1 WO ASH 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 8 9 Rick Valentini, No. CV 19-05608-PHX-MTL (DMF) 10 Plaintiff, 11 v. ORDER 12 David Shinn, et al., 13 Defendants.
14 15 On November 12, 2019, Plaintiff Rick Valentini, who is confined in the Arizona 16 State Prison Complex-Eyman, filed a pro se civil rights Complaint pursuant to 42 U.S.C. 17 § 1983 and an Application to Proceed In Forma Pauperis. In a January 15, 2020 Order, the 18 Court granted the Application to Proceed and dismissed the Complaint because Plaintiff 19 had failed to state a claim. The Court gave Plaintiff 30 days to file an amended complaint 20 that cured the deficiencies identified in the Order. 21 On January 22, 2020, Plaintiff filed his First Amended Complaint (Doc. 8). The 22 Court will dismiss the First Amended Complaint with leave to amend. 23 I. Statutory Screening of Prisoner Complaints 24 The Court is required to screen complaints brought by prisoners seeking relief 25 against a governmental entity or an officer or an employee of a governmental entity. 28 26 U.S.C. § 1915A(a). The Court must dismiss a complaint or portion thereof if a plaintiff 27 has raised claims that are legally frivolous or malicious, that fail to state a claim upon which 28 relief may be granted, or that seek monetary relief from a defendant who is immune from 1 such relief. 28 U.S.C. § 1915A(b)(1)–(2). 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 First Amended Complaint will be dismissed for failure to state a claim, but 26 because it may possibly be amended to state a claim, the Court will dismiss it with leave 27 to amend. 28 . . . . 1 II. First Amended Complaint 2 In his three-count First Amended Complaint, Plaintiff names 21 different 3 Defendants employed in various capacities by the Arizona Department of Corrections 4 (ADC). Plaintiff styles his claims as related to disciplinary proceedings, access to the 5 courts, and “defrauding [the] federal government.” Put broadly, Plaintiff alleges that he 6 received disciplinary tickets on six separate occasions for refusing to attend a Mandatory 7 Literacy class. In each instance, Plaintiff informed officials that he was exempt from the 8 class because he had received his G.E.D. in 1988 from the state of California. Plaintiff was 9 told each time that ADC did not accept G.E.D.’s from California, and that he was required 10 to attend the class. Plaintiff appealed each ticket, but they were all upheld, and Plaintiff 11 was sanctioned each time with 30 days in administrative segregation, the confiscation of 12 his property, an inability to attend religious services, and a change in custody status. 13 Plaintiff further alleges that ADC “receives $30,00 for each completed literacy test and 14 [ADC] wanted their money.” As relief, Plaintiff seeks to have all six tickets “removed,” 15 to have his custody status changed, to have his G.E.D. officially recognized, to be granted 16 a new clemency hearing, monetary relief, and punitive damages. 17 III. Failure to State a Claim 18 To prevail in a § 1983 claim, a plaintiff must show that (1) acts by the defendants 19 (2) under color of state law (3) deprived him of federal rights, privileges or immunities and 20 (4) caused him damage. Thornton v. City of St. Helens, 425 F.3d 1158, 1163-64 (9th Cir. 21 2005) (quoting Shoshone-Bannock Tribes v. Idaho Fish & Game Comm’n, 42 F.3d 1278, 22 1284 (9th Cir. 1994)). In addition, a plaintiff must allege that he suffered a specific injury 23 as a result of the conduct of a particular defendant and he must allege an affirmative link 24 between the injury and the conduct of that defendant. Rizzo v. Goode, 423 U.S. 362, 371- 25 72, 377 (1976). 26 A. “Defrauding [the] Federal Government” 27 Plaintiff has no standing to sue on behalf of the federal government. Accordingly, 28 the First Amended Complaint will be dismissed to the extent Plaintiff seeks relief for 1 “defrauding [the] federal government.” 