1 WO KM 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 8 9 Anthony Charles Hall, No. CV-23-00353-TUC-SHR 10 Plaintiff, 11 v. ORDER 12 Arizona State Prison, et al., 13 Defendants.
15 Self-represented Plaintiff Anthony Charles Hall, who is confined in the Arizona 16 State Prison Complex-Douglas, filed a pro se civil rights Complaint pursuant to 42 U.S.C. 17 § 1983 and an Application to Proceed In Forma Pauperis. The Court denied the 18 Application to Proceed and Plaintiff subsequently filed a completed Application to Proceed 19 (Doc. 6). On January 2, 2024, Plaintiff filed a First Amended Complaint (Doc. 8), Motion 20 for Appointment of Counsel (Doc. 9), and Motion for Case Status Request (Doc. 10). The 21 Court will grant the Application to proceed, dismiss the First Amended Complaint with 22 leave to amend, and deny the Motion for Appointment of Counsel and Motion for Case 23 Status Request. 24 I. Application to Proceed In Forma Pauperis and Filing Fee 25 The Court will grant Plaintiff’s new Application to Proceed In Forma Pauperis. 28 26 U.S.C. § 1915(a). Plaintiff must pay the statutory filing fee of $350.00. 28 U.S.C. 27 § 1915(b)(1). The Court will not assess an initial partial filing fee. Id. The statutory filing 28 fee will be collected monthly in payments of 20% of the previous month’s income credited 1 to Plaintiff’s trust account each time the amount in the account exceeds $10.00. 28 U.S.C. 2 § 1915(b)(2). The Court will enter a separate Order requiring the appropriate government 3 agency to collect and forward the fees according to the statutory formula. 4 II. 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 legally frivolous or malicious claims, failed to state a claim upon which relief 9 may be granted, or sought monetary relief from a defendant who is immune from such 10 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 a pleading could be cured by the allegation of other facts, a 4 pro se litigant is entitled to an opportunity to amend a complaint before dismissal of the 5 action. See Lopez v. Smith, 203 F.3d 1122, 1127–29 (9th Cir. 2000) (en banc). Plaintiff’s 6 First Amended Complaint will be dismissed for failure to state a claim, but because it may 7 possibly be amended to state a claim, the Court will dismiss it with leave to amend. 8 III. First Amended Complaint 9 In his three-count First Amended Complaint, Plaintiff sues the Arizona State Prison 10 and Arizona Department of Corrections (ADC) for monetary damages and injunctive relief. 11 In Count One, Plaintiff claims ADC staff has “engaged in malicious interference in 12 legal access and access to courts.” Plaintiff claims an attorney sent him DVDs with 13 evidence and these DVDs arrived at the prison in October 2022, but mailroom staff 14 incorrectly dated them as arriving on February 10, 2023. He claims when he requested to 15 view materials, he was told “there was none” and “evidence submission for that case 16 ended” on February 10, 2023. He contends “this proves malicious, intentional denial of 17 legal access.” He also claims staff “stamped legal mail over [his] outgoing address” and 18 “filed a motion in [his] case posing as [him]. . ., to keep [him] quiet [and from] pursuing 19 justice.” 20 In Count Two, Plaintiff alleges he sent a “petition for review regarding [his] direct 21 appeal” but it was never received, and other mail he sent to the courts was returned. He 22 claims an attorney wrote to him and Plaintiff used the self-addressed stamped envelope to 23 send back signed paperwork. After several months, Plaintiff asked to call the attorney. He 24 alleges “CO III Leal fake called [the attorney who said] he is not [Plaintiff’s] attorney and 25 he does not want to talk to [Plaintiff].” Plaintiff states this is a lie and ADC staff stalk him 26 and censor his mail. Plaintiff contends ADC staff are preventing his legal mail “from going 27 out,” “stuck [return to sender] stickers on [the mail], making it look like the courts sent 28 1 them back,” and kept Plaintiff’s reply to an attorney “from going out” and are trying to 2 deny him communication with his attorney. 