1 KM 2 WO 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 8 9 Michael Charles Aust, No. CV-24-03410-PHX-JAT (ESW) 10 Plaintiff, 11 v. ORDER 12 City of Phoenix, et al., 13 Defendants.
15 Plaintiff Michael Charles Aust,1 who is not confined, has filed a civil rights 16 Complaint (Doc. 1) and an Application to Proceed in District Without Prepaying Fees or 17 Costs (Doc. 2). The Court will dismiss the Complaint with leave to amend. 18 I. Application to Proceed 19 The Court will grant Plaintiff’s Application to Proceed in District Court Without 20 Prepaying Fees or Costs; Plaintiff may proceed without payment of the filing fee. 21 II. Statutory Screening of In Forma Pauperis Complaints 22 Pursuant to 28 U.S.C. § 1915(e)(2), in a case in which a plaintiff has been granted 23 in forma pauperis status, the Court shall dismiss the case “if the court determines that . . . 24 (B) the action . . . (i) is frivolous or malicious; (ii) fails to state a claim on which relief may 25 26
27 1 Plaintiff filed his Complaint under the name “Michael_Charles:Aust.” However, 28 records of both the Maricopa County Superior Court and Maricopa County Jail list Plaintiff’s name as “Michael Charles Aust.” The Court will direct the Clerk of Court to change Plaintiff’s name on the docket to “Michael Charles Aust.” 1 be granted; or (iii) seeks monetary relief against a defendant who is immune from such 2 relief.” 3 A pleading must contain a “short and plain statement of the claim showing that the 4 pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2) (emphasis added). While Rule 8 does 5 not demand detailed factual allegations, “it demands more than an unadorned, the- 6 defendant-unlawfully-harmed-me accusation.” Ashcroft v. Iqbal, 556 U.S. 662, 678 7 (2009). “Threadbare recitals of the elements of a cause of action, supported by mere 8 conclusory statements, do not suffice.” Id. 9 “[A] complaint must contain sufficient factual matter, accepted as true, to ‘state a 10 claim to relief that is plausible on its face.’” Id. (quoting Bell Atlantic Corp. v. Twombly, 11 550 U.S. 544, 570 (2007)). A claim is plausible “when the plaintiff pleads factual content 12 that allows the court to draw the reasonable inference that the defendant is liable for the 13 misconduct alleged.” Id. “Determining whether a complaint states a plausible claim for 14 relief [is] . . . a context-specific task that requires the reviewing court to draw on its judicial 15 experience and common sense.” Id. at 679. Thus, although a plaintiff’s specific factual 16 allegations may be consistent with a constitutional claim, a court must assess whether there 17 are other “more likely explanations” for a defendant’s conduct. Id. at 681. 18 But as the United States Court of Appeals for the Ninth Circuit has instructed, courts 19 must “continue to construe [self-represented litigant’s] filings liberally.” Hebbe v. Pliler, 20 627 F.3d 338, 342 (9th Cir. 2010). A “complaint [filed by a self-represented prisoner] 21 ‘must be held to less stringent standards than formal pleadings drafted by lawyers.’” Id. 22 (quoting Erickson v. Pardus, 551 U.S. 89, 94 (2007) (per curiam)). 23 If the Court determines that a pleading could be cured by the allegation of other 24 facts, a self-represented litigant is entitled to an opportunity to amend a complaint before 25 dismissal of the action. See Lopez v. Smith, 203 F.3d 1122, 1127-29 (9th Cir. 2000) (en 26 banc). The Court will dismiss Plaintiff’s Complaint for failure to state a claim, but because 27 it may possibly be amended to state a claim, the Court will dismiss it with leave to amend. 28 . . . . 1 III. Complaint 2 In his two-count Complaint, Plaintiff sues the City of Phoenix, “almost two dozen” 3 Unknown Phoenix Police Officers, Phoenix Police Lieutenant Westphal, and Unknown 4 Valley Metro Security Officers and “their corporation.” Plaintiff seeks money damages. 