1 ASH 2 WO 3 4 5 8 9 Ralph F. Esposito, No. CV 22-00815-PHX-JAT (ESW) 10 Plaintiff, 11 v. ORDER 12 David Shinn, et al., 13 14 Defendants.
15 16 On May 12, 2022, Plaintiff Ralph F. Esposito, who is confined in the Arizona State 17 Prison Complex-Tucson, filed a pro se civil rights Complaint pursuant to 42 U.S.C. § 1983 18 and an Application to Proceed In Forma Pauperis. By Order dated May 23, 2022, the Court 19 denied the deficient Application to Proceed, and gave Plaintiff 30 days in which to either 20 pay the filing fees or to submit a complete Application to Proceed In Forma Pauperis. 21 On June 6, 2022, Plaintiff filed a new Application to Proceed In Forma Pauperis, 22 and a First Amended Complaint. By Order dated June 28, 2022, the Court found the 23 Plaintiff’s Application to Proceed indicated the Plaintiff had sufficient monies to pay the 24 filing fees for this action, and gave him 30 days to do so. On July 13, 2022, Plaintiff paid 25 the filing fees for this action in full. Plaintiff subsequently filed a Motion for Preliminary 26 Injunction. In a September 28, 2022 Order, the Court dismissed the First Amended 27 Complaint because Plaintiff had failed to state a claim, and denied the Motion for 28 Preliminary Injunction. The Court gave Plaintiff 30 days to file a second amended 1 complaint that cured the deficiencies identified in the Order. 2 On October 24, 2022, Plaintiff filed a Second Amended Complaint (Doc. 13). The 3 Court will dismiss the Second Amended Complaint with leave to amend. 4 I. Statutory Screening of Prisoner Complaints 5 The Court is required to screen complaints brought by prisoners seeking relief 6 against a governmental entity or an officer or an employee of a governmental entity. 28 7 U.S.C. § 1915A(a). The Court must dismiss a complaint or portion thereof if a plaintiff 8 has raised claims that are legally frivolous or malicious, that fail to state a claim upon which 9 relief may be granted, or that seek monetary relief from a defendant who is immune from 10 such relief. 28 U.S.C. § 1915A(b)(1)–(2). 11 A pleading must contain a “short and plain statement of the claim showing that the 12 pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2) (emphasis added). While Rule 8 does 13 not demand detailed factual allegations, “it demands more than an unadorned, the- 14 defendant-unlawfully-harmed-me accusation.” Ashcroft v. Iqbal, 556 U.S. 662, 678 15 (2009). “Threadbare recitals of the elements of a cause of action, supported by mere 16 conclusory statements, do not suffice.” Id. 17 “[A] complaint must contain sufficient factual matter, accepted as true, to ‘state a 18 claim to relief that is plausible on its face.’” Id. (quoting Bell Atlantic Corp. v. Twombly, 19 550 U.S. 544, 570 (2007)). A claim is plausible “when the plaintiff pleads factual content 20 that allows the court to draw the reasonable inference that the defendant is liable for the 21 misconduct alleged.” Id. “Determining whether a complaint states a plausible claim for 22 relief [is] . . . a context-specific task that requires the reviewing court to draw on its judicial 23 experience and common sense.” Id. at 679. Thus, although a plaintiff’s specific factual 24 allegations may be consistent with a constitutional claim, a court must assess whether there 25 are other “more likely explanations” for a defendant’s conduct. Id. at 681. 26 But as the United States Court of Appeals for the Ninth Circuit has instructed, courts 27 must “continue to construe pro se filings liberally.” Hebbe v. Pliler, 627 F.3d 338, 342 28 (9th Cir. 2010). A “complaint [filed by a pro se prisoner] ‘must be held to less stringent 1 standards than formal pleadings drafted by lawyers.’” Id. (quoting Erickson v. Pardus, 551 2 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 pro se litigant is entitled to an opportunity to amend a complaint before dismissal 5 of the action. See Lopez v. Smith, 203 F.3d 1122, 1127-29 (9th Cir. 2000) (en banc). 6 Plaintiff’s Second Amended Complaint will be dismissed for failure to state a claim, but 7 because it may possibly be amended to state a claim, the Court will dismiss it with leave 8 to amend. 9 II. Second Amended Complaint 10 In his Second Amended Complaint, Plaintiff names Arizona Department of 11 Corrections (ADC) Director David Shinn, and Correctional Officers Saenze and Munoz as 12 Defendants. Plaintiff seeks declaratory, injunctive, and monetary relief, as well as punitive 13 damages. 14 Plaintiff alleges two claims, both of which he styles as Due Process claims. In Count 15 One, Plaintiff alleges that he accrued “Good Time Credits” (GTCs) while incarcerated. 16 However, on April 22, 2022, Saenz informed Plaintiff that his GTCs had been revoked. 17 Plaintiff had not received any disciplinary tickets, nor was he given any explanation for or 18 way to contest the revocation of his GTCs, the effect of which was to prolong his 19 incarceration in prison. 