3 In Count Three, Plaintiff claims he is being denied access to the courts and ADC 4 staff attempted to “throw [him] in a medical hole.” He alleges “admin probably wants to 5 steal my case files, send CO IIs floor guards for this.” 6 IV. Failure to State a Claim 7 The ADC is not a proper Defendant. Under the Eleventh Amendment to the 8 Constitution of the United States, a state or state agency may not be sued in federal court 9 without its consent. Pennhurst State Sch. & Hosp. v. Halderman, 465 U.S. 89, 100 (1984); 10 Taylor v. List, 880 F.2d 1040, 1045 (9th Cir. 1989). Furthermore, “a state is not a ‘person’ 11 for purposes of section 1983. Likewise ‘arms of the State’ such as the Arizona Department 12 of Corrections are not ‘persons’ under section 1983.” Gilbreath v. Cutter Biological, Inc., 13 931 F.2d 1320, 1327 (9th Cir. 1991) (citation omitted). Therefore, the Court will dismiss 14 Defendant Arizona Department of Corrections, Rehabilitation & Reentry. 15 Moreover, § 1983 imposes liability on any “person” who violates an individual’s 16 federal rights while acting under color of state law. Congress intended municipalities and 17 other local government units to be included among those persons to whom § 1983 applies. 18 Monell v. Dept. of Soc. Servs., 436 U.S. 658, 689–90 (1978). However, the Arizona State 19 Prison is a building or collection of buildings, not a person or legally created entity capable 20 of being sued. Thus, the Court will dismiss Defendant Arizona State Prison. 21 Finally, Plaintiff’s allegations against unidentified “ADC Staff” or “Prison Staff” 22 are also insufficient to state claim. See Marcilis v. Twp. of Redford, 693 F.3d 589, 596 (6th 23 Cir. 2012) (upholding dismissal of civil rights complaint referring to all defendants 24 “generally and categorically” because the plaintiff had failed to “‘allege, with particularity, 25 facts that demonstrate what each defendant did to violate the asserted constitutional right.’“ 26 (quoting Lanman v. Hinson, 529 F.3d 673, 684 (6th Cir. 2008))); Robbins v. Oklahoma, 27 519 F.3d 1242, 1250 (10th Cir. 2008) (“Given the complaint’s use of either the collective 28 term ‘Defendants’ or a list of the defendants named individually but with no distinction as 1 to what acts are attributable to whom, it is impossible for any of these individuals to 2 ascertain what particular unconstitutional acts they are alleged to have committed.”). 3 V. Leave to Amend 4 For the foregoing reasons, the Court will dismiss Plaintiff’s First Amended 5 Complaint for failure to state a claim upon which relief may be granted. Plaintiff may 6 submit a second amended complaint to cure the deficiencies outlined above no later than 7 Wednesday, April 3, 2024. The Clerk of Court will mail Plaintiff a court-approved form 8 to use for filing a second amended complaint. If Plaintiff fails to use the court-approved 9 form, the Court may strike the second amended complaint and dismiss this action without 10 further notice to Plaintiff. 11 Plaintiff must clearly designate on the face of the document it is the “Second 12 Amended Complaint.” The second amended complaint must be retyped or rewritten in its 13 entirety on the court-approved form and may not incorporate any part of the original 14 Complaint or First Amended Complaint by reference. Plaintiff may include only one claim 15 per count. 16 In each count, Plaintiff must write short, plain statements telling the Court: (1) the 17 constitutional right Plaintiff believes was violated; (2) the name of the Defendant who 18 violated the right; (3) exactly what each Defendant did or failed to do; (4) how the action 19 or inaction of each Defendant is connected to the violation of Plaintiff’s constitutional 20 right; and (5) what specific injury Plaintiff suffered because of each Defendant’s conduct. 21 See Rizzo v. Goode, 423 U.S. 362, 371–72, 377 (1976). 22 Plaintiff must repeat this process for each person he names as a Defendant. If 23 Plaintiff fails to affirmatively link the conduct of each named Defendant with the specific 24 injury suffered by Plaintiff, the allegations against that Defendant will be dismissed for 25 failure to state a claim. Conclusory allegations that a Defendant or group of 26 Defendants has violated a constitutional right are not acceptable and will be 27 dismissed. 