5 In Count One, Plaintiff alleges his Fifth, Eighth, and Fourteenth Amendment rights 6 were violated when, as he was walking out of a train, a “man dressed as a Phoenix Police 7 Officer” asked him if he had a “bus card.” Plaintiff asked if “it was a detainment,” because 8 he did not want to be late for a noon appointment. Plaintiff claims the man did not respond 9 and Plaintiff “shouted very loudly again ‘is this a detainment?’” Plaintiff states that “with 10 no response, [he] then walked [his] fully/overloaded bicycle for two steps or so” before he 11 was “blocked by security who asked [him] if [he] had a bus card.” Plaintiff started to 12 answer, “but was tackled from behind by a Phoenix Police Officer.” Plaintiff alleges he 13 suffered injuries to his left side and neck. 14 In Count Two, Plaintiff asserts violations of his First, Fourth, Fifth, Eighth, and 15 Fourteenth Amendment rights. Plaintiff claims he “went to the Elwood address to pick up 16 [his] confiscated property and was[ not] returned all of it.” Plaintiff alleges “many dozens 17 of items were not written on the document police put into [his] property at the jail.” 18 IV. Failure to State a Claim 19 Plaintiff brings his claims under 28 U.S.C. § 1331 and Bivens v. Six Unknown 20 Named Agents of Federal Bureau of Narcotics, 403 U.S. 388 (1971). “Actions under 21 § 1983 and those under Bivens are identical save for the replacement of a state actor under 22 § 1983 by a federal actor under Bivens.” Martin v. Sias, 88 F.3d 774, 775 (9th Cir. 1996) 23 (quoting Van Strum v. Lawn, 940 F.2d 406, 409 (9th Cir. 1991)). Because Plaintiff asserts 24 claims against state officials, the Court will construe his claims as raised under 42 U.S.C. 25 § 1983. 26 A. Defendant City of Phoenix 27 “A municipality may not be sued under § 1983 solely because an injury was 28 inflicted by its employees or agents.” Long v. County of Los Angeles, 442 F.3d 1178, 1185 1 (9th Cir. 2006). The actions of individuals may support municipal liability only if the 2 employees were acting pursuant to an official policy or custom of the municipality. Botello 3 v. Gammick, 413 F.3d 971, 978-79 (9th Cir. 2005). A § 1983 claim against a municipal 4 defendant “cannot succeed as a matter of law” unless a plaintiff: (1) contends that the 5 municipal defendant maintains a policy or custom pertinent to the plaintiff’s alleged injury; 6 and (2) explains how such policy or custom caused the plaintiff’s injury. Sadoski v. 7 Mosley, 435 F.3d 1076, 1080 (9th Cir. 2006) (affirming dismissal of a municipal defendant 8 pursuant to Fed. R. Civ. P. 12(b)(6)). Plaintiff has failed to allege facts to support that 9 Defendant City of Phoenix maintained a specific policy or custom that resulted in a 10 violation of Plaintiff’s federal constitutional rights and has failed to explain how his injuries 11 were caused by any municipal policy or custom. Thus, the Court will dismiss without 12 prejudice Defendant City of Phoenix. 13 B. Defendants Phoenix Police Officers 14 Plaintiff names “almost two dozen” Phoenix Police Officers as Defendants but 15 provides no factual specificity as to what any particular Defendant did or failed to do. This 16 is insufficient to state a claim. See Marcilis v. Twp. of Redford, 693 F.3d 589, 596 (6th 17 Cir. 2012) (upholding dismissal of Bivens complaint that referred to all defendants 18 “generally and categorically” because the plaintiff had failed to “‘allege, with particularity, 19 facts that demonstrate what each defendant did to violate the asserted constitutional right.’” 20 (quoting Lanman v. Hinson, 529 F.3d 673, 684 (6th Cir. 2008))); Robbins v. Oklahoma, 21 519 F.3d 1242, 1250 (10th Cir. 2008) (“Given the complaint’s use of either the collective 22 term ‘Defendants’ or a list of the defendants named individually but with no distinction as 23 to what acts are attributable to whom, it is impossible for any of these individuals to 24 ascertain what particular unconstitutional acts they are alleged to have committed.”). Thus, 25 the Court will dismiss without prejudice Defendants Phoenix Police Officers. 