Coffey v. Core Civic America

• Court: District Court, D. Arizona
• Decided: December 4, 2020
• Docket: 2:20-cv-01899
• Status: Unknown

Opinion

1 MDR 2 WO 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 8 9 Dylan Shane Coffey, No. CV 20-01899-PHX-DGC (CDB) 10 Plaintiff, 11 v. ORDER 12 CoreCivic America, et al., 13 Defendants.

14 15 On September 28, 2020, Plaintiff Dylan Shane Coffey, who is confined in 16 CoreCivic’s Red Rock Correctional Center in Eloy, Arizona, filed a pro se Complaint for 17 Defamation of Character. In an October 7, 2020 Order, the Court gave Plaintiff thirty days 18 to either pay the filing and administrative fees or file an Application to Proceed In Forma 19 Pauperis. 20 On October 19, 2020, Plaintiff filed an Application to Proceed In Forma Pauperis. 21 In an October 27, 2020 Order, the Court granted the Application and dismissed the 22 Complaint because Plaintiff had failed to file on a court-approved form. The Court gave 23 Plaintiff thirty days to file an amended complaint using the court-approved form. 24 On November 20, 2020, Plaintiff filed his First Amended Complaint (Doc. 8).1 The 25 Court will dismiss the First Amended Complaint with leave to amend. 26

27 1 Plaintiff alleges the jurisdictional basis for this case is “Tort of Defamation.” This 28 is not a jurisdictional basis. For purposes of this Order, the Court will construe his claims as filed pursuant to 42 U.S.C. § 1983, which provides a cause of action against persons acting under color of state law who have violated rights guaranteed by the United States 1 I. Statutory Screening of Prisoner Complaints 2 The Court is required to screen complaints brought by prisoners seeking relief 3 against a governmental entity or an officer or an employee of a governmental entity. 28 4 U.S.C. § 1915A(a). The Court must dismiss a complaint or portion thereof if a plaintiff 5 has raised claims that are legally frivolous or malicious, that fail to state a claim upon which 6 relief may be granted, or that seek monetary relief from a defendant who is immune from 7 such relief. 28 U.S.C. § 1915A(b)(1)–(2). 8 A pleading must contain a “short and plain statement of the claim showing that the 9 pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2) (emphasis added). While Rule 8 does 10 not demand detailed factual allegations, “it demands more than an unadorned, the- 11 defendant-unlawfully-harmed-me accusation.” Ashcroft v. Iqbal, 556 U.S. 662, 678 12 (2009). “Threadbare recitals of the elements of a cause of action, supported by mere 13 conclusory statements, do not suffice.” Id. 14 “[A] complaint must contain sufficient factual matter, accepted as true, to ‘state a 15 claim to relief that is plausible on its face.’” Id. (quoting Bell Atlantic Corp. v. Twombly, 16 550 U.S. 544, 570 (2007)). A claim is plausible “when the plaintiff pleads factual content 17 that allows the court to draw the reasonable inference that the defendant is liable for the 18 misconduct alleged.” Id. “Determining whether a complaint states a plausible claim for 19 relief [is] . . . a context-specific task that requires the reviewing court to draw on its judicial 20 experience and common sense.” Id. at 679. Thus, although a plaintiff’s specific factual 21 allegations may be consistent with a constitutional claim, a court must assess whether there 22 are other “more likely explanations” for a defendant’s conduct. Id. at 681. 23 But as the United States Court of Appeals for the Ninth Circuit has instructed, courts 24 must “continue to construe pro se filings liberally.” Hebbe v. Pliler, 627 F.3d 338, 342 25 (9th Cir. 2010). A “complaint [filed by a pro se prisoner] ‘must be held to less stringent 26 standards than formal pleadings drafted by lawyers.’” Id. (quoting Erickson v. Pardus, 551 27 U.S. 89, 94 (2007) (per curiam)).