2 B. Access to the Courts 3 The right of meaningful access to the courts prohibits officials from actively 4 interfering with inmates’ attempts to prepare or file legal documents. Lewis v. Casey, 518 5 U.S. 343, 350 (1996). The right of access to the courts is only a right to bring petitions or 6 complaints to federal court and not a right to discover such claims or even to ligate them 7 effectively once filed with a court. Id. at 354. The right “guarantees no particular 8 methodology but rather the conferral of a capability–the capability of bringing 9 contemplated challenges to sentences or conditions of confinement before the courts.” Id. 10 at 356. 11 As a matter of standing, for an access-to-courts claim, a plaintiff must show that he 12 suffered an “actual injury” with respect to contemplated litigation. Id. at 349. To show 13 actual injury with respect to contemplated litigation, the plaintiff must demonstrate that the 14 defendants’ conduct frustrated or impeded him from bringing to court a nonfrivolous claim 15 that he wished to present. Id. at 352-53. 16 “[T]he injury requirement is not satisfied by just any type of frustrated legal claim.” 17 Id. at 354. The right of access to the courts “does not guarantee inmates the wherewithal 18 to transform themselves into litigating engines capable of filing everything from 19 shareholder derivative actions to slip-and-fall claims.” Id. at 355. The nonfrivolous claim 20 must be a direct or collateral attack on the inmate’s sentence or a challenge to the conditions 21 of his confinement. Id. “Impairment of any other litigating capacity is simply one of the 22 incidental (and perfectly constitutional) consequences of conviction and incarceration.” Id. 23 (emphasis in original). 24 Here, however, Plaintiff has alleged no facts to support that any Defendant has 25 actively interfered with Plaintiff’s ability to prepare or file legal documents. Indeed, 26 Plaintiff does not allege that he even attempted to prepare or file any legal documents. 27 Accordingly, the First Amended Complaint will be dismissed to the extent that Plaintiff 28 seeks relief for the denial of any access to the courts. 1 C. Disciplinary Proceedings 2 In analyzing a due process claim with regard to disciplinary proceedings, the Court 3 must first decide whether Plaintiff was entitled to any process, and if so, whether he was 4 denied any constitutionally required procedural safeguard. Liberty interests which entitle 5 an inmate to due process are Agenerally limited to freedom from restraint which, while not 6 exceeding the sentence in such an unexpected manner as to give rise to protection by the 7 Due Process Clause of its own force, nonetheless imposes atypical and significant hardship 8 on the inmate in relation to the ordinary incidents of prison life.@ Sandin v. Conner, 515 9 U.S. 472, 484 (1995) (internal citations omitted). 10 Therefore, to determine whether an inmate is entitled to the procedural protections 11 afforded by the Due Process Clause, the Court must look to the particular restrictions 12 imposed and ask whether they A>present the type of atypical, significant deprivation in 13 which a state might conceivably create a liberty interest.=@ Mujahid v. Meyer, 59 F.3d 931, 14 932 (9th Cir. 1995) (quoting Sandin, 515 U.S. at 486). 15 To determine whether the sanctions are atypical and a significant hardship, courts 16 look to prisoner=s conditions of confinement, the duration of the sanction, and whether the 17 sanction will affect the duration of the prisoner=s sentence. See Keenan v. Hall, 83 F.3d 18 1083, 1088-89 (9th Cir. 1996). AAtypicality@ requires not merely an empirical comparison, 19 but turns on the importance of the right taken away from the prisoner. See Carlo v. City of 20 Chino, 105 F.3d 493, 499 (9th Cir. 1997); see, e.g., Sandin, 515 U.S. at 472 (30 days 21 disciplinary segregation is not atypical and significant); Torres v. Fauver, 292 F.3d 141, 22 151 (3rd Cir. 2002) (four months in administrative segregation is not atypical and 23 significant); Jacks v. Crabtree, 114 F.3d 983 (9th Cir. 1997) (denial of year sentence 24 reduction is not an atypical and significant hardship); Jones v. Baker, 155 F.3d 810 (6th 25 Cir. 1998) (two and one-half years of administrative segregation is not atypical and 26 significant); Griffin v. Vaughn, 112 F.3d 703, 706-708 (3rd Cir.1997) (fifteen months 27 administrative segregation is not atypical and significant); Beverati v. Smith, 120 F.3d 500, 28 504 (4th Cir. 1997) (six months of confinement in especially disgusting conditions that 1 were Amore burdensome than those imposed on the general prison population were not 2 Aatypical ... in relation to the ordinary incidents of prison life.