1 KM 2 WO 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 8 9 Randale Joseph Thomas, No. CV-25-03689-PHX-JAT (JZB) 10 Plaintiff, 11 v. ORDER 12 Jerry Sheridan, et al., 13 Defendants.
15 Self-represented Plaintiff Randale Joseph Thomas, who is confined in a Maricopa 16 County Jail, has filed a civil rights Complaint pursuant to 42 U.S.C. § 1983 (Doc. 1) and 17 an Application to Proceed In Forma Pauperis (Doc. 2). The Court will dismiss the 18 Complaint with leave to amend. 19 I. Application to Proceed In Forma Pauperis and Filing Fee 20 The Court will grant Plaintiff’s Application to Proceed In Forma Pauperis. 28 21 U.S.C. § 1915(a). Plaintiff must pay the statutory filing fee of $350.00. 28 U.S.C. 22 § 1915(b)(1). The Court will assess an initial partial filing fee of $69.17. The remainder 23 of the fee will be collected monthly in payments of 20% of the previous month’s income 24 credited to Plaintiff’s trust account each time the amount in the account exceeds $10.00. 25 28 U.S.C. § 1915(b)(2). The Court will enter a separate Order requiring the appropriate 26 government agency to collect and forward the fees according to the statutory formula. 27 . . . . 28 . . . . 1 II. Statutory Screening of Prisoner Complaints 2 The Court is required to screen complaints brought by prisoners seeking relief 3 against a governmental entity or an officer or an employee of a governmental entity. 28 4 U.S.C. § 1915A(a). The Court must dismiss a complaint or portion thereof if a plaintiff 5 has raised claims that are legally frivolous or malicious, fail to state a claim upon which 6 relief may be granted, or seek monetary relief from a defendant who is immune from such 7 relief. 28 U.S.C. § 1915A(b)(1)–(2). 8 A pleading must contain a “short and plain statement of the claim showing that the 9 pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2) (emphasis added). While Rule 8 does 10 not demand detailed factual allegations, “it demands more than an unadorned, the- 11 defendant-unlawfully-harmed-me accusation.” Ashcroft v. Iqbal, 556 U.S. 662, 678 12 (2009). “Threadbare recitals of the elements of a cause of action, supported by mere 13 conclusory statements, do not suffice.” Id. 14 “[A] complaint must contain sufficient factual matter, accepted as true, to ‘state a 15 claim to relief that is plausible on its face.’” Id. (quoting Bell Atlantic Corp. v. Twombly, 16 550 U.S. 544, 570 (2007)). A claim is plausible “when the plaintiff pleads factual content 17 that allows the court to draw the reasonable inference that the defendant is liable for the 18 misconduct alleged.” Id. “Determining whether a complaint states a plausible claim for 19 relief [is] . . . a context-specific task that requires the reviewing court to draw on its judicial 20 experience and common sense.” Id. at 679. Thus, although a plaintiff’s specific factual 21 allegations may be consistent with a constitutional claim, a court must assess whether there 22 are other “more likely explanations” for a defendant’s conduct. Id. at 681. 23 But as the United States Court of Appeals for the Ninth Circuit has instructed, courts 24 must “continue to construe [self-represented litigant’s] filings liberally.” Hebbe v. Pliler, 25 627 F.3d 338, 342 (9th Cir. 2010). A “complaint [filed by a self-represented prisoner] 26 ‘must be held to less stringent standards than formal pleadings drafted by lawyers.’” Id. 27 (quoting Erickson v. Pardus, 551 U.S. 89, 94 (2007) (per curiam)). 28 1 If the Court determines that a pleading could be cured by the allegation of other 2 facts, a self-represented litigant is entitled to an opportunity to amend a complaint before 3 dismissal of the action. See Lopez v. Smith, 203 F.3d 1122, 1127-29 (9th Cir. 2000) (en 4 banc). The Court will dismiss Plaintiff’s Complaint for failure to state a claim, but because 5 it may possibly be amended to state a claim, the Court will dismiss it with leave to amend. 6 III. Complaint 7 Plaintiff names Defendants Maricopa County Sheriff Jerry Sheridan, Detention 8 Officer Unknown Mackey, and Inmate Legal Services Officer Purdy in his one-count 9 Complaint. Plaintiff seeks monetary damages. 