28 A second amended complaint supersedes the original Complaint and First Amended 1 Complaint. Ferdik v. Bonzelet, 963 F.2d 1258, 1262 (9th Cir. 1992); Hal Roach Studios v. 2 Richard Feiner & Co., 896 F.2d 1542, 1546 (9th Cir. 1990). After amendment, the Court 3 will treat the original Complaint and First Amended Complaint as nonexistent. Ferdik, 4 963 F.2d at 1262. Any cause of action raised in the original Complaint or First Amended 5 Complaint and voluntarily dismissed or dismissed without prejudice is waived if it is not 6 alleged in a second amended complaint. Lacey v. Maricopa County, 693 F.3d 896, 928 7 (9th Cir. 2012) (en banc). 8 VI. Motion for Appointment of Counsel 9 There is no constitutional right to the appointment of counsel in a civil case. See 10 Ivey v. Bd. of Regents, 673 F.2d 266, 269 (9th Cir. 1982). In proceedings in forma pauperis, 11 the court may request an attorney to represent any person unable to afford one. 28 U.S.C. 12 § 1915(e)(1). Appointment of counsel under 28 U.S.C. § 1915(e)(1) is required only when 13 “exceptional circumstances” are present. Terrell v. Brewer, 935 F.2d 1015, 1017 (9th Cir. 14 1991). A determination with respect to exceptional circumstances requires an evaluation 15 of the likelihood of success on the merits as well as the ability of Plaintiff to articulate his 16 claims pro se in light of the complexity of the legal issue involved. Id. “Neither of these 17 factors is dispositive and both must be viewed together before reaching a decision.” Id. 18 (quoting Wilborn v. Escalderon, 789 F.2d 1328, 1331 (9th Cir. 1986)). 19 Having considered both elements, the Court finds there are no exceptional 20 circumstances present at this time and, thus, the appointment of counsel in this case is not 21 warranted. Plaintiff is in no different position than many pro se prisoner litigants. 22 Accordingly, the Court will deny without prejudice Plaintiff’s Motion for Appointment of 23 Counsel. 24 VII. Warnings 25 A. Release 26 If Plaintiff is released while this case remains pending, and the filing fee has not 27 been paid in full, Plaintiff must, within 30 days of his release, either (1) notify the Court 28 he intends to pay the unpaid balance of his filing fee within 120 days of his release or (2) 1 file a non-prisoner application to proceed in forma pauperis. Failure to comply may result 2 in dismissal of this action. 3 B. Address Changes 4 Plaintiff must file and serve a notice of a change of address in accordance with Rule 5 83.3(d) of the Local Rules of Civil Procedure. Plaintiff must not include a motion for other 6 relief with a notice of change of address. Failure to comply may result in dismissal of this 7 action. 8 C. Possible “Strike” 9 Because the First Amended Complaint has been dismissed for failure to state a 10 claim, if Plaintiff fails to file a second amended complaint correcting the deficiencies 11 identified in this Order, the dismissal may count as a “strike” under the “3-strikes” 12 provision of 28 U.S.C. § 1915(g). Under the 3-strikes provision, a prisoner may not bring 13 a civil action or appeal a civil judgment in forma pauperis under 28 U.S.C. § 1915 “if the 14 prisoner has, on 3 or more prior occasions, while incarcerated or detained in any facility, 15 brought an action or appeal in a court of the United States that was dismissed on the 16 grounds that it is frivolous, malicious, or fails to state a claim upon which relief may be 17 granted, unless the prisoner is under imminent danger of serious physical injury.” 28 18 U.S.C. § 1915(g). 19 D. Possible Dismissal 20 If Plaintiff fails to timely comply with every provision of this Order, including these 21 warnings, the Court may dismiss this action without further notice. See Ferdik, 963 F.2d 22 at 1260–61 (a district court may dismiss an action for failure to comply with any order of 23 the Court). 24 . . . . 25 . . . . 26 . . . . 27 . . . . 28 . . . . ITIS ORDERED: 2 (1) Plaintiff's Application to Proceed In Forma Pauperis (Doc. 6) is GRANTED. 3 (2) As required by the accompanying Order to the appropriate government 4) agency, Plaintiff must pay the $350.00 filing fee and is not assessed an initial partial filing 5 | fee. 6 (3) Plaintiff's Motion for Appointment of Counsel (Doc. 9) is DENIED. 7 (4) Plaintiff's Motion for Case Status Request (Doc. 10) is DENIED. 8 (5) | The First Amended Complaint (Doc. 8) is DISMISSED for failure to state a 9| claim. Plaintiff has up to and including Wednesday, April 3, 2024, to file a second 10 | amended complaint in compliance with this Order. 