1 MDR 2 WO 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 8 9 Johann Alexander Bass, No. CV-24-02380-PHX-JAT (JFM) 10 Plaintiff, 11 v. ORDER 12 Arizona Motor Vehicle Division, et al., 13 Defendants.
15 Self-represented Plaintiff Johann Alexander Bass, who is confined in the Greene 16 Correctional Facility in Coxsackie, New York, filed a civil rights Complaint pursuant to 17 42 U.S.C. § 1983 (Doc. 1) and a Motion for Limited Discovery Order to Identify John Doe 18 Defendants. He subsequently filed an Application to Proceed In District Court Without 19 Prepaying Fees or Costs (Doc. 5) and an Amended Motion for Limited Discovery Order to 20 Identify John Doe Defendants (Doc. 7). The Court will grant the Application to Proceed, 21 dismiss the Complaint with leave to amend, and deny without prejudice the Amended 22 Motion. 23 I. Application to Proceed and Filing Fee 24 The Court will grant Plaintiff’s Application to Proceed. 28 U.S.C. § 1915(a). 25 Plaintiff must pay the statutory filing fee of $350.00. 28 U.S.C. § 1915(b)(1). The Court 26 will assess an initial partial filing fee of $9.20. The remainder of the fee will be collected 27 monthly in payments of 20% of the previous month’s income credited to Plaintiff’s trust 28 account each time the amount in the account exceeds $10.00. 28 U.S.C. § 1915(b)(2). The 1 Court will enter a separate Order requiring the appropriate government agency to collect 2 and forward the fees according to the statutory formula. 3 II. Statutory Screening of Prisoner Complaints 4 The Court is required to screen complaints brought by prisoners seeking relief 5 against a governmental entity or an officer or an employee of a governmental entity. 28 6 U.S.C. § 1915A(a). The Court must dismiss a complaint or portion thereof if a plaintiff 7 has raised claims that are legally frivolous or malicious, fail to state a claim upon which 8 relief may be granted, or seek monetary relief from a defendant who is immune from such 9 relief. 28 U.S.C. § 1915A(b)(1)–(2). 10 A pleading must contain a “short and plain statement of the claim showing that the 11 pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2) (emphasis added). While Rule 8 does 12 not demand detailed factual allegations, “it demands more than an unadorned, the- 13 defendant-unlawfully-harmed-me accusation.” Ashcroft v. Iqbal, 556 U.S. 662, 678 14 (2009). “Threadbare recitals of the elements of a cause of action, supported by mere 15 conclusory statements, do not suffice.” Id. 16 “[A] complaint must contain sufficient factual matter, accepted as true, to ‘state a 17 claim to relief that is plausible on its face.’” Id. (quoting Bell Atlantic Corp. v. Twombly, 18 550 U.S. 544, 570 (2007)). A claim is plausible “when the plaintiff pleads factual content 19 that allows the court to draw the reasonable inference that the defendant is liable for the 20 misconduct alleged.” Id. “Determining whether a complaint states a plausible claim for 21 relief [is] . . . a context-specific task that requires the reviewing court to draw on its judicial 22 experience and common sense.” Id. at 679. Thus, although a plaintiff’s specific factual 23 allegations may be consistent with a constitutional claim, a court must assess whether there 24 are other “more likely explanations” for a defendant’s conduct. Id. at 681. 25 But as the United States Court of Appeals for the Ninth Circuit has instructed, courts 26 must “continue to construe [self-represented litigant’s] filings liberally.” Hebbe v. Pliler, 27 627 F.3d 338, 342 (9th Cir. 2010). A “complaint [filed by a self-represented prisoner] 28 1 ‘must be held to less stringent standards than formal pleadings drafted by lawyers.’” Id. 2 (quoting Erickson v. Pardus, 551 U.S. 89, 94 (2007) (per curiam)). 3 If the Court determines that a pleading could be cured by the allegation of other 4 facts, a self-represented litigant is entitled to an opportunity to amend a complaint before 5 dismissal of the action. See Lopez v. Smith, 203 F.3d 1122, 1127-29 (9th Cir. 2000) (en 6 banc). The Court will dismiss Plaintiff’s Complaint for failure to state a claim, with leave 7 to amend because it may possibly be amended to state a claim. 8 III. Complaint 9 In his Complaint,1 Plaintiff names as Defendants the Arizona Motor Vehicle 10 Division (AMVD) and four John Doe employees of the AMVD in their individual and 11 official capacities. Plaintiff makes the following allegations. 