28 Constitution and federal law. 42 U.S.C. § 1983; see also Buckley v. City of Redding, 66 F.3d 188, 190 (9th Cir. 1995). 1 If the Court determines that a pleading could be cured by the allegation of other 2 facts, a pro se litigant is entitled to an opportunity to amend a complaint before dismissal 3 of the action. See Lopez v. Smith, 203 F.3d 1122, 1127-29 (9th Cir. 2000) (en banc). 4 Plaintiff’s First Amended Complaint will be dismissed for failure to state a claim, but 5 because it may possibly be amended to state a claim, the Court will dismiss it with leave 6 to amend. 7 II. First Amended Complaint 8 In his one-count First Amended Complaint, Plaintiff seeks monetary damages and 9 injunctive relief from Defendants Arizona Department of Corrections (ADC), CoreCivic 10 America, and Assistant Deputy Warden/Contract Monitor J. Garrison. 11 Plaintiff alleges his rights under the Fourth, Eighth, and Ninth Amendments and 12 Article IV of the United States Constitution were violated. He contends he received a 13 September 4, 2019 memorandum from Defendant ADC stating that he had been placed on 14 non-visitation status pending the resolution of a disciplinary charge for possession of drugs 15 or narcotics. On September 30, 2019, he received a memorandum stating that full visitation 16 status had been restored because the disciplinary violation had been dismissed at the time 17 of his hearing. 18 Plaintiff contends Defendant CoreCivic is responsible for not following ADC 19 protocol and “inspecting a cell prior to being moved into such cell and allowing [Plaintiff] 20 to watch and sign off they inspected the cell which the violation arose from.” Plaintiff 21 claims Defendant Garrison “should have prevented a guilty charge from being seen 22 online.” Plaintiff also asserts Defendant ADC “should have never allowed false, 23 defamation of character charges to be put on their website without [Plaintiff’s] knowledge 24 or consent [and] made available to the public.” He claims he suffered emotional distress, 25 embarrassment, damage to his reputation, and defamation of character, “all for allowing 26 friends/family and the public to see a guilty charge or a charge online that should have 27 never been published online for the fact that it was not true.” 28 . . . . 1 III. Failure to State a Claim 2 A. Defendant Arizona Department of Corrections 3 The Arizona Department of Corrections is not a proper Defendant. Under the 4 Eleventh Amendment to the Constitution of the United States, a state or state agency may 5 not be sued in federal court without its consent. Pennhurst State Sch. & Hosp. v. 6 Halderman, 465 U.S. 89, 100 (1984); Taylor v. List, 880 F.2d 1040, 1045 (9th Cir. 1989). 7 Furthermore, “a state is not a ‘person’ for purposes of section 1983. Likewise ‘arms of the 8 State’ such as the Arizona Department of Corrections are not ‘persons’ under section 9 1983.” Gilbreath v. Cutter Biological, Inc., 931 F.2d 1320, 1327 (9th Cir. 1991) (citation 10 omitted). Therefore, the Court will dismiss Defendant Arizona Department of Corrections. 11 B. Defendant CoreCivic 12 To state a claim under § 1983 against a private entity performing a traditional public 13 function, such as housing prisoners, a plaintiff must allege facts to support that his 14 constitutional rights were violated as a result of a policy, decision, or custom promulgated 15 or endorsed by the private entity. See Tsao v. Desert Palace, Inc., 698 F.3d 1128, 1138- 16 39 (9th Cir. 2012); Buckner v. Toro, 116 F.3d 450, 452 (11th Cir. 1997) (per curiam). A 17 plaintiff must allege the specific policy or custom and how it violated his constitutional 18 rights. A private entity is not liable merely because it employs persons who allegedly 19 violated a plaintiff’s constitutional rights. See Tsao, 698 F.3d at 1139; Buckner, 116 F.3d 20 at 452. 