11 (6) — If Plaintiff fails to file a second amended complaint by Wednesday, April 12| 3, 2024, the Clerk of Court must, without further notice, enter a judgment of dismissal of 13 | this action with prejudice stating the dismissal may count as a "strike" under 28 U.S.C. 14| § 1915(g) and deny any pending unrelated motions as moot. 15 (7) | The Clerk of Court must mail Plaintiff a court-approved form for filing a civil rights complaint by a prisoner. 17 18 Dated this Ist day of March, 2024. 19 20 /} Aa: hel 22 Honorable Scott H, Rash _/ United States District Judge 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 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 $402.00 ($350.00 filing fee plus $52.00 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 $402 filing and administrative fees or the application to proceed in forma pauperis to:
1 Revised 12/1/20 Phoenix & Prescott Divisions: OR Tucson Division: U.S. District Court Clerk U.S. District Court Clerk U.S. Courthouse, Suite 130 U.S. Courthouse, Suite 1500 401 West Washington Street, SPC 10 405 West Congress Street Phoenix, Arizona 85003-2119 Tucson, Arizona 85701-5010
7. Change of Address. You must immediately notify the Court and the defendants in writing of any change in your mailing address. Failure to notify the Court of any change in your mailing address may result in the dismissal of your case.
8. Certificate of Service. You must furnish the defendants with a copy of any document you submit to the Court (except the initial complaint and application to proceed in forma pauperis). Each original document (except the initial complaint and application to proceed in forma pauperis) must include a certificate of service on the last page of the document stating the date a copy of the document was mailed to the defendants and the address to which it was mailed. See Fed. R. Civ. P. 5(a), (d). Any document received by the Court that does not include a certificate of service may be stricken. This section does not apply to inmates housed at an Arizona Department of Corrections facility that participates in electronic filing. A certificate of service should be in the following form:
I hereby certify that a copy of the foregoing document was mailed this (month, day, year) to: Name: Address: Attorney for Defendant(s)
(Signature)
9. Amended Complaint. If you need to change any of the information in the initial complaint, you must file an amended complaint. The amended complaint must be written on the court- approved civil rights complaint form. You may file one amended complaint without leave (permission) of Court within 21 days after serving it or within 21 days after any defendant has filed an answer, whichever is earlier. See Fed. R. Civ. P. 15(a). Thereafter, you must file a motion for leave to amend and lodge (submit) a proposed amended complaint. LRCiv 15.1. In addition, an amended complaint may not incorporate by reference any part of your prior complaint. LRCiv 15.1(a)(2). Any allegations or defendants not included in the amended complaint are considered dismissed. All amended complaints are subject to screening under the Prison Litigation Reform Act; screening your amendment will take additional processing time.
10. Exhibits. You should not submit exhibits with the complaint or amended complaint. Instead, the relevant information should be paraphrased. You should keep the exhibits to use to support or oppose a motion to dismiss, a motion for summary judgment, or at trial.
11. Letters and Motions. It is generally inappropriate to write a letter to any judge or the staff of any judge. The only appropriate way to communicate with the Court is by filing a written pleading or motion.
2 12. Completing the Civil Rights Complaint Form.
HEADING: 1. Your Name. Print your name, prison or inmate number, and institutional mailing address on the lines provided.
2. Defendants. If there are four or fewer defendants, print the name of each. If you name more than four defendants, print the name of the first defendant on the first line, write the words “and others” on the second line, and attach an additional page listing the names of all of the defendants. Insert the additional page after page 1 and number it “1- A” at the bottom.
3. Jury Demand. If you want a jury trial, you must write “JURY TRIAL DEMANDED” in the space below “CIVIL RIGHTS COMPLAINT BY A PRISONER.” Failure to do so may result in the loss of the right to a jury trial. A jury trial is not available if you are seeking only injunctive relief.