26 C. Defendant Westphal 27 To state a valid claim under § 1983, plaintiffs must allege that they suffered a 28 specific injury as a result of specific conduct of a defendant and show an affirmative link 1 between the injury and the conduct of that defendant. See Rizzo v. Goode, 423 U.S. 362, 2 371-72, 377 (1976). Plaintiff makes no allegations regarding Defendant Westphal and has 3 therefore failed to state a claim against this Defendant. 4 D. Defendants Valley Metro Security Officers and Corporation 5 “Like the state-action requirement of the Fourteenth Amendment, the under-color- 6 of-state-law element of § 1983 excludes from its reach ‘merely private conduct, no matter 7 how discriminatory or wrongful.’” Am. Mfrs. Mut. Ins. Co. v. Sullivan, 526 U.S. 40, 50 8 (1999) (quoting Blum v. Yaretsky, 457 U.S. 991, 1002 (1982)). “[S]tate action requires 9 both an alleged constitutional deprivation ‘caused by the exercise of some right or privilege 10 created by the State or by a rule of conduct imposed by the State or by a person for whom 11 the State is responsible,’ and that ‘the party charged with the deprivation must be a person 12 who may fairly be said to be a state actor.’” Id. (quoting Lugar v. Edmondson Oil Co., 457 13 U.S. 922, 937 (1982)). 14 Defendants Valley Metro Security Officers and “their corporation” are private 15 parties, not state actors. Moreover, although private parties who are jointly engaged with 16 state officials in the challenged action are acting under color of law, Collins v. Womancare, 17 878 F.2d 1145, 1154 (9th Cir. 1989), Plaintiff has stated nothing in his Complaint to 18 suggest that these Defendants were jointly engaged with state officials in the challenged 19 action. “[M]erely complaining to the police does not convert a private party into a state 20 actor. Nor is execution by a private party of a sworn complaint which forms the basis of 21 an arrest enough to convert the private party’s acts into state action.” Collins v. 22 Womancare, 878 F.2d 1145, 1155 (9th Cir. 1989), (internal citations omitted). Thus, the 23 Court will dismiss Defendants Valley Metro Security Officers and “their corporation.” 24 V. Leave to Amend 25 For the foregoing reasons, the Court will dismiss Plaintiff’s Complaint for failure to 26 state a claim upon which relief may be granted. Within 30 days, Plaintiff may submit a 27 first amended complaint to cure the deficiencies outlined above. The Clerk of Court will 28 mail Plaintiff a court-approved form to use for filing a first amended complaint. 1 Plaintiff must clearly designate on the face of the document that it is the “First 2 Amended Complaint.” The first amended complaint must be retyped or rewritten in its 3 entirety on the court-approved form and may not incorporate any part of the original 4 Complaint by reference. Plaintiff may include only one claim per count. 5 A first amended complaint supersedes the original Complaint. Ferdik v. Bonzelet, 6 963 F.2d 1258, 1262 (9th Cir. 1992); Hal Roach Studios v. Richard Feiner & Co., 896 F.2d 7 1542, 1546 (9th Cir. 1990). After amendment, the Court will treat the original Complaint 8 as nonexistent. Ferdik, 963 F.2d at 1262. Any cause of action that was raised in the 9 original Complaint and that was voluntarily dismissed or was dismissed without prejudice 10 is waived if it is not alleged in a first amended complaint. Lacey v. Maricopa County, 693 11 F.3d 896, 928 (9th Cir. 2012) (en banc). 12 If Plaintiff files an amended complaint, Plaintiff must write short, plain statements 13 telling the Court: (1) the constitutional right Plaintiff believes was violated; (2) the name 14 of the Defendant who violated the right; (3) exactly what that Defendant did or failed to do 15 and when; (4) how the action or inaction of that Defendant is connected to the violation of 16 Plaintiff’s constitutional right; and (5) what specific injury Plaintiff suffered because of 17 that Defendant’s conduct. See Rizzo, 423 U.S. at 371-72, 377. 