McClure v. Citrenbaum

• Court: District Court, D. Arizona
• Decided: October 6, 2023
• Docket: 3:23-cv-08133
• Status: Unknown

Opinion

1 KM 2 WO 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 8 9 John Patrick McClure, No. CV-23-08133-PCT-JAT (ASB) 10 Plaintiff, 11 v. ORDER 12 Lewis Citrenbaum, et al., 13 Defendants.

15 Pro se Plaintiff John Patrick McClure has filed a civil rights Complaint pursuant to 16 42 U.S.C. § 1983 (Doc. 1), an Application to Proceed In District Court without Prepaying 17 Fees or Costs (Doc. 2), a Motion for Status (Doc. 5), and two Notices. The Court will grant 18 the Application to Proceed, dismiss the Complaint with leave to amend, and grant the 19 Motion for Status to the extent this Order informs Plaintiff of the status of this case. 20 I. Application to Proceed 21 The Court will grant Plaintiff’s Application to Proceed in District Court Without 22 Prepaying Fees or Costs. 28 U.S.C. § 1915(a). Plaintiff may proceed without payment of 23 the filing fee. 24 II. Statutory Screening of Prisoner Complaints 25 Pursuant to 28 U.S.C. § 1915(e)(2)(B), the Court is required to review complaints 26 brought by all plaintiffs who are proceeding in forma pauperis and must dismiss a 27 complaint or portion thereof if the plaintiff has raised claims that are legally frivolous or 28 malicious, fail to state a claim upon which relief may be granted, or seek monetary relief 1 from a defendant who is immune from such relief. 2 A pleading must contain a “short and plain statement of the claim showing that the 3 pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2) (emphasis added). While Rule 8 does 4 not demand detailed factual allegations, “it demands more than an unadorned, the- 5 defendant-unlawfully-harmed-me accusation.” Ashcroft v. Iqbal, 556 U.S. 662, 678 6 (2009). “Threadbare recitals of the elements of a cause of action, supported by mere 7 conclusory statements, do not suffice.” Id. 8 “[A] complaint must contain sufficient factual matter, accepted as true, to ‘state a 9 claim to relief that is plausible on its face.’” Id. (quoting Bell Atlantic Corp. v. Twombly, 10 550 U.S. 544, 570 (2007)). A claim is plausible “when the plaintiff pleads factual content 11 that allows the court to draw the reasonable inference that the defendant is liable for the 12 misconduct alleged.” Id. “Determining whether a complaint states a plausible claim for 13 relief [is] . . . a context-specific task that requires the reviewing court to draw on its judicial 14 experience and common sense.” Id. at 679. Thus, although a plaintiff’s specific factual 15 allegations may be consistent with a constitutional claim, a court must assess whether there 16 are other “more likely explanations” for a defendant’s conduct. Id. at 681. 17 But as the United States Court of Appeals for the Ninth Circuit has instructed, courts 18 must “continue to construe pro se filings liberally.” Hebbe v. Pliler, 627 F.3d 338, 342 19 (9th Cir. 2010). A “complaint [filed by a pro se prisoner] ‘must be held to less stringent 20 standards than formal pleadings drafted by lawyers.’” Id. (quoting Erickson v. Pardus, 551 21 U.S. 89, 94 (2007) (per curiam)). 22 If the Court determines that a pleading could be cured by the allegation of other 23 facts, a pro se litigant is entitled to an opportunity to amend a complaint before dismissal 24 of the action. See Lopez v. Smith, 203 F.3d 1122, 1127-29 (9th Cir. 2000) (en banc). 25 Plaintiff’s Complaint will be dismissed for failure to state a claim, but because it may 26 possibly be amended to state a claim, the Court will dismiss it with leave to amend. 27 . . . . 28 . . . . 1 III. Complaint 2 Plaintiff names Yavapai County Attorney Lewis Citrenbaum, Private Parties Eric 3 Joseph Cremona and Unknown Roommate, and Prescott Valley Police Department 4 Officers Detective Hohrien and Sergeant Grant. Plaintiff seeks money damages. 5 Plaintiff claims he “made contact” with his neighbors, Defendants Cremona and 6 Unknown Roommate, regarding their loud music and Defendants “got in [his] face” and 7 told him they could play their music as loud as they wanted. Plaintiff claims Defendant 8 Cremona threatened him and the Unknown Roommate said “its not time for that, yet.” 9 Plaintiff noticed people “moving around the driveway of 4537, directly across the street,” 10 and contends “this was a set up.” He alleges Cremona addressed him by his first name, 11 even though Plaintiff had never seen him or met him. Plaintiff claims that the next 12 morning, his window “was blown out . . . all with very large rocks and marble size 13 boulders.” Plaintiff claims the music continued to be very loud every weekend. On May 14 15, 2023, Plaintiff went to talk to Defendant Cremona and Cremona “pulled a knife and 15 tried to cut [Plaintiff’s] throat.” Plaintiff alleges the knife cut him from his neck, across 16 his chest, and down the inside of his right arm, almost to hist wrist.” Plaintiff also severely 17 injured his back while trying to get away. 18 Plaintiff alleges that after he was released from the hospital, the Prescott Valley 19 Police Department refused to arrest Cremona or give Plaintiff a police report. Plaintiff 20 called Defendant Hohrien, but Hohrien initially refused to return Plaintiff’s call. Plaintiff 21 then called Defendant Grant, after which Hohrien returned Plaintiff’s call but refused to 22 give Plaintiff Defendant Cremona’s name or arrest Cremona. Plaintiff alleges Defendant 23 Grant also refused to give Plaintiff “[his] attackers[’] name or any kind of report.” 