Part A. JURISDICTION: 1. Nature of Suit. Mark whether you are filing the complaint pursuant to 42 U.S.C. ' 1983 for state, county, or city defendants; “Bivens v. Six Unknown Federal Narcotics Agents” for federal defendants; or “other.” If you mark “other,” identify the source of that authority.
2. Location. Identify the institution and city where the alleged violation of your rights occurred.
3. Defendants. Print all of the requested information about each of the defendants in the spaces provided. If you are naming more than four defendants, you must provide the necessary information about each additional defendant on separate pages labeled “2-A,” “2-B,” etc., at the bottom. Insert the additional page(s) immediately behind page 2.
Part B. PREVIOUS LAWSUITS: You must identify any other lawsuit you have filed in either state or federal court while you were a prisoner. Print all of the requested information about each lawsuit in the spaces provided. If you have filed more than three lawsuits, you must provide the necessary information about each additional lawsuit on a separate page. Label the page(s) as “2-A,” “2-B,” etc., at the bottom of the page and insert the additional page(s) immediately behind page 2.
Part C. CAUSE OF ACTION: You must identify what rights each defendant violated. The form provides space to allege three separate counts (one violation per count). If you are alleging more than three counts, you must provide the necessary information about each additional count on a separate page. Number the additional pages “5-A,” “5-B,” etc., and insert them immediately behind page 5. Remember that you are limited to a total of fifteen additional pages.
3 1. Counts. You must identify which civil right was violated. You may allege the violation of only one civil right per count.
2. Issue Involved. Check the box that most closely identifies the issue involved in your claim. You may check only one box per count. If you check the box marked “Other,” you must identify the specific issue involved.
3. Supporting Facts. After you have identified which civil right was violated, you must state the supporting facts. Be as specific as possible. You must state what each individual defendant did to violate your rights. If there is more than one defendant, you must identify which defendant did what act. You also should state the date(s) on which the act(s) occurred, if possible.
4. Injury. State precisely how you were injured by the alleged violation of your rights.
5. Administrative Remedies. You must exhaust any available administrative remedies before you file a civil rights complaint. See 42 U.S.C. § 1997e. Consequently, you should disclose whether you have exhausted the inmate grievance procedures or administrative appeals for each count in your complaint. If the grievance procedures were not available for any of your counts, fully explain why on the lines provided.
Part D. REQUEST FOR RELIEF: Print the relief you are seeking in the space provided.
SIGNATURE: You must sign your name and print the date you signed the complaint. Failure to sign the complaint will delay the processing of your action. Unless you are an attorney, you may not bring an action on behalf of anyone but yourself.
FINAL NOTE
You should follow these instructions carefully. Failure to do so may result in your complaint being stricken or dismissed. All questions must be answered concisely in the proper space on the form. If you need more space, you may attach no more than fifteen additional pages. But the form must be completely filled in to the extent applicable. If you attach additional pages, be sure to identify which section of the complaint is being continued and number the pages.
4 ___________________________________________ Name and Prisoner/Booking Number ___________________________________________ Place of Confinement ___________________________________________ Mailing Address ___________________________________________ City, State, Zip Code (Failure to notify the Court of your change of address may result in dismissal of this action.)
IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF ARIZONA
_________________________________________ , (Full Name of Plaintiff) ) Plaintiff, v. CASE NO. __________________________________ (To be supplied by the Clerk) (1) _______________________________________ ,
(Full Name of Defendant) CIVIL RIGHTS COMPLAINT (2) _______________________________________ , BY A PRISONER
(3) _______________________________________ , G Original Complaint (4) _______________________________________ , G First Amended Complaint G Second Amended Complaint Defendant(s).
G Check if there are additional Defendants and attach page 1-A listing them.
A. JURISDICTION
1. This Court has jurisdiction over this action pursuant to: G 28 U.S.C. § 1343(a); 42 U.S.C. § 1983 G 28 U.S.C. § 1331; Bivens v. Six Unknown Federal Narcotics Agents, 403 U.S. 388 (1971). G Other: .