18 Plaintiff must repeat this process for each person he names as a Defendant. If 19 Plaintiff fails to affirmatively link the conduct of each named Defendant with the specific 20 injury suffered by Plaintiff, the allegations against that Defendant will be dismissed for 21 failure to state a claim. Conclusory allegations that a Defendant or group of 22 Defendants has violated a constitutional right are not acceptable and will be 23 dismissed. 24 Plaintiff should note that the use of excessive force by police officers in the course 25 of an arrest can violate the arrestee’s Fourth Amendment right to be free from unreasonable 26 seizures. See White by White v. Pierce County, 797 F.2d 812, 816 (9th Cir. 1986). The 27 Fourth Amendment does not prohibit the use of reasonable force. Tatum v. City & County 28 of S.F., 441 F.3d 1090, 1095 (9th Cir. 2006). Whether the force was excessive depends on 1 “whether the officers’ actions [were] ‘objectively reasonable’ in light of the facts and 2 circumstances confronting them, without regard to their underlying intent or motivation.” 3 Graham v. Connor, 490 U.S. 386, 397 (1989); Tatum, 441 F.3d at 1095; Lolli v. County of 4 Orange, 351 F.3d 410, 415 (9th Cir. 2003). The Court must balance the nature and quality 5 of the intrusion against the countervailing governmental interests at stake. Graham, 490 6 U.S. at 396; Lolli, 351 F.3d at 415. Moreover, 7 [t]he “reasonableness” of a particular use of force must be judged from the perspective of a reasonable officer on the 8 scene, rather than with the 20/20 vision of hindsight. . . . . “Not every push or shove, even if it may later seem unnecessary in 9 the peace of a judge’s chambers,” violates the Fourth 10 Amendment. 11 Graham, 490 U.S. at 396 (citations omitted). “Whether a particular use of force was 12 ‘objectively reasonable’ depends on several factors, including the severity of the crime that 13 prompted the use of force, the threat posed by a suspect to the police or to others, and 14 whether the suspect was resisting arrest.” Tatum, 441 F.3d at 1095. 15 VI. Warnings 16 A. Address Changes 17 Plaintiff must file and serve a notice of a change of address in accordance with Rule 18 83.3(d) of the Local Rules of Civil Procedure. Plaintiff must not include a motion for other 19 relief with a notice of change of address. Failure to comply may result in dismissal of this 20 action. 21 B. Possible Dismissal 22 If Plaintiff fails to timely comply with every provision of this Order, including these 23 warnings, the Court may dismiss this action without further notice. See Ferdik, 963 F.2d 24 at 1260-61 (a district court may dismiss an action for failure to comply with any order of 25 the Court). 26 . . . . 27 . . . . 28 . . . . 1| ITIS ORDERED: 2 (1) The Clerk of Court must change Plaintiff’s name on the docket to “Michael 3| Charles Aust.” 4 (2) Plaintiff’s Application to Proceed in District Court Without Prepaying Fees or Costs (Doc. 2) is granted. Plaintiff is not required to pay the filing fee for this action. 6 (3) |The Complaint (Doc. 1) is dismissed for failure to state a claim. Plaintiff 7 | has 30 days from the date this Order is filed to file a first amended complaint in compliance 8 | with this Order. 9 (4) If Plaintiff fails to file an amended complaint within 30 days, the Clerk of 10| Court must, without further notice, enter a judgment of dismissal of this action with 11 | prejudice and deny any pending unrelated motions as moot. 12 (5) | The Clerk of Court must mail Plaintiff a court-approved form for filing a civil 13 | rights complaint by a prisoner. 14 Dated this 3rd day of April, 2025. 15 16 □ 3 17 18 _ James A. Teil Org Senior United States District Judge 19 20 21 22 23 24 25 26 27 28