10 Plaintiff alleges Defendants violated his Fourteenth Amendment rights when they 11 denied him access to the courts. On November 9, 2024, Plaintiff gave Defendant Mackey 12 a “motion for sanction disclosure” to be submitted to Inmate Legal Services. Defendant 13 Mackey counted the pages in the motion, signed the Inmate Legal Request, and gave 14 Plaintiff the yellow copy of the request. A few days later, Inmate Legal Services sent the 15 motion back to Plaintiff and explained they could not file the motion because pages were 16 missing. Plaintiff wrote to Inmate Legal Services and said all of the pages were included 17 and Defendant Mackey had counted them and “signed off.” Inmate Legal Services 18 responded, “that was all they got and pages were missing.” Plaintiff filed a grievance and 19 asked for the missing pages. He received replies saying, “they didn’t know w[h]ere [his] 20 missing pages [were] and that they couldn’t do [anything].” A week before this incident, 21 Plaintiff filed a notice with the state court stating that during a search, the Special Response 22 Team, “Phoenix Police, MCSO Detention Officers, and Jail intelligence declared they were 23 inspecting . . . cells for contraband but ended up taking legal documents.” 24 Plaintiff alleges Defendant Sheridan “is the final decision and policy maker for the 25 Maricopa County Sheriff’s Office” and his “failure to properly train and supervise his 26 employees resulted in a violation of [Plaintiff’s] constitutional rights through their 27 unprofessional mishandling and misplacing [of Plaintiff’s] legal documents.” He claims 28 1 Defendant Sheridan’s employees “did not follow any type of policy or procedures” 2 regarding collection and delivery of inmates’ legal documents for filing. 3 As his injury, Plaintiff states that “due to the fact that [his] motion wasn’t filed they 4 deprived [him] of [his] due process to be able to have access to the discovery [he] 5 requested.” 6 IV. Failure to State a Claim 7 A. Access to Courts 8 The right of meaningful access to the courts prohibits officials from actively 9 interfering with inmates’ attempts to prepare or file legal documents. Lewis v. Casey, 518 10 U.S. 343, 350 (1996). The right of access to the courts is only a right to bring petitions or 11 complaints to federal court and not a right to discover such claims or even to litigate them 12 effectively once filed with a court. Id. at 354. The right “guarantees no particular 13 methodology but rather the conferral of a capability–the capability of bringing 14 contemplated challenges to sentences or conditions of confinement before the courts.” Id. 15 at 356. 16 As a matter of standing, for an access-to-courts claim, a plaintiff must show that he 17 suffered an “actual injury” with respect to contemplated litigation. Id. at 349. To show 18 actual injury with respect to contemplated litigation, the plaintiff must demonstrate that the 19 defendants’ conduct frustrated or impeded him from bringing to court a nonfrivolous claim 20 that he wished to present. Id. at 352-53. 21 “[T]he injury requirement is not satisfied by just any type of frustrated legal claim.” 22 Id. at 354. The right of access to the courts “does not guarantee inmates the wherewithal 23 to transform themselves into litigating engines capable of filing everything from 24 shareholder derivative actions to slip-and-fall claims.” Id. at 355. The nonfrivolous claim 25 must be a direct or collateral attack on the inmate’s sentence or a challenge to the conditions 26 of his confinement. Id. “Impairment of any other litigating capacity is simply one of the 27 incidental (and perfectly constitutional) consequences of conviction and incarceration.” Id. 28 (emphasis in original). 1 Further, “the Due Process Clause [of the Fourteenth Amendment] is simply not 2 implicated by a negligent act of an official causing unintended loss or injury to life, liberty, 3 or property.” Daniels v. Williams, 474 U.S. 327, 328 (1986) (emphasis in original). 