@). 3 Here, none of the sanctions imposed on Plaintiff were atypical and significant. 4 Accordingly, Plaintiff has failed to state a due process claim with regard to his disciplinary 5 proceedings, and the First Amended Complaint will thus be dismissed. 6 IV. Leave to Amend 7 Within 30 days, Plaintiff may submit a second amended complaint to cure the 8 deficiencies outlined above. The Clerk of Court will mail Plaintiff a court-approved form 9 to use for filing a second amended complaint. If Plaintiff fails to use the court-approved 10 form, the Court may strike the second amended complaint and dismiss this action without 11 further notice to Plaintiff. 12 Plaintiff must clearly designate on the face of the document that it is the “Second 13 Amended Complaint.” The second amended complaint must be retyped or rewritten in its 14 entirety on the court-approved form and may not incorporate any part of the original 15 Complaint or First Amended Complaint by reference. Plaintiff may include only one claim 16 per count. 17 A second amended complaint supersedes the original Complaint and First Amended 18 Complaint. Ferdik v. Bonzelet, 963 F.2d 1258, 1262 (9th Cir. 1992); Hal Roach Studios v. 19 Richard Feiner & Co., 896 F.2d 1542, 1546 (9th Cir. 1990). After amendment, the Court 20 will treat the original Complaint and First Amended Complaint as nonexistent. Ferdik, 21 963 F.2d at 1262. Any cause of action that was raised in the original Complaint or First 22 Amended Complaint and that was voluntarily dismissed or was dismissed without 23 prejudice is waived if it is not alleged in a second amended complaint. Lacey v. Maricopa 24 County, 693 F.3d 896, 928 (9th Cir. 2012) (en banc). 25 V. Warnings 26 A. Release 27 If Plaintiff is released while this case remains pending, and the filing fee has not 28 been paid in full, Plaintiff must, within 30 days of his release, either (1) notify the Court 1 that he intends to pay the unpaid balance of his filing fee within 120 days of his release or 2 (2) file a non-prisoner application to proceed in forma pauperis. Failure to comply may 3 result in dismissal of this action. 4 B. Address Changes 5 If Plaintiff’s address changes, Plaintiff must file and serve a notice of a change of 6 address in accordance with Rule 83.3(d) of the Local Rules of Civil Procedure. Plaintiff 7 must not include a motion for other relief with a notice of change of address. Failure to 8 comply may result in dismissal of this action. 9 C. Possible “Strike” 10 Because the First Amended Complaint has been dismissed for failure to state a 11 claim, if Plaintiff fails to file a second amended complaint correcting the deficiencies 12 identified in this Order, the dismissal may count as a “strike” under the “3-strikes” 13 provision of 28 U.S.C. § 1915(g). Under the 3-strikes provision, a prisoner may not bring 14 a civil action or appeal a civil judgment in forma pauperis under 28 U.S.C. § 1915 “if the 15 prisoner has, on 3 or more prior occasions, while incarcerated or detained in any facility, 16 brought an action or appeal in a court of the United States that was dismissed on the 17 grounds that it is frivolous, malicious, or fails to state a claim upon which relief may be 18 granted, unless the prisoner is under imminent danger of serious physical injury.” 28 19 U.S.C. § 1915(g). 20 D. Possible Dismissal 21 If Plaintiff fails to timely comply with every provision of this Order, including these 22 warnings, the Court may dismiss this action without further notice. See Ferdik, 963 F.2d 23 at 1260-61 (a district court may dismiss an action for failure to comply with any order of 24 the Court). 25 IT IS ORDERED: 26 (1) The First Amended Complaint (Doc. 8) is dismissed for failure to state a 27 claim. Plaintiff has 30 days from the date this Order is filed to file a second amended 28 complaint in compliance with this Order. 1 (2) ‘If Plaintiff fails to file a second amended complaint within 30 days, the Clerk 2| of Court must, without further notice, enter a judgment of dismissal of this action with prejudice that states that the dismissal may count as a “strike” under 28 U.S.C. § 1915(g) 4| and deny any pending unrelated motions as moot. 5 (3) The Clerk of Court must mail Plaintiff a court-approved form for filing a 6| civil rights complaint by a prisoner. 7 Dated this 8th day of April, 2020. 8