Instructions for a Prisoner Filing a Civil Rights Complaint in the United States District Court for the District of Arizona
1. Who May Use This Form. The civil rights complaint form is designed to help incarcerated persons prepare a complaint seeking relief for a violation of their federal civil rights. These complaints typically concern, but are not limited to, conditions of confinement. This form should not be used to challenge your conviction or sentence. If you want to challenge a state conviction or sentence, you should file a petition under 28 U.S.C. ' 2254 for a writ of habeas corpus by a person in state custody. If you want to challenge a federal conviction or sentence, you should file a motion under 28 U.S.C. § 2255 to vacate sentence in the federal court that entered the judgment. 2. The Form. Local Rule of Civil Procedure (LRCiv) 3.4 provides that complaints by incarcerated persons must be filed on the court-approved form. The form must be typed or neatly handwritten. The form must be completely filled in to the extent applicable. All questions must be answered clearly and concisely in the appropriate space on the form. If needed, you may attach additional pages, but no more than fifteen additional pages, of standard letter-sized paper. You must identify which part of the complaint is being continued and number all pages. If you do not fill out the form properly, you will be asked to submit additional or corrected information, which may delay the processing of your action. You do not need to cite law. 3. Your Signature. You must tell the truth and sign the form. If you make a false statement of a material fact, you may be prosecuted for perjury. 4. The Filing and Administrative Fees. The total fees for this action are $405.00 ($350.00 filing fee plus $55.00 administrative fee). If you are unable to immediately pay the fees, you may request leave to proceed in forma pauperis. Please review the “Information for Prisoners Seeking Leave to Proceed with a (Non-Habeas) Civil Action in Federal Court In Forma Pauperis Pursuant to 28 U.S.C. ' 1915” for additional instructions. 5. Original and Judge=s Copy. You must send an original plus one copy of your complaint and of any other documents submitted to the Court. You must send one additional copy to the Court if you wish to have a file-stamped copy of the document returned to you. All copies must be identical to the original. Copies may be legibly handwritten. This section does not apply to inmates housed at an Arizona Department of Corrections facility that participates in electronic filing. 6. Where to File. You should file your complaint in the division where you were confined when your rights were allegedly violated. See LRCiv 5.1(a) and 77.1(a). If you were confined in Maricopa, Pinal, Yuma, La Paz, or Gila County, file in the Phoenix Division. If you were confined in Apache, Navajo, Coconino, Mohave, or Yavapai County, file in the Prescott Division. If you were confined in Pima, Cochise, Santa Cruz, Graham, or Greenlee County, file in the Tucson Division. Unless you are an inmate housed at an Arizona Department of Corrections facility that participates in electronic filing, mail the original and one copy of the complaint with the $405 filing and administrative fees or the application to proceed in forma pauperis to:
1 Revised 11/6/24 Phoenix & Prescott Divisions: OR Tucson Division: U.S. District Court Clerk U.S. District Court Clerk U.S. Courthouse, Suite 130 U.S. Courthouse, Suite 1500 401 West Washington Street, SPC 10 405 West Congress Street Phoenix, Arizona 85003-2119 Tucson, Arizona 85701-5010
7. Change of Address. You must immediately notify the Court and the defendants in writing of any change in your mailing address. Failure to notify the Court of any change in your mailing address may result in the dismissal of your case.