12 After being stopped by the South Dakota Department of Public Safety while driving 13 a semi-truck in May 2021, Plaintiff pleaded guilty to ingestion of a controlled substance 14 and was sentenced to probation. He was told the conviction would not affect his 15 Commercial Driver’s License (CDL), the state court “did not make any kind of order 16 affecting Plaintiff’s CDL,” and the conviction “does not constitute committing a felony in 17 a Commercial Motor Vehicle” under South Dakota law. However, Plaintiff subsequently 18 received a letter from the South Dakota Department of Public Safety stating that his CDL 19 “had been withdrawn for committing a felony in a commercial motor vehicle.” 20 Plaintiff attempted to get an administrative hearing in South Dakota, but he did not 21 receive one. He contacted Defendant AMVD and requested a hearing but was told that 22 “because the situation happened in South Dakota, [Defendant] AMVD could not help him.” 23 He claims Arizona law requires notice and an opportunity to be heard, but he “never 24 received any kind of notice” from Defendant AMVD and was not given a hearing, even 25 though he timely requested one.2
26 1 Plaintiff’s Complaint contains minor misspellings and misplaced or omitted 27 punctuation. The Court, when quoting the Complaint, has corrected these without specifically noting them. 28 2 Plaintiff claims he received a document from Defendant AMVD “with a caption 1 After filing a 2023 civil rights lawsuit in the United States District Court for the 2 Central District of South Dakota, Plaintiff wrote letters to Defendant AMVD “requesting 3 records pertaining to the disqualification/withdrawal of his CDL.” He never received the 4 documents because, according to Plaintiff, Defendant AMVD “has a policy of not 5 providing records to those in custody until they are within 90 days of their release.” A 6 judge in the Central District of South Dakota denied Plaintiff’s motion to subpoena those 7 records, but Plaintiff obtained, through family members, his “driver records” from 8 Defendant AMVD. The records “contained the South Dakota court case number but had 9 Arizona Revised Statutes in the violation information.” 10 In July 2024, Plaintiff wrote to Defendant AMVD and the Arizona Attorney 11 General’s Office, requesting “the incorrectly reported violation be removed from his 12 records because he did not violate any laws in either state that required his CDL to be 13 withdrawn or disqualified." The Arizona Attorney General’s Office recommended 14 Plaintiff “submit the Complaint to the South Dakota [Department of Public Safety].” 15 According to Plaintiff, his drivers license record lists two Arizona statutes in the 16 “Violation information.” He claims, however, that his South Dakota conviction does not 17 meet the criteria in these statutes “for taking away his CDL” in either Arizona or South 18 Dakota. 19 Plaintiff contends Defendants John Does 1-4 violated his due process rights “by 20 entering a decision to withdraw suspend, revoke, or disqualify his CDL,” without sufficient 21 evidence, without comparing the out-of-state information to Arizona law, and without 22 providing notice and an opportunity to be heard. He also invokes the Court’s supplemental 23 jurisdiction and contends Defendants John Does 1-4 breached their duty to obtain sufficient 24 information, compare the out-of-state information to Arizona law, and provide notice and 25 an opportunity to be heard. 26 . . . . 27 . . . .
28 indicating the [a]dministrative procedures were dismissed due to the incident having occurred in South Dakota.” 1 Plaintiff seeks monetary damages, an order directing Defendants to remove the 2 violation from Plaintiff’s driver records held by Defendant AMVD, and his filing fees, 3 attorney’s fees, and court costs. 4 IV. Failure to State a Claim 5 Although self-represented pleadings are liberally construed, Haines v. Kerner, 404 6 U.S. 519, 520-21 (1972), conclusory and vague allegations will not support a cause of 7 action. Ivey v. Bd. of Regents, 673 F.2d 266, 268 (9th Cir. 1982). Further, a liberal 8 interpretation of a civil rights complaint may not supply essential elements of the claim 9 that were not initially pled. Id. 10 A. Defendant AMVD 11 The Arizona Motor Vehicle Division is not a proper Defendant. Under the Eleventh 12 Amendment to the Constitution of the United States, a state or state agency may not be 13 sued in federal court without its consent. Pennhurst State Sch. & Hosp. v. Halderman, 465 14 U.S. 89, 100 (1984); Taylor v. List, 880 F.2d 1040, 1045 (9th Cir. 1989). Furthermore, “a 15 state is not a ‘person’ for purposes of section 1983. Likewise ‘arms of the State’ . . . are 16 not ‘persons’ under section 1983.” Gilbreath v. Cutter Biological, Inc., 931 F.2d 1320, 17 1327 (9th Cir. 1991) (citation omitted). Therefore, the Court will dismiss Defendant 18 Arizona Motor Vehicle Division. 