Michak T. giburge Michael T. Liburdi 11 United States District Judge 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
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Instructions for a Prisoner Filing a Civil Rights Complaint in the United States District Court for the District of Arizona
1. Who May Use This Form. The civil rights complaint form is designed to help incarcerated persons prepare a complaint seeking relief for a violation of their federal civil rights. These complaints typically concern, but are not limited to, conditions of confinement. This form should not be used to challenge your conviction or sentence. If you want to challenge a state conviction or sentence, you should file a petition under 28 U.S.C. ' 2254 for a writ of habeas corpus by a person in state custody. If you want to challenge a federal conviction or sentence, you should file a motion under 28 U.S.C. § 2255 to vacate sentence in the federal court that entered the judgment.
2. The Form. Local Rule of Civil Procedure (LRCiv) 3.4(a) provides that complaints by incarcerated persons must be filed on the court-approved form. The form must be typed or neatly handwritten. The form must be completely filled in to the extent applicable. All questions must be answered clearly and concisely in the appropriate space on the form. If needed, you may attach additional pages, but no more than fifteen additional pages, of standard letter-sized paper. You must identify which part of the complaint is being continued and number all pages. If you do not fill out the form properly, you will be asked to submit additional or corrected information, which may delay the processing of your action. You do not need to cite law.
3. Your Signature. You must tell the truth and sign the form. If you make a false statement of a material fact, you may be prosecuted for perjury.
4. The Filing and Administrative Fees. The total fees for this action are $400.00 ($350.00 filing fee plus $50.00 administrative fee). If you are unable to immediately pay the fees, you may request leave to proceed in forma pauperis. Please review the “Information for Prisoners Seeking Leave to Proceed with a (Non-Habeas) Civil Action in Federal Court In Forma Pauperis Pursuant to 28 U.S.C. ' 1915” for additional instructions.
5. Original and Judge=s Copy. You must send an original plus one copy of your complaint and of any other documents submitted to the Court. You must send one additional copy to the Court if you wish to have a file-stamped copy of the document returned to you. All copies must be identical to the original. Copies may be legibly handwritten. This section does not apply to inmates housed at an Arizona Department of Corrections facility that participates in electronic filing.
6. Where to File. You should file your complaint in the division where you were confined when your rights were allegedly violated. See LRCiv 5.1(a) and 77.1(a). If you were confined in Maricopa, Pinal, Yuma, La Paz, or Gila County, file in the Phoenix Division. If you were confined in Apache, Navajo, Coconino, Mohave, or Yavapai County, file in the Prescott Division. If you were confined in Pima, Cochise, Santa Cruz, Graham, or Greenlee County, file in the Tucson Division. Mail the original and one copy of the complaint with the $400 filing and administrative fees or the application to proceed in forma pauperis to:
Revised 3/11/16 1 Phoenix & Prescott Divisions: OR Tucson Division: U.S. District Court Clerk U.S. District Court Clerk U.S. Courthouse, Suite 130 U.S. Courthouse, Suite 1500 401 West Washington Street, SPC 10 405 West Congress Street Phoenix, Arizona 85003-2119 Tucson, Arizona 85701-5010
7. Change of Address. You must immediately notify the Court and the defendants in writing of any change in your mailing address. Failure to notify the Court of any change in your mailing address may result in the dismissal of your case.