8. Certificate of Service. You must furnish the defendants with a copy of any document you submit to the Court (except the initial complaint and application to proceed in forma pauperis). Each original document (except the initial complaint and application to proceed in forma pauperis) must include a certificate of service on the last page of the document stating the date a copy of the document was mailed to the defendants and the address to which it was mailed. See Fed. R. Civ. P. 5(a), (d). Any document received by the Court that does not include a certificate of service may be stricken. This section does not apply to inmates housed at an Arizona Department of Corrections facility that participates in electronic filing. A certificate of service should be in the following form:
I hereby certify that a copy of the foregoing document was mailed this (month, day, year) to: Name: Address: Attorney for Defendant(s)
(Signature)
9. Amended Complaint. If you need to change any of the information in the initial complaint, you must file an amended complaint. The amended complaint must be written on the court- approved civil rights complaint form. You may file one amended complaint without leave (permission) of Court within 21 days after serving it or within 21 days after any defendant has filed an answer, whichever is earlier. See Fed. R. Civ. P. 15(a). Thereafter, you must file a motion for leave to amend and lodge (submit) a proposed amended complaint. LRCiv 15.1. In addition, an amended complaint may not incorporate by reference any part of your prior complaint. LRCiv 15.1(a)(2). Any allegations or defendants not included in the amended complaint are considered dismissed. All amended complaints are subject to screening under the Prison Litigation Reform Act; screening your amendment will take additional processing time.
10. Exhibits. You should not submit exhibits with the complaint or amended complaint. Instead, the relevant information should be paraphrased. You should keep the exhibits to use to support or oppose a motion to dismiss, a motion for summary judgment, or at trial.
11. Letters and Motions. It is generally inappropriate to write a letter to any judge or the staff of any judge. The only appropriate way to communicate with the Court is by filing a written pleading or motion.
2 12. Completing the Civil Rights Complaint Form.
HEADING: 1. Your Name. Print your name, prison or inmate number, and institutional mailing address on the lines provided.
2. Defendants. If there are four or fewer defendants, print the name of each. If you name more than four defendants, print the name of the first defendant on the first line, write the words “and others” on the second line, and attach an additional page listing the names of all of the defendants. Insert the additional page after page 1 and number it “1- A” at the bottom.
3. Jury Demand. If you want a jury trial, you must write “JURY TRIAL DEMANDED” in the space below “CIVIL RIGHTS COMPLAINT BY A PRISONER.” Failure to do so may result in the loss of the right to a jury trial. A jury trial is not available if you are seeking only injunctive relief.
Part A. JURISDICTION: 1. Nature of Suit. Mark whether you are filing the complaint pursuant to 42 U.S.C. ' 1983 for state, county, or city defendants; “Bivens v. Six Unknown Federal Narcotics Agents” for federal defendants; or “other.” If you mark “other,” identify the source of that authority.
2. Location. Identify the institution and city where the alleged violation of your rights occurred.
3. Defendants. Print all of the requested information about each of the defendants in the spaces provided. If you are naming more than four defendants, you must provide the necessary information about each additional defendant on separate pages labeled “2-A,” “2-B,” etc., at the bottom. Insert the additional page(s) immediately behind page 2.
Part B. PREVIOUS LAWSUITS: You must identify any other lawsuit you have filed in either state or federal court while you were a prisoner. Print all of the requested information about each lawsuit in the spaces provided. If you have filed more than three lawsuits, you must provide the necessary information about each additional lawsuit on a separate page. Label the page(s) as “2-A,” “2-B,” etc., at the bottom of the page and insert the additional page(s) immediately behind page 2.
Part C. CAUSE OF ACTION: You must identify what rights each defendant violated. The form provides space to allege three separate counts (one violation per count). If you are alleging more than three counts, you must provide the necessary information about each additional count on a separate page. Number the additional pages “5-A,” “5-B,” etc., and insert them immediately behind page 5. Remember that you are limited to a total of fifteen additional pages.