20 In Count Two, Plaintiff alleges that on September 17, 2020, Munoz falsely classified 21 him as a sex offender. Plaintiff asserts that he has not been convicted of a sex crime, had 22 not been classified as a sex offender since he entered prison in 2014, and was not given an 23 explanation or way to contest the change in classification. The result of the sex offender 24 classification was to raise his internal risk factor score from 2 to 3, making him ineligible 25 for housing on certain yards, from holding certain jobs, and that he has now been “place[d] 26 next to more violent offenders.” Plaintiff also indicates that “shortly after” he was 27 classified as a sex offender “he lost his good time credits.” 28 . . . . 1 III. Failure to State a Claim 2 A. Count One 3 As the Court explained in its September 28, 2022 Order, “a state prisoner seeking 4 injunctive relief against the denial or revocation of good-time credits must proceed in 5 habeas corpus, and not under § 1983.” Nonnette v. Small, 316 F.3d 872, 875 (9th Cir. 6 2002). Habeas corpus is the proper proceeding in which to challenge the legality or 7 duration of confinement. Badea v. Cox, 931 F.2d 573, 574 (9th Cir. 1991) (citing Preiser 8 v. Rodriguez, 411 U.S. 475, 484 (1973). In contrast, a civil rights action is the proper 9 method for challenging the conditions of a prisoner’s confinement. Id. (citing Preiser, 411 10 U.S. at 498-99); Crawford v. Bell, 599 F.2d 890, 891-92 (9th Cir. 1979) (the proper remedy 11 for complaints challenging conditions of confinement is a civil rights action under 42 12 U.S.C. § 1983). 13 Here, Plaintiff’s claim, if decided in his favor, would either invalidate or imply the 14 invalidity of the deprivation of his GTCs, and his claim is therefore barred. If Plaintiff 15 seeks the reinstatement of his release credits, his sole avenue for such relief in federal court 16 is via a petition for a writ of habeas corpus. Therefore, the Court will dismiss Count One. 17 B. Count Two 18 It is unclear if Plaintiff’s allegations in Count Two relate to the loss of his GTCs. If 19 Plaintiff’s GTCs were revoked due to his reclassification and subsequent increase in risk 20 score, then Count Two is barred for the same reasons as Count One. 21 Even if Plaintiff’s allegations in Count Two do not relate to the loss of his GTCs, 22 however, he has still failed to state a claim. In analyzing a due process claim, the Court 23 must first decide whether Plaintiff was entitled to any process, and if so, whether he was 24 denied any constitutionally required procedural safeguard. Liberty interests that may not 25 be deprived without due process are “generally limited to freedom from restraint which, 26 while not exceeding the sentence in such an unexpected manner as to give rise to protection 27 by the Due Process Clause of its own force, nonetheless imposes atypical and significant 28 hardship on the inmate in relation to the ordinary incidents of prison life.” Sandin v. 1 Conner, 515 U.S. 472, 484 (1995) (internal citations omitted). 2 To determine whether a prisoner is entitled to the procedural protections afforded 3 by the Due Process Clause, the Court must look to the particular restrictions imposed and 4 ask whether they “‘present the type of atypical, significant deprivation in which a state 5 might conceivably create a liberty interest.’” Mujahid v. Meyer, 59 F.3d 931, 932 (9th Cir. 6 1995) (quoting Sandin, 515 U.S. at 486). “Atypicality” requires not merely an empirical 7 comparison, but turns on the importance of the right taken away from the prisoner. See 8 Carlo v. City of Chino, 105 F.3d 493, 499 (9th Cir. 1997). To determine whether the 9 sanctions are atypical and a significant hardship, courts look to prisoner’s conditions of 10 confinement, the duration of the sanction, and whether the sanction will affect the duration 11 of the prisoner’s sentence. See Keenan v. Hall, 83 F.3d 1083, 1088-89 (9th Cir. 1996). 12 Plaintiff indicates that, as a result of being reclassified, he is unable to house on 13 certain yards, has been placed “next to more violent offenders,” and is not allowed to hold 14 certain jobs. These sanctions are not atypical and significant. See Sandin, 515 U.S. at 475- 15 76, 487 (30 days’ disciplinary segregation is not atypical and significant); Smith v. 16 Mensinger, 293 F.3d 641, 654 (3rd Cir. 2002) (seven months of disciplinary confinement 17 “does not, on its own, violate a protected liberty interest”); Jones v. Baker, 155 F.3d 810 18 (6th Cir. 1998) (two and one-half years’ administrative segregation is not atypical and 19 significant); Rizzo v. Dawson, 778 F.2d 527, 530 (9th Cir. 1985) (prison authorities may 20 change a prisoner’s “place of confinement even though the degree of confinement may be 21 different and prison life may be more disagreeable in one institution than in another” 22 without violating a prisoner’s due process rights); Lucero v. Russell, 741 F.2d 1129 (9th 23 Cir. 1984) (administrative transfer to maximum security without a hearing does not infringe 24 on any protected liberty interest). Accordingly, Plaintiff has failed to state a claim in Count 25 Two, and it will thus be dismissed. 