2. Institution/city where violation occurred: .
550/555 B. DEFENDANTS
1. Name of first Defendant: . The first Defendant is employed as: ______________________________________________ at_______________________________________. (Position and Title) (Institution)
2. Name of second Defendant: . The second Defendant is employed as: as: ______________________________________________ at_______________________________________. (Position and Title) (Institution)
3. Name of third Defendant: . The third Defendant is employed as: ______________________________________________ at_______________________________________. (Position and Title) (Institution)
4. Name of fourth Defendant: . The fourth Defendant is employed as: ______________________________________________ at_______________________________________. (Position and Title) (Institution)
If you name more than four Defendants, answer the questions listed above for each additional Defendant on a separate page.
C. PREVIOUS LAWSUITS
1. Have you filed any other lawsuits while you were a prisoner? G Yes G No
2. If yes, how many lawsuits have you filed? . Describe the previous lawsuits:
a. First prior lawsuit: 1. Parties: v. 2. Court and case number: . 3. Result: (Was the case dismissed? Was it appealed? Is it still pending?) .
b. Second prior lawsuit: 1. Parties: v. 2. Court and case number: . 3. Result: (Was the case dismissed? Was it appealed? Is it still pending?) .
c. Third prior lawsuit: 1. Parties: v. 2. Court and case number: . 3. Result: (Was the case dismissed? Was it appealed? Is it still pending?) .
If you filed more than three lawsuits, answer the questions listed above for each additional lawsuit on a separate page. 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. .
3 COUNT II 1. State the constitutional or other federal civil right that was violated: .
2. Count II. Identify the issue involved. Check only one. State additional issues in separate counts. G Basic necessities G Mail G Access to the court G Medical care G Disciplinary proceedings G Property G Exercise of religion G Retaliation G Excessive force by an officer G Threat to safety G Other: .
3. Supporting Facts. State as briefly as possible the FACTS supporting Count II. Describe exactly what each Defendant did or did not do that violated your rights. State the facts clearly in your own words without citing legal authority or arguments.
4. Injury. State how you were injured by the actions or inactions of the Defendant(s).
5. Administrative Remedies. a. Are there any administrative remedies (grievance procedures or administrative appeals) available at your institution? G Yes G No b. Did you submit a request for administrative relief on Count II? G Yes G No c. Did you appeal your request for relief on Count II to the highest level? G Yes G No d. If you did not submit or appeal a request for administrative relief at any level, briefly explain why you did not. .
4 COUNT III 1. State the constitutional or other federal civil right that was violated: .
2. Count III. Identify the issue involved. Check only one. State additional issues in separate counts. G Basic necessities G Mail G Access to the court G Medical care G Disciplinary proceedings G Property G Exercise of religion G Retaliation G Excessive force by an officer G Threat to safety G Other: .
3. Supporting Facts. State as briefly as possible the FACTS supporting Count III. Describe exactly what each Defendant did or did not do that violated your rights. State the facts clearly in your own words without citing legal authority or arguments.
4. Injury. State how you were injured by the actions or inactions of the Defendant(s).
5. Administrative Remedies. a. Are there any administrative remedies (grievance procedures or administrative appeals) available at your institution? G Yes G No b. Did you submit a request for administrative relief on Count III? G Yes G No c. Did you appeal your request for relief on Count III to the highest level? G Yes G No d. If you did not submit or appeal a request for administrative relief at any level, briefly explain why you did not. .
If you assert more than three Counts, answer the questions listed above for each additional Count on a separate page.
5 E. REQUEST FOR RELIEF
State the relief you are seeking:
I declare under penalty of perjury that the foregoing is true and correct.
Executed on DATE SIGNATURE OF PLAINTIFF
___________________________________________ (Name and title of paralegal, legal assistant, or other person who helped prepare this complaint)
___________________________________________ (Signature of attorney, if any)
___________________________________________ (Attorney=s address & telephone number)
ADDITIONAL PAGES
All questions must be answered concisely in the proper space on the form. If you need more space, you may attach no more than fifteen additional pages. But the form must be completely filled in to the extent applicable. If you attach additional pages, be sure to identify which section of the complaint is being continued and number all pages.