4 Plaintiff alleges that because Inmate Legal Services did not file his incomplete 5 motion, he was unable to “have access to the discovery [he] requested.” Plaintiff has not 6 alleged he was prevented from filing a non-frivolous claim, nor has he explained why he 7 was unable to simply resubmit his complete motion to Inmate Legal Services for filing 8 after being notified that pages were missing. 9 With respect to Defendant Purdy, Plaintiff alleges no facts regarding Defendant 10 Purdy and therefore fails to state a claim against this Defendant. 11 Plaintiff’s only allegation regarding Defendant Mackey is that Mackey received 12 Plaintiff’s motion, counted the number of pages, and gave Plaintiff a receipt for the motion. 13 Plaintiff does not allege any facts showing Defendant Mackey was responsible for the lost 14 pages in Plaintiff’s motion. Accordingly, Plaintiff has failed to state an access-to-the-court 15 claim. 16 B. Failure to Train 17 To state a claim based on a failure to train or supervise, a plaintiff must allege facts 18 to support that the alleged failure amounted to deliberate indifference. Canell v. Lightner, 19 143 F.3d 1210, 1213 (9th Cir. 1998). A plaintiff must allege facts to support that not only 20 was particular training or supervision inadequate, but also that such inadequacy was the 21 result of “a ‘deliberate’ or ‘conscious’ choice” on the part of the defendant. Id. at 1213- 22 14; see Clement v. Gomez, 298 F.3d 898, 905 (9th Cir. 2002) (a plaintiff must allege facts 23 to support that “in light of the duties assigned to specific officers or employees, the need 24 for more or different training is obvious, and the inadequacy so likely to result in violations 25 of constitutional rights, that the policy[]makers . . . can reasonably be said to have been 26 deliberately indifferent to the need.” (quoting City of Canton v. Harris, 489 U.S. 378, 390 27 (1989))). A plaintiff must also show a “sufficient causal connection between the 28 1 supervisor’s wrongful conduct and the constitutional violation.” Redman v. County of San 2 Diego, 942 F.2d 1435, 1446 (9th Cir. 1991) (citations omitted). 3 Plaintiff makes the conclusory allegation that Defendant Sheridan’s failure to 4 properly train and supervise employees resulted in the violation of Plaintiff’s constitutional 5 rights, but Plaintiff alleges no facts showing a particular training or supervision was 6 inadequate, or that such inadequacy was the result of a deliberate or conscious choice of 7 Defendant Sheridan. Plaintiff has there for failed to state a claim against Defendant 8 Sheridan. 9 V. Leave to Amend 10 For the foregoing reasons, the Court will dismiss Plaintiff’s Complaint for failure to 11 state a claim upon which relief may be granted. Within 30 days, Plaintiff may submit a 12 first amended complaint to cure the deficiencies outlined above. The Clerk of Court will 13 mail Plaintiff a court-approved form to use for filing a first amended complaint. If Plaintiff 14 fails to use the court-approved form, the Court may strike the amended complaint and 15 dismiss this action without further notice to Plaintiff. 16 Plaintiff must clearly designate on the face of the document that it is the “First 17 Amended Complaint.” The first amended complaint must be retyped or rewritten in its 18 entirety on the court-approved form and may not incorporate any part of the original 19 Complaint by reference. Plaintiff may include only one claim per count. 20 A first amended complaint supersedes the original Complaint. Ferdik v. Bonzelet, 21 963 F.2d 1258, 1262 (9th Cir. 1992); Hal Roach Studios v. Richard Feiner & Co., 896 F.2d 22 1542, 1546 (9th Cir. 1990). After amendment, the Court will treat the original Complaint 23 as nonexistent. Ferdik, 963 F.2d at 1262. Any cause of action that was raised in the 24 original Complaint and that was voluntarily dismissed or was dismissed without prejudice 25 is waived if it is not alleged in a first amended complaint. Lacey v. Maricopa County, 693 26 F.3d 896, 928 (9th Cir. 2012) (en banc). 27 If Plaintiff files an amended complaint, Plaintiff must write short, plain statements 28 telling the Court: (1) the constitutional right Plaintiff believes was violated; (2) the name 1 of the Defendant who violated the right; (3) exactly what that Defendant did or failed to 2 do; (4) how the action or inaction of that Defendant is connected to the violation of 3 Plaintiff’s constitutional right; and (5) what specific injury Plaintiff suffered because of 4 that Defendant’s conduct. See Rizzo v. Goode, 423 U.S. 362, 371-72, 377 (1976). 