26 IV. Leave to Amend 27 For the foregoing reasons, the Court will dismiss Plaintiff’s Second Amended 28 Complaint for failure to state a claim upon which relief may be granted. Within 30 days, 1 Plaintiff may submit a third amended complaint to cure the deficiencies outlined above. 2 The Clerk of Court will mail Plaintiff a court-approved form to use for filing a third 3 amended complaint. If Plaintiff fails to use the court-approved form, the Court may strike 4 the third amended complaint and dismiss this action without further notice to Plaintiff. 5 Plaintiff must clearly designate on the face of the document that it is the “Third 6 Amended Complaint.” The third amended complaint must be retyped or rewritten in its 7 entirety on the court-approved form and may not incorporate any part of the original 8 Complaint or prior Amended Complaints by reference. Plaintiff may include only one 9 claim per count. 10 A third amended complaint supersedes the original Complaint and prior Amended 11 Complaints. Ferdik v. Bonzelet, 963 F.2d 1258, 1262 (9th Cir. 1992); Hal Roach Studios 12 v. Richard Feiner & Co., 896 F.2d 1542, 1546 (9th Cir. 1990). After amendment, the Court 13 will treat the original Complaint and prior Amended Complaints as nonexistent. Ferdik, 14 963 F.2d at 1262. Any cause of action that was raised in the original Complaint or a prior 15 Amended Complaint and that was voluntarily dismissed or was dismissed without 16 prejudice is waived if it is not alleged in a third amended complaint. Lacey v. Maricopa 17 County, 693 F.3d 896, 928 (9th Cir. 2012) (en banc). 18 V. Warnings 19 A. Release 20 If Plaintiff is released while this case remains pending, and the filing fee has not 21 been paid in full, Plaintiff must, within 30 days of his release, either (1) notify the Court 22 that he intends to pay the unpaid balance of his filing fee within 120 days of his release or 23 (2) file a non-prisoner application to proceed in forma pauperis. Failure to comply may 24 result in dismissal of this action. 25 B. Address Changes 26 If Plaintiff’s address changes, Plaintiff must file and serve a notice of a change of 27 address in accordance with Rule 83.3(d) of the Local Rules of Civil Procedure. Plaintiff 28 must not include a motion for other relief with a notice of change of address. Failure to 1 comply may result in dismissal of this action. 2 C. Possible “Strike” 3 Because the Second Amended Complaint has been dismissed for failure to state a 4 claim, if Plaintiff fails to file a third amended complaint correcting the deficiencies 5 identified in this Order, the dismissal may count as a “strike” under the “3-strikes” 6 provision of 28 U.S.C. § 1915(g). Under the 3-strikes provision, a prisoner may not bring 7 a civil action or appeal a civil judgment in forma pauperis under 28 U.S.C. § 1915 “if the 8 prisoner has, on 3 or more prior occasions, while incarcerated or detained in any facility, 9 brought an action or appeal in a court of the United States that was dismissed on the 10 grounds that it is frivolous, malicious, or fails to state a claim upon which relief may be 11 granted, unless the prisoner is under imminent danger of serious physical injury.” 28 12 U.S.C. § 1915(g). 13 D. Possible Dismissal 14 If Plaintiff fails to timely comply with every provision of this Order, including these 15 warnings, the Court may dismiss this action without further notice. See Ferdik, 963 F.2d 16 at 1260-61 (a district court may dismiss an action for failure to comply with any order of 17 the Court). 18 IT IS ORDERED: 19 (1) The Second Amended Complaint (Doc. 13) is dismissed for failure to state 20 a claim. Plaintiff has 30 days from the date this Order is filed to file a third amended 21 complaint in compliance with this Order. 22 (2) If Plaintiff fails to file a third amended complaint within 30 days, the Clerk 23 of Court must, without further notice, enter a judgment of dismissal of this action with 24 prejudice that states that the dismissal may count as a “strike” under 28 U.S.C. § 1915(g) 25 and deny any pending unrelated motions as moot. 26 . . . . 27 . . . . 28 . . . . 1 (3) The Clerk of Court must mail Plaintiff a court-approved form for filing a civil rights complaint by a prisoner. 3 Dated this 16th day of December, 2022. 4 5 ' ° 7 = James A. C rg Senior United States District Judge 8 9 10 11 12 13 14 15 16 17 18 19 20 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.