8. Certificate of Service. You must furnish the defendants with a copy of any document you submit to the Court (except the initial complaint and application to proceed in forma pauperis). Each original document (except the initial complaint and application to proceed in forma pauperis) must include a certificate of service on the last page of the document stating the date a copy of the document was mailed to the defendants and the address to which it was mailed. See Fed. R. Civ. P. 5(a), (d). Any document received by the Court that does not include a certificate of service may be stricken. This section does not apply to inmates housed at an Arizona Department of Corrections facility that participates in electronic filing. A certificate of service should be in the following form:
I hereby certify that a copy of the foregoing document was mailed this (month, day, year) to: Name: Address: Attorney for Defendant(s)
(Signature)
9. Amended Complaint. If you need to change any of the information in the initial complaint, you must file an amended complaint. The amended complaint must be written on the court-approved civil rights complaint form. You may file one amended complaint without leave (permission) of Court within 21 days after serving it or within 21 days after any defendant has filed an answer, whichever is earlier. See Fed. R. Civ. P. 15(a). Thereafter, you must file a motion for leave to amend and lodge (submit) a proposed amended complaint. LRCiv 15.1. In addition, an amended complaint may not incorporate by reference any part of your prior complaint. LRCiv 15.1(a)(2). Any allegations or defendants not included in the amended complaint are considered dismissed. All amended complaints are subject to screening under the Prison Litigation Reform Act; screening your amendment will take additional processing time.
10. Exhibits. You should not submit exhibits with the complaint or amended complaint. Instead, the relevant information should be paraphrased. You should keep the exhibits to use to support or oppose a motion to dismiss, a motion for summary judgment, or at trial.
11. Letters and Motions. It is generally inappropriate to write a letter to any judge or the staff of any judge. The only appropriate way to communicate with the Court is by filing a written pleading or motion. 12. Completing the Civil Rights Complaint Form.
HEADING: 1. Your Name. Print your name, prison or inmate number, and institutional mailing address on the lines provided.
2. Defendants. If there are four or fewer defendants, print the name of each. If you name more than four defendants, print the name of the first defendant on the first line, write the words “and others” on the second line, and attach an additional page listing the names of all of the defendants. Insert the additional page after page 1 and number it “1-A” at the bottom.
3. Jury Demand. If you want a jury trial, you must write “JURY TRIAL DEMANDED” in the space below “CIVIL RIGHTS COMPLAINT BY A PRISONER.” Failure to do so may result in the loss of the right to a jury trial. A jury trial is not available if you are seeking only injunctive relief.
Part A. JURISDICTION: 1. Nature of Suit. Mark whether you are filing the complaint pursuant to 42 U.S.C. ' 1983 for state, county, or city defendants; “Bivens v. Six Unknown Federal Narcotics Agents” for federal defendants; or “other.” If you mark “other,” identify the source of that authority.
2. Location. Identify the institution and city where the alleged violation of your rights occurred.
3. Defendants. Print all of the requested information about each of the defendants in the spaces provided. If you are naming more than four defendants, you must provide the necessary information about each additional defendant on separate pages labeled “2-A,” “2-B,” etc., at the bottom. Insert the additional page(s) immediately behind page 2.
Part B. PREVIOUS LAWSUITS: You must identify any other lawsuit you have filed in either state or federal court while you were a prisoner. Print all of the requested information about each lawsuit in the spaces provided. If you have filed more than three lawsuits, you must provide the necessary information about each additional lawsuit on a separate page. Label the page(s) as “2-A,” “2-B,” etc., at the bottom of the page and insert the additional page(s) immediately behind page 2.
