Valenzuela v. Monson

• Court: District Court, D. Arizona
• Decided: March 2, 2020
• Docket: 2:19-cv-05162
• Status: Unknown

Opinion

1 WO KM 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 8 9 Melinda Gabriella Valenzuela, No. CV 19-05162-PHX-MTL (MHB) 10 Plaintiff, 11 v. ORDER 12 Jason Monson, et al., 13 Defendants.

14 15 On September 12, 2019, Plaintiff Melinda Gabriella Valenzuela,1 who is confined 16 in the Arizona State Prison Complex-Florence, filed a “Motion for Leave to File Pursuant 17 to Court Order,” lodged a pro se civil rights Complaint pursuant to 42 U.S.C. § 1983, and 18 filed an Application to Proceed In Forma Pauperis. On September 12 and 13, and October 19 3 and 11, 2019, Plaintiff filed Motions to File Exhibits Under Seal and attached relevant 20 exhibits. In a December 23, 2019 Order, the Court granted the Motion to File, the 21 Application to Proceed In Forma Pauperis, and the Motions to File Exhibits Under Seal; 22 directed the Clerk of Court file the Complaint; and dismissed the Complaint with leave to 23 amend. 24 On January 29, 2020, Plaintiff filed a Motion for Leave to File Amended 25 Complaint (Doc. 19) and a First Amended Complaint (Doc. 20). On February 13, 2020, 26 Plaintiff filed a Motion for Emergency Removal (Doc. 21) and an “Expedited Motion for 27 28 1 Plaintiff has also filed Complaints under the names Enrique Gabrielle Mendez, Enrique Mendez-Valenzuela, and Quennell Glover. Plaintiff is biologically male, but identifies as female and uses feminine pronouns to reference herself. 1 Emergency Injunction” (Doc. 22). The Court will grant the Motion for Leave to File, 2 dismiss the First Amended Complaint with leave to amend, and deny the Motions for 3 Emergency Removal and Emergency Injunction. 4 I. Statutory Screening of Prisoner Complaints 5 The Court is required to screen complaints brought by prisoners seeking relief 6 against a governmental entity or an officer or an employee of a governmental entity. 28 7 U.S.C. § 1915A(a). The Court must dismiss a complaint or portion thereof if a plaintiff 8 has raised claims that are legally frivolous or malicious, that fail to state a claim upon which 9 relief may be granted, or that seek monetary relief from a defendant who is immune from 10 such relief. 28 U.S.C. § 1915A(b)(1)–(2). 11 A pleading must contain a “short and plain statement of the claim showing that the 12 pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2) (emphasis added). While Rule 8 does 13 not demand detailed factual allegations, “it demands more than an unadorned, the- 14 defendant-unlawfully-harmed-me accusation.” Ashcroft v. Iqbal, 556 U.S. 662, 678 15 (2009). “Threadbare recitals of the elements of a cause of action, supported by mere 16 conclusory statements, do not suffice.” Id. 17 “[A] complaint must contain sufficient factual matter, accepted as true, to ‘state a 18 claim to relief that is plausible on its face.’” Id. (quoting Bell Atlantic Corp. v. Twombly, 19 550 U.S. 544, 570 (2007)). A claim is plausible “when the plaintiff pleads factual content 20 that allows the court to draw the reasonable inference that the defendant is liable for the 21 misconduct alleged.” Id. “Determining whether a complaint states a plausible claim for 22 relief [is] . . . a context-specific task that requires the reviewing court to draw on its judicial 23 experience and common sense.” Id. at 679. Thus, although a plaintiff’s specific factual 24 allegations may be consistent with a constitutional claim, a court must assess whether there 25 are other “more likely explanations” for a defendant’s conduct. Id. at 681. 26 But as the United States Court of Appeals for the Ninth Circuit has instructed, courts 27 must “continue to construe pro se filings liberally.” Hebbe v. Pliler, 627 F.3d 338, 342 28 (9th Cir. 2010). A “complaint [filed by a pro se prisoner] ‘must be held to less stringent 1 standards than formal pleadings drafted by lawyers.’” Id. (quoting Erickson v. Pardus, 551 2 U.S. 89, 94 (2007) (per curiam)). 3 If the Court determines that a pleading could be cured by the allegation of other 4 facts, a pro se litigant is entitled to an opportunity to amend a complaint before dismissal 5 of the action. See Lopez v. Smith, 203 F.3d 1122, 1127-29 (9th Cir. 2000) (en banc). 6 Plaintiff’s First Amended Complaint will be dismissed for failure to state a claim, but 7 because it may possibly be amended to state a claim, the Court will dismiss it with leave 8 to amend. 9 II. First Amended Complaint 10 Plaintiff names 43 Defendants in her three-count First Amended Complaint and 11 seeks injunctive relief and money damages. 