1 WO MDR 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 8 9 Alfred E. Caraffa, No. CV 19-05492-PHX-MTL (ESW) 10 Plaintiff, 11 v. ORDER 12 Tempe (AZ) Police Department, et al., 13 Defendants.
14 15 On October 24, 2019, Plaintiff Alfred E. Caraffa filed a pro se civil rights Complaint 16 pursuant to 42 U.S.C. § 1983 (Doc. 1) and an Application to Proceed In District Court 17 Without Prepaying Fees or Costs (Doc. 2). The Court will grant the Application to Proceed 18 and will dismiss the Complaint with leave to amend. 19 I. Application to Proceed and Filing Fee 20 The Court, in its discretion, will grant the Application to Proceed. Plaintiff will be 21 allowed to proceed without paying the filing fee. See 28 U.S.C. § 1915(a)(1). 22 II. Statutory Screening of In Forma Pauperis Complaints 23 Pursuant to 28 U.S.C. § 1915(e)(2), in a case in which a plaintiff has been granted 24 in forma pauperis status, the Court shall dismiss the case “if the court determines that . . . 25 (B) the action . . . (i) is frivolous or malicious; (ii) fails to state a claim on which relief may 26 be granted; or (iii) seeks monetary relief against a defendant who is immune from such 27 relief.” 28 . . . . 1 A pleading must contain a “short and plain statement of the claim showing that the 2 pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2) (emphasis added). While Rule 8 does 3 not demand detailed factual allegations, “it demands more than an unadorned, the- 4 defendant-unlawfully-harmed-me accusation.” Ashcroft v. Iqbal, 556 U.S. 662, 678 5 (2009). “Threadbare recitals of the elements of a cause of action, supported by mere 6 conclusory statements, do not suffice.” Id. 7 “[A] complaint must contain sufficient factual matter, accepted as true, to ‘state a 8 claim to relief that is plausible on its face.’” Id. (quoting Bell Atlantic Corp. v. Twombly, 9 550 U.S. 544, 570 (2007)). A claim is plausible “when the plaintiff pleads factual content 10 that allows the court to draw the reasonable inference that the defendant is liable for the 11 misconduct alleged.” Id. “Determining whether a complaint states a plausible claim for 12 relief [is] . . . a context-specific task that requires the reviewing court to draw on its judicial 13 experience and common sense.” Id. at 679. Thus, although a plaintiff’s specific factual 14 allegations may be consistent with a constitutional claim, a court must assess whether there 15 are other “more likely explanations” for a defendant’s conduct. Id. at 681. 16 But as the United States Court of Appeals for the Ninth Circuit has instructed, courts 17 must “continue to construe pro se filings liberally.” Hebbe v. Pliler, 627 F.3d 338, 342 18 (9th Cir. 2010). A “complaint [filed by a pro se individual] ‘must be held to less stringent 19 standards than formal pleadings drafted by lawyers.’” Id. (quoting Erickson v. Pardus, 551 20 U.S. 89, 94 (2007) (per curiam)). 21 If the Court determines that a pleading could be cured by the allegation of other 22 facts, a pro se litigant is entitled to an opportunity to amend a complaint before dismissal 23 of the action. See Lopez v. Smith, 203 F.3d 1122, 1127-29 (9th Cir. 2000) (en banc). 24 Plaintiff’s Complaint will be dismissed for failure to state a claim, but because it may 25 possibly be amended to state a claim, the Court will dismiss it with leave to amend. 26 III. Complaint 27 In his Complaint, Plaintiff seeks monetary damages from Defendants Tempe Police 28 Department and Tempe Police Officer Guajardo. Plaintiff alleges a violation of “Due 1 Process, False Arrest, False I[m]prisonment, Unlawful Confinement, Cruel and Unusual 2 Punishment.” He claims that while he was looking in the window of a restaurant “and 3 playing with an I.D. in the refle[c]tion,” Defendant Guajardo came up behind Plaintiff, 4 grabbed his wrist, restrained his arm, and, without stating that he was a police officer, told 5 Plaintiff he was being detained for disorderly conduct. Plaintiff alleges he was arrested for 6 “disorderly conduct-fighting,” in violation of Arizona Revised Statutes section 13- 7 2904(A)(1), and was jailed for two-and-a-half days. He claims the charge of “disorderly 8 conduct-fighting” is a “total falsehood of the truth and a miscarriage of justice.” 