Part C. CAUSE OF ACTION: You must identify what rights each defendant violated. The form provides space to allege three separate counts (one violation per count). If you are alleging more than three counts, you must provide the necessary information about each additional count on a separate page. Number the additional pages “5-A,” “5-B,” etc., and insert them immediately behind page 5. Remember that you are limited to a total of fifteen additional pages. 1. Counts. You must identify which civil right was violated. You may allege the violation of only one civil right per count.
2. Issue Involved. Check the box that most closely identifies the issue involved in your claim. You may check only one box per count. If you check the box marked “Other,” you must identify the specific issue involved.
3. Supporting Facts. After you have identified which civil right was violated, you must state the supporting facts. Be as specific as possible. You must state what each individual defendant did to violate your rights. If there is more than one defendant, you must identify which defendant did what act. You also should state the date(s) on which the act(s) occurred, if possible.
4. Injury. State precisely how you were injured by the alleged violation of your rights.
5. Administrative Remedies. You must exhaust any available administrative remedies before you file a civil rights complaint. See 42 U.S.C. § 1997e. Consequently, you should disclose whether you have exhausted the inmate grievance procedures or administrative appeals for each count in your complaint. If the grievance procedures were not available for any of your counts, fully explain why on the lines provided.
Part D. REQUEST FOR RELIEF: Print the relief you are seeking in the space provided.
SIGNATURE: You must sign your name and print the date you signed the complaint. Failure to sign the complaint will delay the processing of your action. Unless you are an attorney, you may not bring an action on behalf of anyone but yourself.
FINAL NOTE
You should follow these instructions carefully. Failure to do so may result in your complaint being stricken or dismissed. All questions must be answered concisely in the proper space on the form. If you need more space, you may attach no more than fifteen additional pages. But the form must be completely filled in to the extent applicable. If you attach additional pages, be sure to identify which section of the complaint is being continued and number the pages.
4 ___________________________________________ Name and Prisoner/Booking Number ___________________________________________ Place of Confinement ___________________________________________ Mailing Address ___________________________________________ City, State, Zip Code (Failure to notify the Court of your change of address may result in dismissal of this action.)
IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF ARIZONA
_________________________________________ , (Full Name of Plaintiff) ) Plaintiff, v. CASE NO. __________________________________ (To be supplied by the Clerk) (1) _______________________________________ ,
(Full Name of Defendant) CIVIL RIGHTS COMPLAINT (2) _______________________________________ , BY A PRISONER
(3) _______________________________________ , G Original Complaint (4) _______________________________________ , G First Amended Complaint G Second Amended Complaint Defendant(s).
G Check if there are additional Defendants and attach page 1-A listing them.
A. JURISDICTION
1. This Court has jurisdiction over this action pursuant to: G 28 U.S.C. § 1343(a); 42 U.S.C. § 1983 G 28 U.S.C. § 1331; Bivens v. Six Unknown Federal Narcotics Agents, 403 U.S. 388 (1971). G Other: .
2. Institution/city where violation occurred: .
550/555 B. DEFENDANTS
1. Name of first Defendant: . The first Defendant is employed as: ______________________________________________ at_______________________________________. (Position and Title) (Institution)
2. Name of second Defendant: . The second Defendant is employed as: as: ______________________________________________ at_______________________________________. (Position and Title) (Institution)
3. Name of third Defendant: . The third Defendant is employed as: ______________________________________________ at_______________________________________. (Position and Title) (Institution)
4. Name of fourth Defendant: . The fourth Defendant is employed as: ______________________________________________ at_______________________________________. (Position and Title) (Institution)
If you name more than four Defendants, answer the questions listed above for each additional Defendant on a separate page.
C. PREVIOUS LAWSUITS
1. Have you filed any other lawsuits while you were a prisoner? G Yes G No
2. If yes, how many lawsuits have you filed? . Describe the previous lawsuits:
a. First prior lawsuit: 1. Parties: v. 2. Court and case number: . 3. Result: (Was the case dismissed? Was it appealed? Is it still pending?) .
b. Second prior lawsuit: 1. Parties: v. 2. Court and case number: . 3. Result: (Was the case dismissed? Was it appealed? Is it still pending?) .
c. Third prior lawsuit: 1. Parties: v. 2. Court and case number: . 3. Result: (Was the case dismissed? Was it appealed? Is it still pending?) .