12 In Count One, Plaintiff claims that from April 2019 to present, Defendants Monson, 13 Evans, Jensen, Van Winkle, and Coleman have failed to protect her from assaults by other 14 inmates. Plaintiff alleges she was “sexually assaulted/harassed by CO II Amezquita, 15 Miller[,] Medley, Reyes, Rodriguez, Jensen, Evens[,] and [illegible] and nothing is done 16 or was done to address the issues[,] and sexually assaulted by [illegible] Angel, 17 Montgomery, Valles, Connolly, Alvarez and nothing was done when she reported these 18 sexual assaults and threats.” Plaintiff further claims “Able, Dr. Pelton, Dr. Calcote would 19 not do anything when she reported directly to them the assaults [that] took place, they 20 instead allowed the assaults to take place and did nothing to help protect [Plaintiff from] 21 the assaults.” 22 In Count Two, Plaintiff alleges that from April 2019 to present, she “personally told 23 DW Monson, Jensen, Hetrick, Van Winkle, Barnes, Gurrola, Suckle, Coleman, Renault, 24 Repp, Kelly, [and] Ordaz that she has been threatened with bodily harm by I/M Breslin 25 who said he was gonna smash Plaintiff meaning beat her down.” Plaintiff claims “they let 26 people spit on [her] and let people threaten [her] daily and they do nothing to address the 27 issues or assaults.” 28 . . . . 1 In Count Three, Plaintiff claims that “from 2016 to present[,] Plaintiff continues to 2 be assaulted, threatened by the following[:] Goodman, Davis, Miller, Jones, Harris, 3 Amezquita, Camp, Chavez, Lenos, Velasquez, Castillo, [illegible], Moses, Galvan, 4 Pascarelli, Garcia, Ordaz, Kelly, Castro, Repp, Medley, Reyes, Gurrola, Renault, Coleman, 5 [illegible], Hamilton, Jensen, [and] Evans.” She contends “they personally sexually & 6 physically assaulted Plaintiff and she wrote and told DW Monson and DWOP Barnes and 7 they did nothing about the assaults.” 8 III. Failure to State a Claim 9 A prison official violates the Eighth Amendment in failing to protect one inmate 10 from another only when two conditions are met. First, the alleged constitutional 11 deprivation must be, objectively, “sufficiently serious;” the official’s act or omission must 12 result in the denial of “the minimal civilized measure of life=s necessities.” Farmer v. 13 Brennan, 511 U.S. 825, 834 (1994). Second, the prison official must have a “sufficiently 14 culpable state of mind,” i.e., he must act with deliberate indifference to inmate health or 15 safety. Id. In defining “deliberate indifference” in this context, the Supreme Court has 16 imposed a subjective test: “the official must both be aware of the facts from which the 17 inference could be drawn that a substantial risk of serious harm exists, and he must also 18 draw the inference.” Id. at 839 (emphasis supplied). 19 Plaintiff has not alleged sufficient facts to show that each of the 43 named 20 Defendants was deliberately indifferent to a substantial risk of harm to Plaintiff. Plaintiff 21 alleges “they,” or large groups of defendants, “did nothing,” without any factual specificity 22 as to what any particular Defendant did or failed to do. This is insufficient. See Marcilis 23 v. Township of Redford, 693 F.3d 589, 596 (6th Cir. 2012) (upholding dismissal of Bivens 24 complaint that referred to all defendants “generally and categorically” because the plaintiff 25 had failed to “‘allege, with particularity, facts that demonstrate what each defendant did to 26 violate the asserted constitutional right.’” (quoting Lanman v. Hinson, 529 F.3d 673, 684 27 (6th Cir. 2008))); Robbins v. Oklahoma, 519 F.3d 1242, 1250 (10th Cir. 2008) (“Given the 28 complaint’s use of either the collective term ‘Defendants’ or a list of the defendants named 1 individually but with no distinction as to what acts are attributable to whom, it is impossible 2 for any of these individuals to ascertain what particular unconstitutional acts they are 3 alleged to have committed.”). 4 Further, Plaintiff does not allege the dates of assaults by other inmates, when she 5 reported to the assaults, to whom, and what, if any, response each of the 43 Defendants 6 provided. Further, to the extent Plaintiff seeks different housing, she does not allege which 7 of the 43 Defendants is responsible for housing assignments, when and how she made that 8 Defendant aware of threats to her safety, and what response, if any, she received from that 9 Defendant. Plaintiff’s allegations are too vague to state a claim and will be dismissed. 10 To the extent Plaintiff alleges she was sexually assaulted by large numbers of ADC 11 staff, the Court finds her claims implausible in light of her significant history of filing 12 unsubstantiated sexual assault claims in this Court.2 13 Accordingly, Plaintiff has failed to state a claim in the First Amended Complaint. 14 IV. Leave to Amend 15 For the foregoing reasons, Plaintiff’s First Amended Complaint will be dismissed 16 for failure to state a claim upon which relief may be granted. Within 30 days, Plaintiff may