21 Plaintiff does not allege that any of the conduct described in the First Amended 22 Complaint was the result of a specific policy or custom of Defendant CoreCivic. Thus, the 23 Court will dismiss without prejudice Defendant CoreCivic. 24 C. Defendant Garrison 25 Although pro se pleadings are liberally construed, Haines v. Kerner, 404 U.S. 519, 26 520-21 (1972), conclusory and vague allegations will not support a cause of action. Ivey 27 v. Bd. of Regents, 673 F.2d 266, 268 (9th Cir. 1982). Further, a liberal interpretation of a 28 1 civil rights complaint may not supply essential elements of the claim that were not initially 2 pled. Id. 3 To state a valid claim under § 1983, plaintiffs must allege that they suffered a 4 specific injury as a result of specific conduct of a defendant and show an affirmative link 5 between the injury and the conduct of that defendant. See Rizzo v. Goode, 423 U.S. 362, 6 371-72, 377 (1976). There is no respondeat superior liability under § 1983, and therefore, 7 a defendant’s position as the supervisor of persons who allegedly violated Plaintiff’s 8 constitutional rights does not impose liability. Monell v. Dep’t of Soc. Servs., 436 U.S. 658 9 (1978); Hamilton v. Endell, 981 F.2d 1062, 1067 (9th Cir. 1992); Taylor v. List, 880 F.2d 10 1040, 1045 (9th Cir. 1989). “Because vicarious liability is inapplicable to . . . § 1983 suits, 11 a plaintiff must plead that each Government-official defendant, through the official’s own 12 individual actions, has violated the Constitution.” Iqbal, 556 U.S. at 676. “A plaintiff must 13 allege facts, not simply conclusions, that show that an individual was personally involved 14 in the deprivation of his civil rights.” Barren v. Harrington, 152 F.3d 1193, 1194 (9th Cir. 15 1998). 16 Plaintiff alleges Defendant Garrison should have prevented a “guilty charge from 17 being seen online.” It is unclear what a “guilty charge” is, but based on the allegations in 18 Plaintiff’s original Complaint, Plaintiff is claiming that the fact that he was charged with 19 possession of drugs or narcotics was published on ADC’s website. Plaintiff has alleged 20 nothing to suggest Defendant Garrison was responsible for placing this information online 21 or had the authority to prevent it from appearing online. 22 Moreover, as explained to Plaintiff in the October 27, 2020 Order, an action for 23 damage to reputation ordinarily “lies . . . in the tort of defamation, not in section 1983.” 24 Fleming v. Dep’t of Pub. Safety, 837 F.2d 401, 409 (9th Cir. 1988), overruled on other 25 grounds in DeNieva v. Reyes, 966 F.2d 480 (9th Cir. 1992). To recover damages for 26 defamation under § 1983, a plaintiff must meet the “defamation-plus” test, which requires 27 a plaintiff to show either that “the injury to reputation was inflicted in connection with a 28 federally protected right,” or that “the injury to reputation caused the denial of a federally 1 protected right.” Herb Hallman Chevrolet, Inc. v. Nash-Holmes, 169 F.3d 636, 645 (9th 2 Cir. 1999) (emphasis in original). He has done neither. 3 In addition, “[t]o be defamatory, a publication must be false, and truth is a defense.” 4 Godbehere v. Phx. Newspapers, Inc., 783 P.2d 781, 787 (Ariz. 1989) (emphasis added); 5 see also Read v. Phx. Newspapers, Inc., 819 P.2d 939, 941 (Ariz. 1991) (“Substantial truth 6 is an absolute defense to a defamation action in Arizona. Slight inaccuracies will not 7 prevent a statement from being true in substance, as long as the ‘gist’ or ‘sting’ of the 8 publication is justified.”) (citations omitted). A statement on ADC’s website that Plaintiff 9 was charged with an offense is true; Plaintiff does not dispute that he was charged with 10 possession of drugs or narcotics. 11 Thus, the Court will dismiss without prejudice Plaintiff’s claim against Defendant 12 Garrison. 