IN THE SUPREME COURT OF THE UNITED STATES NAYITZW I I (Your Name) Vs RESPONDENTGS) MOTION FOR LEAVE T0 PROCEED IN FORMA PAUPERIS 'I'he petltloner aka leave to file the attached petltlon for a of ceruoran . vnthout prepeyment of cost: and to proceed for-ma. pauper>> Petitioner has previously been granted leave to proceed formd pauporu 111 th follovnng court(e) Megnts em" all-c.d+ gt 1 Petntzoner has not prevmusly been granted leave to proceed fonm paupem an my other court Petitioner': amdavtt or declaratlon In support of the motlon 13 attached hereto (SIznature) Employment .GrlIs AFFIDAVIT OR DECLARATION IN SUPPORT OF MOTION FOR LEAVE TO PROCEED IN FORMA PAUPEHIS I am the petmoner the case In support of 1 For both you and your spouse estimate the average amount of money receured from each of weekly, bureekly, quarterly, or annually to show the rate. Use gross amounts, that Is, amounts before any deductions for taxes or othervnae. Income source Average amount during Amount expected the past 12 months next month You 3 You i' rO'0g Sellemployment Income from real property (such es rental Income) Oo00>>o0 one 00 00?00 0 0 0 000 Alimony 69$-$69 Child Support 0 00000 000 Retirement (such as social A security pensions Insurance) security Insurance payments) Unemployment payments 3 Public assistance 8 (such as welfare) '59 00o0? Totel Income 3 2 Last your employment hntory for the past two years, most recent ll:-at (Gross pay ll before taxes or other Employer Detee of Grace pay mam>>. womb si 3 List your spouse': employment history for the past two years, most recent employer fix-at (Groea pay 1: before taxea or other deductlona) Employer Datee of Groee pay (come. rLot_z.e. fin :1 :fi:ii 4 How much cash do you and your epouee have? 3 matztutaon Flnenelellneututlon Typedekwunt Qmount _epoueehae 5 List the assets, and thelr values, which you own or your spouse owns Do not hit clotlung and ordmary houeehold furmahmgs <> 'me: Vme Value Q0119: Value 0 6 State every person, busmess, or orgamzatmn ovnng you or your spouse money, and the amount owed Amountowadtoyou Amountowadtoyourapouaa your spouse money 3 3 fbQ9.% flow; mane 0_pn.E> ftoab 3 noun>> wanna 7 State the persons who rely on you or your spouse for support Nana Ialatlonaillp Ago Mn; (boa-Pa Q0034 flnh?a name; none. Mme; 8 Estunate the average expenses of you and your family Show separately the amounts pend by your spouse Adjust any payments that are made weekly, blweekly quarterly, or annually to show the rate. You Your spouse Are real estate taxes Included'! CI Yes No . Is property Insurance Included? Yes Utihtles (electricity, heating fuel, 0 water, sewer, and telephone) 3 0 Home nmntenanoe (repairs and upkeep) ma 3 0 Clothmg 3 3 0 0 Laundry and dry-cleanmg Medical and dental expenses 3 3 You Your apouaa Transportmon (not mcludmg motor velncle payments) 3 Recreatlon, entertainment, newspapers, magamnes, etc 3 0 Insurance (not deducted from wages or mcluded 1n mortgage payments) Homeowners or router's 0 3 Llfe 0 0 Health 0 Motor Vehlcle 3 0 other 0:00-22 5 0 3 0 Taxes (not deducted from wages or mcluded 1n mortgage payments) (mm, so 0 3 0 Installment payments Motor Veh1c1e 3 3 Credlt card(fl) 3 3) 0 Department store(s) 9 '3 om, (Lotte Alimony, maintenance, and support paid to others 3 . 