19 B. Defendants Does 1-4 20 Plaintiff has simply made vague and conclusory allegations against a group of 21 Defendants, without any factual specificity as to what any particular Defendant did or 22 failed to do. This is insufficient. See Marcilis v. Twp. of Redford, 693 F.3d 589, 596 (6th 23 Cir. 2012) (upholding dismissal of complaint that referred to all defendants “generally and 24 categorically” because the plaintiff had failed to “‘allege, with particularity, facts that 25 demonstrate what each defendant did to violate the asserted constitutional right.’” (quoting 26 Lanman v. Hinson, 529 F.3d 673, 684 (6th Cir. 2008))); Robbins v. Oklahoma, 519 F.3d 27 1242, 1250 (10th Cir. 2008) (“Given the complaint’s use of either the collective term 28 ‘Defendants’ or a list of the defendants named individually but with no distinction as to 1 what acts are attributable to whom, it is impossible for any of these individuals to ascertain 2 what particular unconstitutional acts they are alleged to have committed.”). Thus, the 3 Court will dismiss without prejudice Defendants Does 1-4. 4 C. Supplemental Jurisdiction 5 The Court will not exercise supplemental jurisdiction under 28 U.S.C. § 1367 over 6 Plaintiff’s state-law claim because Plaintiff’s federal claims have been dismissed. See Ove 7 v. Gwinn, 264 F.3d 817, 826 (9th Cir. 2001) (“A court may decline to exercise supplemental 8 jurisdiction over related state-law claims once it has ‘dismissed all claims over which it has 9 original jurisdiction.’” (quoting 28 U.S.C. § 1367(c)(3))); Gini v. Las Vegas Metro. Police 10 Dep’t, 40 F.3d 1041, 1046 (9th Cir. 1994) (when federal law claims are eliminated before 11 trial, the court generally should decline jurisdiction over state law claims and dismiss them 12 without prejudice). Thus, the Court will dismiss without prejudice Plaintiff’s state-law 13 claim. 14 V. Leave to Amend 15 For the foregoing reasons, the Court will dismiss Plaintiff’s Complaint for failure to 16 state a claim upon which relief may be granted. Within 30 days, Plaintiff may submit a 17 first amended complaint to cure the deficiencies outlined above. The Clerk of Court will 18 mail Plaintiff a court-approved form to use for filing a first amended complaint. If Plaintiff 19 fails to use the court-approved form, the Court may strike the amended complaint and 20 dismiss this action without further notice to Plaintiff. 21 Plaintiff must clearly designate on the face of the document that it is the “First 22 Amended Complaint.” The first amended complaint must be retyped or rewritten in its 23 entirety on the court-approved form and may not incorporate any part of the original 24 Complaint by reference. Plaintiff may include only one claim per count. 25 A first amended complaint supersedes the original Complaint. Ferdik v. Bonzelet, 26 963 F.2d 1258, 1262 (9th Cir. 1992); Hal Roach Studios v. Richard Feiner & Co., 896 F.2d 27 1542, 1546 (9th Cir. 1990). After amendment, the Court will treat the original Complaint 28 as nonexistent. Ferdik, 963 F.2d at 1262. Any cause of action that was raised in the 1 original Complaint and that was voluntarily dismissed or was dismissed without prejudice 2 is waived if it is not alleged in a first amended complaint. Lacey v. Maricopa County, 693 3 F.3d 896, 928 (9th Cir. 2012) (en banc). 4 If Plaintiff files an amended complaint, Plaintiff must write short, plain statements 5 telling the Court: (1) the constitutional right Plaintiff believes was violated; (2) the name 6 of the Defendant who violated the right; (3) exactly what that Defendant did or failed to 7 do; (4) how the action or inaction of that Defendant is connected to the violation of 8 Plaintiff’s constitutional right; and (5) what specific injury Plaintiff suffered because of 9 that Defendant’s conduct. See Rizzo v. Goode, 423 U.S. 362, 371-72, 377 (1976). 10 Plaintiff must repeat this process for each person he names as a Defendant. If 11 Plaintiff fails to affirmatively link the conduct of each named Defendant with the specific 12 injury suffered by Plaintiff, the allegations against that Defendant will be dismissed for 13 failure to state a claim. Conclusory allegations that a Defendant or group of 14 Defendants has violated a constitutional right are not acceptable and will be 15 dismissed. 