13 IV. Leave to Amend 14 Plaintiff’s First Amended Complaint will be dismissed for failure to state a claim 15 upon which relief may be granted. Within 30 days, Plaintiff may submit a second amended 16 complaint to cure the deficiencies outlined above. The Clerk of Court will mail Plaintiff a 17 court-approved form to use for filing a second amended complaint. If Plaintiff fails to use 18 the court-approved form, the Court may strike the second amended complaint and dismiss 19 this action without further notice to Plaintiff. 20 Plaintiff must clearly designate on the face of the document that it is the “Second 21 Amended Complaint.” The second amended complaint must be retyped or rewritten in its 22 entirety on the court-approved form and may not incorporate any part of the original 23 Complaint or First Amended Complaint by reference. Plaintiff may include only one claim 24 per count. 25 A second amended complaint supersedes the original Complaint and First Amended 26 Complaint. Ferdik v. Bonzelet, 963 F.2d 1258, 1262 (9th Cir. 1992); Hal Roach Studios v. 27 Richard Feiner & Co., 896 F.2d 1542, 1546 (9th Cir. 1990). After amendment, the Court 28 will treat the original Complaint and First Amended Complaint as nonexistent. Ferdik, 1 963 F.2d at 1262. Any cause of action that was raised in the original Complaint or First 2 Amended Complaint and that was voluntarily dismissed or was dismissed without 3 prejudice is waived if it is not alleged in a second amended complaint. Lacey v. Maricopa 4 County, 693 F.3d 896, 928 (9th Cir. 2012) (en banc). 5 V. Warnings 6 A. Release 7 If Plaintiff is released while this case remains pending, and the filing fee has not 8 been paid in full, Plaintiff must, within 30 days of his release, either (1) notify the Court 9 that he intends to pay the unpaid balance of his filing fee within 120 days of his release or 10 (2) file a non-prisoner application to proceed in forma pauperis. Failure to comply may 11 result in dismissal of this action. 12 B. Address Changes 13 Plaintiff must file and serve a notice of a change of address in accordance with Rule 14 83.3(d) of the Local Rules of Civil Procedure. Plaintiff must not include a motion for other 15 relief with a notice of change of address. Failure to comply may result in dismissal of this 16 action. 17 C. Possible “Strike” 18 Because the First Amended Complaint has been dismissed for failure to state a 19 claim, if Plaintiff fails to file a second amended complaint correcting the deficiencies 20 identified in this Order, the dismissal may count as a “strike” under the “3-strikes” 21 provision of 28 U.S.C. § 1915(g). Under the 3-strikes provision, a prisoner may not bring 22 a civil action or appeal a civil judgment in forma pauperis under 28 U.S.C. § 1915 “if the 23 prisoner has, on 3 or more prior occasions, while incarcerated or detained in any facility, 24 brought an action or appeal in a court of the United States that was dismissed on the 25 grounds that it is frivolous, malicious, or fails to state a claim upon which relief may be 26 granted, unless the prisoner is under imminent danger of serious physical injury.” 28 27 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) The First Amended Complaint (Doc. 8) is dismissed for failure to state a 8 | claim. Plaintiff has 30 days from the date this Order is filed to file a second amended complaint in compliance with this Order. 10 (2) If Plaintiff fails to file a second amended complaint within 30 days, the Clerk 11 | of Court must, without further notice, enter a judgment of dismissal of this action with 12 | prejudice that states that the dismissal may count as a “strike” under 28 U.S.C. § 1915(g) 13 | and deny any pending unrelated motions as moot. 14 (3) The Clerk of Court must mail Plaintiff a court-approved form for filing a 15 | civil rights complaint by a prisoner. 16 Dated this 4th day of December, 2020. 17 aur 6 Cour pel 19 David G. Campbell 20 Senior United States District Judge 21 22 23 24 25 26 27 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(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.