5 Plaintiff must repeat this process for each person he names as a Defendant. If 6 Plaintiff fails to affirmatively link the conduct of each named Defendant with the specific 7 injury suffered by Plaintiff, the allegations against that Defendant will be dismissed for 8 failure to state a claim. Conclusory allegations that a Defendant or group of 9 Defendants has violated a constitutional right are not acceptable and will be 10 dismissed. 11 VI. Warnings 12 A. Release 13 If Plaintiff is released while this case remains pending, and the filing fee has not 14 been paid in full, Plaintiff must, within 30 days of his release, either (1) notify the Court 15 that he intends to pay the unpaid balance of his filing fee within 120 days of his release or 16 (2) file a non-prisoner application to proceed in forma pauperis. Failure to comply may 17 result in dismissal of this action. 18 B. Address Changes 19 Plaintiff must file and serve a notice of a change of address in accordance with Rule 20 83.3(d) of the Local Rules of Civil Procedure. Plaintiff must not include a motion for other 21 relief with a notice of change of address. Failure to comply may result in dismissal of this 22 action. 23 C. Possible “Strike” 24 Because the Complaint has been dismissed for failure to state a claim, if Plaintiff 25 fails to file an amended complaint correcting the deficiencies identified in this Order, the 26 dismissal may count as a “strike” under the “3-strikes” provision of 28 U.S.C. § 1915(g). 27 Under the 3-strikes provision, a prisoner may not bring a civil action or appeal a civil 28 judgment in forma pauperis under 28 U.S.C. § 1915 “if the prisoner has, on 3 or more prior occasions, while incarcerated or detained in any facility, brought an action or appeal in a court of the United States that was dismissed on the grounds that it is frivolous, malicious, or fails to state a claim upon which relief may be granted, unless the prisoner is under imminent danger of serious physical injury.” 28 U.S.C. § 1915(g). 5 D. Possible Dismissal 6 If Plaintiff fails to timely comply with every provision of this Order, including these 7 | warnings, the Court may dismiss this action without further notice. See Ferdik, 963 F.2d 8 | at 1260-61 (a district court may dismiss an action for failure to comply with any order of 9| the Court). 10} ITIS ORDERED: 11 (1) Plaintiff’s Application to Proceed In Forma Pauperis (Doc. 2) is granted. 12 (2) As required by the accompanying Order to the appropriate government 13 | agency, Plaintiff must pay the $350.00 filing fee and is assessed an initial partial filing fee 14| of $69.17. 15 (3) The Complaint (Doc. 1) is dismissed for failure to state a claim. Plaintiff has 30 days from the date this Order is filed to file a first amended complaint in compliance 17 | with this Order. 18 (4) — If Plaintiff fails to file an amended complaint within 30 days, the Clerk of Court must, without further notice, enter a judgment of dismissal of this action with 20 | prejudice that states that the dismissal may count as a “strike” under 28 U.S.C. § 1915(g) 21 and deny any pending unrelated motions as moot. 22 (5) The Clerk of Court must mail Plaintiff court-approved form for filing a civil 23 | rights complaint by a prisoner. 24 Dated this 5th day of December, 2025. 25
27 28 _ James A. Teil Org Senior United States District Judge
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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 $405.00 ($350.00 filing fee plus $55.00 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. Unless you are an inmate housed at an Arizona Department of Corrections facility that participates in electronic filing, mail the original and one copy of the complaint with the $405 filing and administrative fees or the application to proceed in forma pauperis to:
1 Revised 11/6/24 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. 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.