24 Two weeks later, Plaintiff received “victim’s right paperwork” in the mail with 25 Cremona’s name. On July 12, 2023, Plaintiff had a phone conference with Defendant 26 Citrenbaum. Plaintiff told Citrenbaum he was elderly and was attacked with a deadly 27 weapon by Cremona and “Cremona may be an informant with his roommate to set 28 [Plaintiff] up for an attack to cause serious injury or death.” Plaintiff claims Citrenbaum 1 “didn’t want to hear it” and told Plaintiff that Plaintiff might be charged with assault “as 2 he has pictures [and] a witness.” Plaintiff “took this as a direct threat” and ended the phone 3 call. 4 Plaintiff contends “Yavapai County has clearly refused the victim of due process 5 withholding names and protecting the suspect, putting the Plaintiff[’s] PTSD in a serious 6 line of treatment for many years to come.” 7 IV. Failure to State a Claim 8 A. Defendants Cremona and Unknown Roommate 9 “Like the state-action requirement of the Fourteenth Amendment, the under-color- 10 of-state-law element of § 1983 excludes from its reach ‘merely private conduct, no matter 11 how discriminatory or wrongful.’” Am. Mfrs. Mut. Ins. Co. v. Sullivan, 526 U.S. 40, 50 12 (1999) (quoting Blum v. Yaretsky, 457 U.S. 991, 1002 (1982)). “[S]tate action requires 13 both an alleged constitutional deprivation ‘caused by the exercise of some right or privilege 14 created by the State or by a rule of conduct imposed by the State or by a person for whom 15 the State is responsible,’ and that ‘the party charged with the deprivation must be a person 16 who may fairly be said to be a state actor.’” Id. (quoting Lugar v. Edmondson Oil Co., 457 17 U.S. 922, 937 (1982)). 18 Defendants Cremona and Unknown Roommate are private parties, not state actors. 19 Moreover, although private parties who are jointly engaged with state officials in the 20 challenged action are acting under color of law, Collins v. Womancare, 878 F.2d 1145, 21 1154 (9th Cir. 1989), Plaintiff has stated nothing in his Complaint to suggest that these 22 Defendants were jointly engaged with state officials in the challenged action. Moreover, 23 “merely complaining to the police does not convert a private party into a state actor.” Id. 24 at 1155 (internal citations omitted). Thus, the Court will dismiss Defendants Cremona and 25 Unknown Roommate. 26 B. Defendant Citrenbaum 27 Prosecutors are absolutely immune from liability for damages under § 1983 for their 28 conduct in “initiating a prosecution and in presenting the State’s case” insofar as that 1 conduct is “intimately associated with the judicial phase of the criminal process.” Buckley 2 v. Fitzsimmons, 509 U.S. 259, 270 (1993) (quoting Imbler v. Pachtman, 424 U.S. 409, 430- 3 31 (1976)). Immunity even extends to prosecutors for “eliciting false or defamatory 4 testimony from witnesses or for making false or defamatory statements during, and related 5 to, judicial proceedings.” Buckley, 509 U.S. at 270; see also Broam v. Bogan, 320 F.3d 6 1023, 1029-30 (9th Cir. 2003) (prosecutor absolutely immune from liability for failure to 7 investigate the accusations against a defendant before filing charges; for knowingly using 8 false testimony at trial; and for deciding not to preserve or turn over exculpatory material 9 before trial, during trial, or after conviction); Roe v. City & County of S.F., 109 F.3d 578, 10 583-84 (9th Cir. 1997) (absolute immunity for decision to prosecute or not to prosecute 11 and for professional evaluation of a witness and evidence assembled by the police). 12 Plaintiff claims Defendant Citrenbaum is liable for his decision not to prosecute 13 Defendant Cremona. Defendant Citrenbaum is immune from suit for such actions and the 14 Court will therefore dismiss him. See also Leeke v. Timmerman, 454 U.S. 83, 85-86 (1981) 15 (“a private citizen lacks a judicially cognizable interest in the prosecution or non- 16 prosecution of another”). 