9 IV. Failure to State a Claim 10 A. Defendant Tempe Police Department 11 Defendant Tempe Police Department is a subpart of the City of Tempe, not a 12 separate entity for purposes of suit. Gotbaum v. City of Phoenix, 617 F. Supp. 2d 878, 886 13 (D. Ariz. 2008); see Braillard, 232 P.3d at 1269 (county sheriff’s office is a nonjural 14 entity); see also Vincente v. City of Prescott, 2012 WL 1438695 (D. Ariz. 2012) (city fire 15 department is a nonjural entity); Wilson v. Yavapai Cnty., 2012 WL 1067959 (D. Ariz. 16 2012) (county sheriff’s office and county attorney’s office are nonjural entities). Because 17 Defendant Tempe Police Department is not a separate entity, it is not capable of being 18 separately sued. Thus, the Court will dismiss Defendant Tempe Police Department. 19 B. Defendant Guajardo 20 Although pro se pleadings are liberally construed, Haines v. Kerner, 404 U.S. 519, 21 520-21 (1972), conclusory and vague allegations will not support a cause of action. Ivey 22 v. Bd. of Regents of the Univ. of Alaska, 673 F.2d 266, 268 (9th Cir. 1982). Further, a 23 liberal interpretation of a civil rights complaint may not supply essential elements of the 24 claim that were not initially pled. Id. 25 To state a valid claim under § 1983, plaintiffs must allege that they suffered a 26 specific injury as a result of specific conduct of a defendant and show an affirmative link 27 between the injury and the conduct of that defendant. See Rizzo v. Goode, 423 U.S. 362, 28 371-72, 377 (1976). “[A] plaintiff must plead that each Government-official defendant, 1 through the official’s own individual actions, has violated the Constitution.” Iqbal, 556 2 U.S. at 676. “A plaintiff must allege facts, not simply conclusions, that show that an 3 individual was personally involved in the deprivation of his civil rights.” Barren v. 4 Harrington, 152 F.3d 1193, 1194 (9th Cir. 1998). 5 “False arrest, a species of false imprisonment, is the detention of a person without 6 his consent and without lawful authority.” Donahoe v. Arpaio, 869 F. Supp. 2d 1020, 1064 7 (D. Ariz. 2012) (quoting Reams v. City of Tucson, 701 P.2d 598, 601 (Ariz. Ct. App. 1985)), 8 aff’d sub nom. Stapley v. Pestalozzi, 733 F.3d 804 (9th Cir. 2013). Under Arizona law, 9 false imprisonment and false arrest consist of non-consensual detention of a person 10 “without lawful authority.” Slade v. City of Phoenix, 541 P.2d 550, 552 (Ariz. 1975). 11 “Reflective of the fact that false imprisonment consists of detention without legal process, 12 a false imprisonment ends once the victim becomes held pursuant to such process— when, 13 for example, he is bound over by a magistrate or arraigned on charges.” Wallace v. Kato, 14 549 U.S. 384, 389 (2007) (emphasis in original). 15 “[A] claim for false arrest turns only on whether probable cause existed to arrest a 16 defendant, and . . . it is not relevant whether probable cause existed with respect to each 17 individual charge, or, indeed, any charge actually invoked by the arresting officer at the 18 time of arrest.” Jaegly v. Couch, 439 F.3d 149, 154 (2d Cir. 2006); see also Price v. Roark, 19 256 F.3d 364, 369 (5th Cir. 2001) (“Claims for false arrest focus on the validity of the 20 arrest, not on the validity of each individual charge made during the course of the arrest.”). 21 “Thus . . . ‘[i]f there was probable cause for any of the charges made . . . then the arrest 22 was supported by probable cause, and the claim for false arrest fails.’” Price, 256 F.3d at 23 369 (quoting Wells v. Bonner, 45 F.3d 90, 95 (5th Cir. 1995)); see also Barry v. Fowler, 24 902 F.2d 770, 773 n.5 (9th Cir. 1990) (no unconstitutional seizure where police had 25 probable cause to arrest plaintiff for one offense, even if police lacked probable cause to 26 arrest for a second offense). Although Plaintiff alleges that disorderly conduct-fighting is 27 a “total falsehood,” he does not allege that Defendant Guajardo lacked probable cause to 28 arrest Plaintiff for engaging in conduct constituting disorderly conduct under Arizona 1 Revised Statutes section 13-2904, or any other offense. Thus, Plaintiff has failed to state 2 a false arrest, false imprisonment, or unlawful confinement claim. The Court will dismiss 3 without prejudice these claims. 