If you filed more than three lawsuits, answer the questions listed above for each additional lawsuit on a separate page. 2 D. CAUSE OF ACTION
COUNT I 1. State the constitutional or other federal civil right that was violated: .
2. Count I. Identify the issue involved. Check only one. State additional issues in separate counts. G Basic necessities G Mail G Access to the court G Medical care G Disciplinary proceedings G Property G Exercise of religion G Retaliation G Excessive force by an officer G Threat to safety G Other: .
3. Supporting Facts. State as briefly as possible the FACTS supporting Count I. Describe exactly what each Defendant did or did not do that violated your rights. State the facts clearly in your own words without citing legal authority or arguments.
.
4. Injury. State how you were injured by the actions or inactions of the Defendant(s).
5. Administrative Remedies: a. Are there any administrative remedies (grievance procedures or administrative appeals) available at your institution? G Yes G No b. Did you submit a request for administrative relief on Count I? G Yes G No c. Did you appeal your request for relief on Count I to the highest level? G Yes G No d. If you did not submit or appeal a request for administrative relief at any level, briefly explain why you did not. . COUNT II 1. State the constitutional or other federal civil right that was violated: .
2. Count II. Identify the issue involved. Check only one. State additional issues in separate counts. G Basic necessities G Mail G Access to the court G Medical care G Disciplinary proceedings G Property G Exercise of religion G Retaliation G Excessive force by an officer G Threat to safety G Other: .
3. Supporting Facts. State as briefly as possible the FACTS supporting Count II. Describe exactly what each Defendant did or did not do that violated your rights. State the facts clearly in your own words without citing legal authority or arguments.
4. Injury. State how you were injured by the actions or inactions of the Defendant(s).
5. Administrative Remedies. a. Are there any administrative remedies (grievance procedures or administrative appeals) available at your institution? G Yes G No b. Did you submit a request for administrative relief on Count II? G Yes G No c. Did you appeal your request for relief on Count II to the highest level? G Yes G No d. If you did not submit or appeal a request for administrative relief at any level, briefly explain why you did not. . COUNT III 1. State the constitutional or other federal civil right that was violated: .
2. Count III. Identify the issue involved. Check only one. State additional issues in separate counts. G Basic necessities G Mail G Access to the court G Medical care G Disciplinary proceedings G Property G Exercise of religion G Retaliation G Excessive force by an officer G Threat to safety G Other: .
3. Supporting Facts. State as briefly as possible the FACTS supporting Count III. Describe exactly what each Defendant did or did not do that violated your rights. State the facts clearly in your own words without citing legal authority or arguments.
4. Injury. State how you were injured by the actions or inactions of the Defendant(s).
5. Administrative Remedies. a. Are there any administrative remedies (grievance procedures or administrative appeals) available at your institution? G Yes G No b. Did you submit a request for administrative relief on Count III? G Yes G No c. Did you appeal your request for relief on Count III to the highest level? G Yes G No d. If you did not submit or appeal a request for administrative relief at any level, briefly explain why you did not. .
If you assert more than three Counts, answer the questions listed above for each additional Count on a separate page. E. REQUEST FOR RELIEF
State the relief you are seeking:
I declare under penalty of perjury that the foregoing is true and correct.
Executed on DATE SIGNATURE OF PLAINTIFF
___________________________________________ (Name and title of paralegal, legal assistant, or other person who helped prepare this complaint)
___________________________________________ (Signature of attorney, if any)
___________________________________________ (Attorney=s address & telephone number)
ADDITIONAL PAGES
All questions must be answered concisely in the proper space on the form. If you need more space, you may attach no more than fifteen additional pages. But the form must be completely filled in to the extent applicable. If you attach additional pages, be sure to identify which section of the complaint is being continued and number all pages.