0 Other (specify) 3 3 0 0 Total expenses 9 Do you expect any mayor changes to your income or expenaea or in your aaseta or liabilmea during the next 12 months? 1] Yea M1510 If yea, deacnbe on an attached aheet 10 Have you paid - or will you be paying - an attorney any money for aervioea in connection with this case, including the completion of the form'? El Yea xNo If yes how much'? If yes, state the attorney': name, addresa, and telephone number Qplbea 11 Have you will you be payin?--anyone other than an attorney (auch as a paralegal or a typiat) any money for aervices in connection with this case, including the completion of this form? [3 Yea No If yes, how much'? up 18' If yea, state the peraon'a name, addreaa, and telephone number 9.00.22 12 Q0 out-sidaea foregoingiatrueandcorrect Executadon . .29'q~ (Smuture) 2' |b|cJa 3 2012 t" SUPREME COURT OF THE UNITED STATES I I PETITIONER (Your Meme) V8 5 . -- ON PETITION FOR A warr OF cermonaan TO PETITION FOR WRIT OF CERTIORARI (Your Name) 9 (Address) Lgmisburgi ?ca (City Stete Zip Code) 0.19. (Phone Number) Qu Esnoum "Es ""53 FM LLQ 31> 'Ever mm R1 R11 QR: um MQRR by "mag "Sh "hm (30.-.3 H. -2 \qmQn' Ye; us. I Riipefl' JR QQCL Vex- EN NS \'Q)kcL\ Ufiqimk Wu i3\ 9-b QM. 3 QQ 'We, mfifir +0 Om 89-Vhq' 3) Lu he, . 9\Qf,j? %uQ% 39% Woks W3 0% Mu? I We LIST OF PARTI Ahstof petition 15 as follows sTa:rE.s 0ouPtr OF 2) 5149.92, IT gm WED COQPEE: 1), WI LLIFUTL TABLE OF CONTENTS OPINIONS BELOW .. 1 JURISDICTION CONSTITUTIONAL AND STATUTORY PROVISIONS INVOLVED 5 STATEMENT or THE CASE A Q, REASONS FOR enmrme THE wan 3 CONCLUSION )5 INDEX TO APPENDIC APPENDIX . '55' APPENDIX -. um>> oauzg ems Q9 Isl APPENDIX APPENDIX APPENDIX APPENDIX TABLE OF AUTHORITIES CITED CASES 6' Lawcw>> main 9 - mu'; STATUTES AND RULES I?"muad1wm- gin' (.112; 12 u.a..cs4o~I1 -- I OTHER (iv) IN THE SUPREME COURT OF THE UNITED STATES PETITION FOR WRIT OF CERTIORARI Petitioner respectfully pray: that a writ of oertiorari issue to review the Judgment below OPINIONS BELOW []Forcasesfrom1'ederalcourte The opinion of the United States court of appeals appears at Appendix to the petition and II reported at or, has been designated for publication but ll not yet reported, or, is unpublished -b The opinion ofthe Umted States district court appears the petition and II reported at or, has been designated for publication but is not yet reported, or, 90 ll unpublished - Illibrcasesfromatatecourta The opinion of the highest court to review the merits appears at Appendix to the petition and is reported at or, has been designated for publication but is not yet reported, or, ll unpuhhshed The opinion of the court appears at Appendix to the petition and is reported at or, has been designated for publication but is-not yet reported, or, is unpublished JURISDICTION fxFoi-caaesfromfederalcourts Umtedstates Com'tofAppealsdec1dedmycaae