C. § 1915(a)(3) that any appeal from this order would not be taken in good faith, and therefore IFP status is denied for the purpose of an appeal. See Coppedge v. United States, 369 U.S. 438, 444-45 (1962). SO ORDERED. Dated: September 2, 2020 New York, New York hie. In Wh Chief United States District Judge

' The $50.00 administrative fee for filing a civil action does not apply to persons granted IFP status under 28 U.S.C. § 1915.

UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF NEW YORK

(Full name(s) of the plaintiff or petitioner applying (each person must submit a separate application) CV ( ) ( ) -against- (Enter case number and initials of assigned judges, if available; if filing this with your complaint, you will not yet have a case number or assigned judges.) (Full name(s) of the defendant(s)/respondent(s).)

APPLICATION TO PROCEED WITHOUT PREPAYING FEES OR COSTS I am a plaintiff/petitionerin this case and declare that I am unable to pay the costs of these proceedingsand I believe that I am entitled to the relief requested in this action. In support of this applicationto proceed in forma pauperis(“IFP”) (without prepaying fees or costs), I declare that the responses below are true: 1. Are you incarcerated? Yes No (If “No,” go to Question 2.) I am being held at: Do you receive any payment from this institution? Yes No Monthly amount: If I am a prisoner, see28 U.S.C. §1915(h), I have attached to this document a “Prisoner Authorization” directing the facility where I am incarcerated to deduct the filing fee from my account in installments and to send to the Court certified copies of my account statements forthe past six months. See 28 U.S.C. §1915(a)(2), (b). I understand that this means that I will be required to pay the full filing fee. 2. Are you presently employed? Yes No If “yes,” my employer’s name and address are: Gross monthly pay or wages: If “no,” what was your last date of employment? Gross monthly wages at the time: 3. In addition to your income stated above(which you should not repeat here), have you or anyone else living at the same residence as you received more than $200 in the past 12 months from any of the following sources? Check all that apply. (a) Business, profession, or other self-employment Yes No (b) Rent payments, interest, or dividends Yes No (c) Pension, annuity, or life insurance payments [] Yes [] No (d) Disability or worker’s compensation payments [] Yes [] No (e) Gifts or inheritances [] Yes [] No Any oth blic benefit ] t ial it (f) Any other public ene its (unemployment, social security, Yes No food stamps, veteran’s, etc.) (g) Any other sources [] Yes [] No If you answered “Yes” to any question above, describe below or on separate pages each source of money and state the amount that you received and what you expect to receive in the future.

If you answered “No” to all of the questions above, explain how you are paying your expenses:

4. How much money do you have in cash or in a checking, savings, or inmate account?

5. Do you own any automobile, real estate, stock, bond, security, trust, jewelry, art work, or other financial instrument or thing of value, including any item of value held in someone else’s name? If so, describe the property and its approximate value:

6. Do you have any housing, transportation, utilities, or loan payments, or other regular monthly expenses? describe and provide the amount of the monthly expense:

7. List all people who are dependent on you for support, your relationship with each person, and how much you contribute to their support (only provide initials for minors under 18):

8. Do you have any debts or financial obligations not described above? Ifso, describe the amounts owed and to whom they are payable:

Declaration: | declare under penalty of perjury that the above information is true. I understand that a false statement may result in a dismissal of my claims.

Dated Signature

Name (Last, First, MI) Prison Identification # {if incarcerated)

Address City State Zip Code

Telephone Number E-mail Address (if available) IFP Application, page 2

UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF NEW YORK

(full name of the plaintiff/petitioner) CV C JC) -against- (Provide docket number, if available; if filing this with your complaint, you will not yet have a docket number.)

(full name(s) of the defendant(s)/respondent(s)) PRISONER AUTHORIZATION By signing below, I acknowledge that: (1) because I filed this action as a prisoner,! I am required by statute (28 U.S.C. § 1915) to pay the full filing fees for this case, even if am granted the right to proceed in forma pauperis (IFP), that is, without prepayment of fees; (2) if lam granted IFP status, the full $350 filing fee will be deducted in installments from my prison account, even if my case is dismissed or I voluntarily withdraw it. I authorize the agency holding me in custody to: (1) send a certified copy of my prison trust fund account statement for the past six months (from my current institution or any institution in which I was incarcerated during the past six months); (2) calculate the amounts specified by 28 U.S.C. § 1915(b), deduct those amounts from my prison trust fund, and disburse those amounts to the Court. This authorization applies to any agency into whose custody I may be transferred and to any other district court to which my case may be transferred.

Date Signature

Name (Last, First, Ml) Prison Identification #

Address City State Zip Code

“prisoner” is “any person incarcerated or detained in any facility who is accused of, convicted of, sentenced for, or adjudicated delinquent for, violations of criminal law or the terms or conditions of parole, probation, pretrial release, or diversionary program.” 28 U.S.C. § 1915(h).