4 Plaintiff has failed to explain how Defendant Guajardo denied him due process1 or 5 subjected him to cruel and unusual punishment. Thus, the Court will dismiss without 6 prejudice these claims. 7 V. Leave to Amend 8 For the foregoing reasons, Plaintiff’s Complaint will be dismissed for failure to state 9 a claim upon which relief may be granted. Within 30 days, Plaintiff may submit a first 10 amended complaint to cure the deficiencies outlined above. The Clerk of Court will mail 11 Plaintiff a court-approved form to use for filing a first amended complaint.2 12 Plaintiff must clearly designate on the face of the document that it is the “First 13 Amended Complaint.” The first amended complaint must be retyped or rewritten in its 14 entirety on the court-approved form and may not incorporate any part of the original 15 Complaint by reference. Plaintiff may include only one claim per count. 16 A first amended complaint supersedes the original Complaint. Ferdik v. Bonzelet, 17 963 F.2d 1258, 1262 (9th Cir. 1992); Hal Roach Studios v. Richard Feiner & Co., 896 F.2d 18 1542, 1546 (9th Cir. 1990). After amendment, the Court will treat the original Complaint 19 as nonexistent. Ferdik, 963 F.2d at 1262. Any cause of action that was raised in the 20 original Complaint and that was voluntarily dismissed or was dismissed without prejudice 21 is waived if it is not alleged in a first amended complaint. Lacey v. Maricopa County, 693 22 F.3d 896, 928 (9th Cir. 2012) (en banc). 23 . . . . 24 . . . . 25
26 1 The criminal charge against Plaintiff is still pending in the Tempe Municipal Court. See https://courtcaseinfo.tempe.gov/ (search “Last Name” for “Caraffa” and “First Name” 27 for “Alfred”; select Case Number “19-038379-2”) (last visited Oct. 28, 2019). 28 2 Although Plaintiff is not a prisoner, the Court suggests Plaintiff use this form to assist him in coherently presenting his claims to the Court. VI. Warnings 2 A. Address Changes 3 Plaintiff must file and serve a notice of a change of address in accordance with Rule 4| 83.3(d) of the Local Rules of Civil Procedure. Plaintiff must not include a motion for other relief with a notice of change of address. Failure to comply may result in dismissal of this action. 7 B. Possible Dismissal 8 If Plaintiff fails to ttmely comply with every provision of this Order, including these 9] warnings, the Court may dismiss this action without further notice. See Ferdik, 963 F.2d 10] at 1260-61 (a district court may dismiss an action for failure to comply with any order of 11} the Court). 12} ITIS ORDERED: 13 (1) Plaintiff’s Application to Proceed In District Court Without Prepaying Fees 14] or Costs (Doc. 2) is granted. 15 (2) |The Complaint (Doc. 1) is dismissed for failure to state a claim. Plaintiff 16 | has 30 days from the date this Order is filed to file a first amended complaint in compliance 17 | with this Order. 18 (3) Plaintiff fails to file an amended complaint within 30 days, the Clerk of 19 | Court must, without further notice, enter a judgment of dismissal of this action with 20 | prejudice and deny any pending unrelated motions as moot. 21 (4) The Clerk of Court must mail Plaintiff a court-approved form for filing a civil rights complaint by a prisoner. 23 Dated this 16th day of December, 2019. 24
Michael T. Liburdi 27 United States District Judge 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(a) 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 $400.00 ($350.00 filing fee plus $50.00 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. Mail the original and one copy of the complaint with the $400 filing and administrative fees or the application to proceed in forma pauperis to:
Revised 3/11/16 1 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. 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. 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. 2 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. . 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. . 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. 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.