A timely petition for rehearing by the Umted States Court of Appeals on the following date and a copy of the order denying rehearing appears at Appendix An extension of We the petition for a writ of orari was granted to and including (date) on (date) in Application No The Jurisdiction ofthis Court 13 invoked under 28 1254(1) Fbrcasesfromltatecoiirts The date on which the highest state court decided my case was A copy of that decision appears at Appendix A timely petition for rehearmg was thereafter denied on the following date and a copy of the order denying rehearing appears at Appendix []Anextension oftime toflle the petition forawnt ofcertiorariwas granted to and including (date) on (date) in Apphcation No The Jurisdiction of this Court II invoked under 28 ?1257(a) (2) CONSTITUTIONAL AND PROVISIONS INVOLVED Orb non: mama: . . mm, Pr-osridfia Fa>> Gue.9.e.x>>cu\ {The smdes. 'va mm.w.. Maw o=x-aha om>> Hut. uni-um wuNe.s wqmu . 09.2, which -Hula .(nmu,n "gm bung; an. at 0. ms>> wean-, 23 0.6.. .8 1% (mun. CV-TCLR.) . mmcxuama .2. rz.o\- umug Qubvuae. 'mm. -PM 119% On (3) 035,9,' mm \angg' mam as mgomcxv ewfiowwgda bggaw +0 ewe. - ?m Mama \oWHoo;.> owuwa- or: .QV A-hm 0155 or mama on $Peecha: m5Z;r= or 'I-kg OF Pe.oP0.. ubacacaeb gr M1039 a?!aeum\ m% ox>> some. kg up 0.93:; 041139;-to beg). NN rant' mvqd; xa am>> ?h.eu\ b(R) +cRex2. V-'ow ma-0.0m 9.2; fig16%cn%e> andnmigwa -as ~m ., 'ad ":L_As..1n" U. 23.14' .4014." \5 0 1 '5 .21-3 STATEMENT OF THE CASE on. or FLbou.+ SW we I Y-pose; 0/10 ivw En?emema Cmm'w:2emn Mam mp. bu>> when :mum was \oW2cL dim 5 WW ow) bow 00'? n2r>\d? 0" I b9 'Lea? or owls 3; ?oz Ma' fiat ob <> 44.9 tmteww 'Wen 55'd-' W3 Raneu who we, F3-ow; Ugh u)0$ 4 (DWI 0 Wm' \neD REL: a . Wm I '04 bug|3M'1'n1{1 A 1 9 .0 usQVQQ U5 3: 3.. :57: av ve, "surm- -94 1: A. sumb 'J"hxM? 44;; mgcavwem we 1 .1. - srr" REASONS FOR GRANTING THE PETITION The Ow) me; Tm-d>> exvvomm am. +0 ms 0.069.>> om on c.\rwL map swan>> own, +0 30.; Q0325 me>> owm?mvxdaamm 0. 930% Msm, (know: axon. 0 '1 ommna (ma, bib Mam 6 Wm t" much on. tgwhem no>> um-Tvueoun . Dacia 0. \v A mm.) uQ QWM uepmsa>> unwed: susw sgieygufes (WW8 Om OQ, 30*' mu. mt aiuxm. (8) [fa gga>> 2.. (mu nc 'ma gxgl. 'meg; an 4e, 2' mm ongb Rom mm mam'; ':50 \?fl ?fmv flu-H 0 Kg. C1230 v, JQRUJ 4 .1 7.1 W@m 1%-adxaa tag 5, 1% Eel>> 0333 2 :33 ;ao,,m~d ?121; 2 3.: 4 cf' 51.3 1' CW 5 1-ml. .9 IL -1 $25 29.. 2 mom; CA ~b0fi>> 304% e, (Lu mU% cm. __jj22gr m; Thar}; mm om ga1amwmb . Cb 1? 2 Hafiz few "1 .4 - 4Ao> vnaa- *-ma as aw\C.m 0% WW "he. 4-'mar -fine, ..: *scu..no+~ 335:; .3 U633 pm>> or; 599*" 0" ggzmam WW 9? 5 59:53 O. ae "Mon mm\e3~2 9% iamw 9 3 unu, gage. ta Wk 2 wm5'55'__ \g,C42Wm" MEEWOV x' )3 $137? <> 3 E21, -so om:.3% 4&8' \p,ppgg\ 5. - 'Men gamma 10.0 .13 'as. A A Ovtmfi" 'm mg tum chi: oQg\9\@, meqmg' QC \n Cm of). 2 Qitfim swim>> 10;; P3 3353>>. ~ihni- N.