3 1. Counts. You must identify which civil right was violated. You may allege the violation of only one civil right per count.
2. Issue Involved. Check the box that most closely identifies the issue involved in your claim. You may check only one box per count. If you check the box marked “Other,” you must identify the specific issue involved.
3. Supporting Facts. After you have identified which civil right was violated, you must state the supporting facts. Be as specific as possible. You must state what each individual defendant did to violate your rights. If there is more than one defendant, you must identify which defendant did what act. You also should state the date(s) on which the act(s) occurred, if possible.
4. Injury. State precisely how you were injured by the alleged violation of your rights.
5. Administrative Remedies. You must exhaust any available administrative remedies before you file a civil rights complaint. See 42 U.S.C. § 1997e. Consequently, you should disclose whether you have exhausted the inmate grievance procedures or administrative appeals for each count in your complaint. If the grievance procedures were not available for any of your counts, fully explain why on the lines provided.
Part D. REQUEST FOR RELIEF: Print the relief you are seeking in the space provided.
SIGNATURE: You must sign your name and print the date you signed the complaint. Failure to sign the complaint will delay the processing of your action. Unless you are an attorney, you may not bring an action on behalf of anyone but yourself.
FINAL NOTE
You should follow these instructions carefully. Failure to do so may result in your complaint being stricken or dismissed. All questions must be answered concisely in the proper space on the form. If you need more space, you may attach no more than fifteen additional pages. But the form must be completely filled in to the extent applicable. If you attach additional pages, be sure to identify which section of the complaint is being continued and number the pages.
4 ___________________________________________ Name and Prisoner/Booking Number ___________________________________________ Place of Confinement ___________________________________________ Mailing Address ___________________________________________ City, State, Zip Code (Failure to notify the Court of your change of address may result in dismissal of this action.)
IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF ARIZONA
_________________________________________ , (Full Name of Plaintiff)
Plaintiff, v. CASE NO. __________________________________ (To be supplied by the Clerk) (1) _______________________________________ , (Full Name of Defendant) CIVIL RIGHTS COMPLAINT (2) _______________________________________ , BY A PRISONER
(3) _______________________________________ , G Original Complaint (4) _______________________________________ , G First Amended Complaint G Second Amended Complaint Defendant(s).
G Check if there are additional Defendants and attach page 1-A listing them.
A. JURISDICTION
1. This Court has jurisdiction over this action pursuant to: G 28 U.S.C. § 1343(a); 42 U.S.C. § 1983 G 28 U.S.C. § 1331; Bivens v. Six Unknown Federal Narcotics Agents, 403 U.S. 388 (1971). G Other: .
2. Institution/city where violation occurred: .
550/555 B. DEFENDANTS
1. Name of first Defendant: . The first Defendant is employed as: ______________________________________________ at_______________________________________. (Position and Title) (Institution)
2. Name of second Defendant: . The second Defendant is employed as: as: ______________________________________________ at_______________________________________. (Position and Title) (Institution)
3. Name of third Defendant: . The third Defendant is employed as: ______________________________________________ at_______________________________________. (Position and Title) (Institution)
4. Name of fourth Defendant: . The fourth Defendant is employed as: ______________________________________________ at_______________________________________. (Position and Title) (Institution)
If you name more than four Defendants, answer the questions listed above for each additional Defendant on a separate page.
C. PREVIOUS LAWSUITS
1. Have you filed any other lawsuits while you were a prisoner? G Yes G No
2. If yes, how many lawsuits have you filed? . Describe the previous lawsuits:
a. First prior lawsuit: 1. Parties: v. 2. Court and case number: . 3. Result: (Was the case dismissed? Was it appealed? Is it still pending?) .
b. Second prior lawsuit: 1. Parties: v. 2. Court and case number: . 3. Result: (Was the case dismissed? Was it appealed? Is it still pending?) .
c. Third prior lawsuit: 1. Parties: v. 2. Court and case number: . 3. Result: (Was the case dismissed? Was it appealed? Is it still pending?) .