17 C. Defendants Hohrien and Grant 18 Plaintiff’s allegations against Defendants Hohrien and Grant are unclear. To the 19 extent Plaintiff alleges these Defendants refused to provide him with the name of his 20 attacker, he has not alleged how this violated his constitutional rights. Moreover, Plaintiff 21 states he received this information two weeks later via mail. 22 To the extent Plaintiff claims Defendants Hohrien and Grant violated his due 23 process rights by failing to investigate his claims or arrest Cremona, he fails to state a claim. 24 The Due Process Clause generally does not create an obligation on the state to protect 25 individuals from injury to life, liberty, or property caused by the acts of private parties. 26 DeShaney v. Winnebago County, 489 U.S. 189, 195-97 (1989). “The police have no 27 affirmative obligation to investigate a crime in a particular way or to protect one citizen 28 from another even when one citizen deprives the other of liberty or property.” Gini v. Las 1 Vegas Metropolitan Police Dept., 40 F.3d 1041, 1045 (9th Cir. 1994) (citing DeShaney, 2 489 U.S. at 195-96). Accordingly, the Court will dismiss these Defendants. 3 V. Leave to Amend 4 For the foregoing reasons, the Court will dismiss Plaintiff’s Complaint for failure to 5 state a claim upon which relief may be granted. Within 30 days, Plaintiff may submit a 6 first amended complaint to cure the deficiencies outlined above. Although Plaintiff is not 7 required to use the court-approved form, the Court will direct the Clerk of Court to send 8 Plaintiff a court-approved form to assist him in drafting a first amended complaint. 9 Plaintiff must clearly designate on the face of the document that it is the “First 10 Amended Complaint.” The first amended complaint must be retyped or rewritten in its 11 entirety on the court-approved form and may not incorporate any part of the original 12 Complaint by reference. Plaintiff may include only one claim per count. 13 A first amended complaint supersedes the original Complaint. Ferdik v. Bonzelet, 14 963 F.2d 1258, 1262 (9th Cir. 1992); Hal Roach Studios v. Richard Feiner & Co., 896 F.2d 15 1542, 1546 (9th Cir. 1990). After amendment, the Court will treat the original Complaint 16 as nonexistent. Ferdik, 963 F.2d at 1262. Any cause of action that was raised in the 17 original Complaint and that was voluntarily dismissed or was dismissed without prejudice 18 is waived if it is not alleged in a first amended complaint. Lacey v. Maricopa County, 693 19 F.3d 896, 928 (9th Cir. 2012) (en banc). 20 VI. Warnings 21 A. Address Changes 22 Plaintiff must file and serve a notice of a change of address in accordance with Rule 23 83.3(d) of the Local Rules of Civil Procedure. Plaintiff must not include a motion for other 24 relief with a notice of change of address. Failure to comply may result in dismissal of this 25 action. 26 B. Possible Dismissal 27 If Plaintiff fails to timely comply with every provision of this Order, including these 28 warnings, the Court may dismiss this action without further notice. See Ferdik, 963 F.2d 1| at 1260-61 (a district court may dismiss an action for failure to comply with any order of the Court). 3| ITIS ORDERED: 4 (1) Plaintiff's Application to Proceed In District Court Without Prepaying Fees or Costs (Doc. 2) is granted. 6 (2) Plaintiff's Motion for Status (Doc. 5) is granted to the extent this Order 7 | informs Plaintiff of the status of this case and denied with respect to all other relief 8 | requested. 9 (3) | The Complaint (Doc. 1) is dismissed for failure to state a claim. Plaintiff 10 | has 30 days from the date this Order is filed to file a first amended complaint in compliance 11 | with this Order. 12 (4) If Plaintiff fails to file an amended complaint within 30 days, the Clerk of 13 | Court must, without further notice, enter a judgment of dismissal of this action with prejudice and deny any pending unrelated motions as moot. 15 (5) | The Clerk of Court must mail Plaintiff a court-approved form for filing a civil rights complaint by a prisoner. 17 Dated this 6th day of October, 2023. 18 19 A 20 _ James A. Teil Org Senior United States District Judge 22 23 24 25 26 27 28

Instructions for a Prisoner Filing a Civil Rights Complaint in the United States District Court for the District of Arizona

1. Who May Use This Form. The civil rights complaint form is designed to help incarcerated persons prepare a complaint seeking relief for a violation of their federal civil rights. These complaints typically concern, but are not limited to, conditions of confinement. This form should not be used to challenge your conviction or sentence. If you want to challenge a state conviction or sentence, you should file a petition under 28 U.S.C. ' 2254 for a writ of habeas corpus by a person in state custody. If you want to challenge a federal conviction or sentence, you should file a motion under 28 U.S.C. § 2255 to vacate sentence in the federal court that entered the judgment.

2. The Form. Local Rule of Civil Procedure (LRCiv) 3.4 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.