- mafia The petmon for a of eertloren should be granted Respectfully 11 Date cm ?55! . oazw. UNITED STATES COURT OF APPEALS FOR THE THIRD CIRCUIT No 12-1531 KIM MILLBROOK, Appellant UNITED STATESUOF AMERICA On Appeal from the Umted States Court for the Middle ofPeImsy1vtn1n (D cm: No. 11-ev-00131) Judge Honorable William I Neulon Before and WEIS, 911% I D1stnet Court ?1915(e)(2)(B)orsummaryact1on 106onApn112,2012 On consnderauon whereof, It Is now hereby (D CourtenteredFebruary Allofthe oftlus Court ATTEST Clerk DATED Apnl23,2012 ALB-155 NOT PRECEBENTIAL UNITED STATES comm' 01? APPEALS FOR um THIRD CIRCUIT No 12-1531 KIM MILLBROOK, Appellant UNITED STATES OF AMERICA forthe M1ddleD1.-met (D Ctv1lNo ll-cv-00131) Judge Honorable Wilham Nealon Submitted for Possible Dismissal Pursuantto 28 l9l5(e)(2)(B) or SmnmaryAct1onPursuentto andIO.P 10 6 Apnl 12, 2012 Before (Opunon filed Apnl 23, 2012) OPINION PERCURIAM (U SP-Lewnsburg), appeals fiom an order of the 1 Court granting defendant's motnon for summary Judgment. For the I (FICA), 23 nammg as defendant me Umted States of Amenca. whnle housed the Speclal Management Umt (SMU) at USP-Lewlsburg on or abontMarch5,20l0 Mn'ch4,20l0 fromthenrcell by conecnonal stafi' Followmg an mtemal meluded a medneal assessment, M1llbrook's clam was foundto be Imsubstantnated Afierrevnewmg response to defendant's motlon, the Court concluded the defendant was entitled to summary judgment because M1llbrook's FTCA 78'lF2d868, 872 (3d Cu' 1986) Tlus appeal followed II Wehave1unsd1cuonImder28USC ?l29l Weexerclseplenaryrevww l_3_ggm455F3d4l8,422 (3dC1r 2006) ?ggFed 56(c) Ammg' 477US 242,248 (1986) questlon. &3dC1r a1legedassaultonMarch5,20l0 Under28USC generally not huble for mtentuonal torts of Its employees except for certam intentional or law mforcement oficers $28 USC ?2680 executmgasearch, offederallaw ?m1g;,787F2dat872 assault did not anse outof conduct during an arrest, search, or seizure, tortclumtsnotcogmzable 1g_ S328 USC ?2680(h) 4 &3dCn' L.A.R.274and3dC1r 10.1' 10 6 M1llbrook's motions for appomunent of counsel are domed sggcomplamtats gm! l2(b)(5) 5 "n A 1 Difia-'M Gawk. 1 no"? zen. UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF KIMMILLBROOK, CIVILACTIONNO 311-av-I31 Phumfl (Judge Nealon)F ILE FEB UNITED sums or AMERICA. Dcfendant Inkunn! Mxlibrook, Pem1sylvanu(USP-Lewuburg) Nuned as sole the Umted sum ommem. 2010 (Doc 1,1Iv) . (oonunued. s,a(Doc 9) The Sm(Doc 18,1) 4) &g!(Doc 24) Ihectossmouonsforsunmmuudpnent uenpefiurdasposxuon. pleadings Federal Rule of Cm! Procedure I2(d)prov1des In part as follows Ifionamouonmdafkule l2(b)(6)or 56 oonmmod) sufiindmoiherpmoner atUSP-Terrefimte purtyw1llbeu'lhebmdenItu'1Il" #322-23 "'Suchamrmat1veev1dcnoe-- 32(mm 891 I-126458.460-61 (3dC1r 1989)) 2umL withdrawn." motion. Slnoe (Doc l8,p 6) 4 872(3dCu' 1986) makinunmest" Id. I?.atl72 560 Seoond,thecha!lenged Plnnuif 3 7 broadervicw sgmuzmugur supp NY 2mm 9196095 (MD Uumdsmunnumsuage DATED FEBRUARY 16, 2012 UNITED STATES DISTRICT COURT FOR THE MIDDLE OF KIN MILLBROOK, CIVIL ACTION N0 3 1 1-cv-131 Plunt1fl' (Judge Ncalon) FILE UNITED STATES OF AMERICA, FEB 3 2012 Defendant Par - ORDER NOW, 11-118 16'' DAY OF FEBRUARY, 2012, In accordance With the Memorandum 1 PlamtIfl'smot1on(Doc WITHDRAWN 2 3 4