If you filed more than three lawsuits, answer the questions listed above for each additional lawsuit on a separate page. D. CAUSE OF ACTION
COUNT I 1. State the constitutional or other federal civil right that was violated: .
2. Count I. Identify the issue involved. Check only one. State additional issues in separate counts. G Basic necessities G Mail G Access to the court G Medical care G Disciplinary proceedings G Property G Exercise of religion G Retaliation G Excessive force by an officer G Threat to safety G Other: .
3. Supporting Facts. State as briefly as possible the FACTS supporting Count I. Describe exactly what each Defendant did or did not do that violated your rights. State the facts clearly in your own words without citing legal authority or arguments.
.
4. Injury. State how you were injured by the actions or inactions of the Defendant(s).
5. Administrative Remedies: a. Are there any administrative remedies (grievance procedures or administrative appeals) available at your institution? G Yes G No b. Did you submit a request for administrative relief on Count I? G Yes G No c. Did you appeal your request for relief on Count I to the highest level? G Yes G No d. If you did not submit or appeal a request for administrative relief at any level, briefly explain why you did not. .
3 COUNT II 1. State the constitutional or other federal civil right that was violated: .
2. Count II. Identify the issue involved. Check only one. State additional issues in separate counts. G Basic necessities G Mail G Access to the court G Medical care G Disciplinary proceedings G Property G Exercise of religion G Retaliation G Excessive force by an officer G Threat to safety G Other: .
3. Supporting Facts. State as briefly as possible the FACTS supporting Count II. Describe exactly what each Defendant did or did not do that violated your rights. State the facts clearly in your own words without citing legal authority or arguments.
4. Injury. State how you were injured by the actions or inactions of the Defendant(s).
5. Administrative Remedies. a. Are there any administrative remedies (grievance procedures or administrative appeals) available at your institution? G Yes G No b. Did you submit a request for administrative relief on Count II? G Yes G No c. Did you appeal your request for relief on Count II to the highest level? G Yes G No d. If you did not submit or appeal a request for administrative relief at any level, briefly explain why you did not. .
4 COUNT III 1. State the constitutional or other federal civil right that was violated: .
2. Count III. Identify the issue involved. Check only one. State additional issues in separate counts. G Basic necessities G Mail G Access to the court G Medical care G Disciplinary proceedings G Property G Exercise of religion G Retaliation G Excessive force by an officer G Threat to safety G Other: .
3. Supporting Facts. State as briefly as possible the FACTS supporting Count III. Describe exactly what each Defendant did or did not do that violated your rights. State the facts clearly in your own words without citing legal authority or arguments.
4. Injury. State how you were injured by the actions or inactions of the Defendant(s).
5. Administrative Remedies. a. Are there any administrative remedies (grievance procedures or administrative appeals) available at your institution? G Yes G No b. Did you submit a request for administrative relief on Count III? G Yes G No c. Did you appeal your request for relief on Count III to the highest level? G Yes G No d. If you did not submit or appeal a request for administrative relief at any level, briefly explain why you did not. .
If you assert more than three Counts, answer the questions listed above for each additional Count on a separate page.
5 E. REQUEST FOR RELIEF
State the relief you are seeking:
I declare under penalty of perjury that the foregoing is true and correct.
Executed on DATE SIGNATURE OF PLAINTIFF
___________________________________________ (Name and title of paralegal, legal assistant, or other person who helped prepare this complaint)
___________________________________________ (Signature of attorney, if any)
___________________________________________ (Attorney=s address & telephone number)
ADDITIONAL PAGES
All questions must be answered concisely in the proper space on the form. If you need more space, you may attach no more than fifteen additional pages. But the form must be completely filled in to the extent applicable. If you attach additional pages, be sure to identify which section of the complaint is being continued and number all pages.