16 If Plaintiff does not know the names of individual Defendants, he must list the 17 individual unknown Defendants as Defendant John (or Jane) Doe 1, John Doe 2, and so on 18 in the caption of his amended complaint. In the body of the amended complaint, Plaintiff 19 must allege facts to support how each particular Doe Defendant violated Plaintiff’s rights. 20 It is insufficient to simply list a category of Defendants (such as “John Does 1-4”) and 21 make conclusory allegations against them as a group. 22 VI. Amended Motion for Limited Discovery Order 23 In his Amended Motion for Limited Discovery Order to Identify John Doe 24 Defendants, Plaintiff requests the Court order the Arizona Attorney General’s Office to 25 identify the John Doe employees who “entered the violation and withdrew Plaintiff’s 26 CDL,” “were required to provide notice and opportunity to be heard,” and “were required 27 to compare the South Dakota conviction with Arizona’s laws as required under Arizona 28 law before taking enforcement action against the Plaintiff.” 1 The Court, in its discretion, will not permit discovery at this juncture. If Plaintiff 2 files an amended complaint, the Court will screen it pursuant to 28 U.S.C. § 1915A. If the 3 Court determines an answer is required against a particular Doe Defendant, the Court 4 will give Plaintiff an opportunity through discovery to identify that particular unknown 5 defendant. Thus, the Court will deny as premature Plaintiff’s Amended Motion. 6 VII. Warnings 7 A. Release 8 If Plaintiff is released while this case remains pending, and the filing fee has not 9 been paid in full, Plaintiff must, within 30 days of his release, either (1) notify the Court 10 that he intends to pay the unpaid balance of his filing fee within 120 days of his release or 11 (2) file a non-prisoner application to proceed in forma pauperis. Failure to comply may 12 result in dismissal of this action. 13 B. Address Changes 14 Plaintiff must file and serve a notice of a change of address in accordance with Rule 15 83.3(d) of the Local Rules of Civil Procedure. Plaintiff must not include a motion for other 16 relief with a notice of change of address. Failure to comply may result in dismissal of this 17 action. 18 C. Possible “Strike” 19 Because the Complaint has been dismissed for failure to state a claim, if Plaintiff 20 fails to file an amended complaint correcting the deficiencies identified in this Order, the 21 dismissal may count as a “strike” under the “3-strikes” provision of 28 U.S.C. § 1915(g). 22 Under the 3-strikes provision, a prisoner may not bring a civil action or appeal a civil 23 judgment in forma pauperis under 28 U.S.C. § 1915 “if the prisoner has, on 3 or more prior 24 occasions, while incarcerated or detained in any facility, brought an action or appeal in a 25 court of the United States that was dismissed on the grounds that it is frivolous, malicious, 26 or fails to state a claim upon which relief may be granted, unless the prisoner is under 27 imminent danger of serious physical injury.” 28 U.S.C. § 1915(g). 28 . . . . 1 D. Possible Dismissal 2 If Plaintiff fails to ttmely comply with every provision of this Order, including these 3) warnings, the Court may dismiss this action without further notice. See Ferdik, 963 F.2d 4) at 1260-61 (a district court may dismiss an action for failure to comply with any order of 5 | the Court). 6| ORDERED: 7 (1) Plaintiff's Application to Proceed In District Court Without Prepaying Fees 8 | or Costs (Doc. 5) is granted. 9 (2) As required by the accompanying Order to the appropriate government agency, Plaintiff must pay the $350.00 filing fee and is assessed an initial partial filing fee 11] of $9.20. 12 (3) |The Complaint (Doc. 1) is dismissed for failure to state a claim. Plaintiff 13 | has 30 days from the date this Order is filed to file a first amended complaint in compliance with this Order. 15 (4) — If Plaintiff fails to file an amended complaint within 30 days, the Clerk of Court must, without further notice, enter a judgment of dismissal of this action with 17 | prejudice that states that the dismissal may count as a “strike” under 28 U.S.C. § 1915(g) 18 | and deny any pending unrelated motions as moot. 19 (5) Plaintiff’s Amended Motion for Limited Discovery Order to Identify John 20 | Doe Defendants (Doc. 7) is denied as premature. 21 (6) The Clerk of Court must mail Plaintiffa court-approved form for filing a civil 22 | rights complaint by a prisoner. 23 Dated this 29th day of January, 2025. 24 25 A 26 7 _ James A. Teil Org Senior United States District Judge 28
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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.