17 2 See CV 02-02385-PHX-JAT (DKD); CV 02-02166-PHX-JAT (DKD); CV 03- 18 00371-PHX-JAT (DKD); CV 02-02007-PHX-JAT (DKD); CV 03-01479-PHX-JAT (DKD); CV 05-01092-PHX-JAT (DKD); CV 07-00207-PHX-JAT (DKD); CV 08-01773- 19 PHX-NVW (MHB); CV 09-01832-PHX-NVW (MHB); CV 09-02544-PHX-NVW (MHB); CV 09-01427-PHX-NVW (MHB); CV 09-01833-PHX-NVW (MHB); CV 10- 20 02721-PHX-NVW (MHB); CV 11-02403-PHX-NVW (MHB); CV 15-00158-PHX-NVW (MHB); CV 15-00722-PHX-NVW (MHB); CV 16-00683-PHX-NVW (MHB); CV 17- 21 01582-PHX-DLR (MHB); CV 17-02089-PHX-DLR (MHB); and CV 17-02716-PHX- DLR (MHB). 22 In CV 09-1832-PHX-NVW (MHB), the Court granted summary judgment for 23 Defendants because Defendants presented evidence demonstrating that they investigated each alleged incident of rape reported by Plaintiff, found each claim to be unsubstantiated, 24 and submitted records of medical examinations showing that Plaintiff did not suffer any of the injuries alleged in her Complaint. More importantly, Plaintiff herself acknowledged in 25 writing that her allegations were false. See Doc. 114 in CV 09-1832, at 6-7. 26 In CV 09-2544-PHX-NVW (MHB), the Court granted summary judgment for Defendants after finding that Plaintiff knowingly and willfully submitted a false affidavit 27 in support of her claim that she was raped. See Doc. 76 in CV 09-2544. 28 In CV 15-00158-PHX-NVW, the case proceeded to trial, after which the jury found against Plaintiff and in favor of Defendants. 1 submit a second amended complaint to cure the deficiencies outlined above. The Clerk of 2 Court will mail Plaintiff a court-approved form to use for filing a second amended 3 complaint. If Plaintiff fails to use the court-approved form, the Court may strike the second 4 amended complaint and dismiss this action without further notice to Plaintiff. 5 Plaintiff must clearly designate on the face of the document that it is the “Second 6 Amended Complaint.” The second amended complaint must be retyped or rewritten in its 7 entirety on the court-approved form and may not incorporate any part of the original 8 Complaint or First Amended Complaint by reference. Plaintiff may include only one claim 9 per count. 10 A second amended complaint supersedes the original Complaint and First Amended 11 Complaint. Ferdik v. Bonzelet, 963 F.2d 1258, 1262 (9th Cir. 1992); Hal Roach Studios v. 12 Richard Feiner & Co., 896 F.2d 1542, 1546 (9th Cir. 1990). After amendment, the Court 13 will treat the original Complaint and First Amended Complaint as nonexistent. Ferdik, 14 963 F.2d at 1262. Any cause of action that was raised in the original Complaint or First 15 Amended Complaint and that was voluntarily dismissed or was dismissed without 16 prejudice is waived if it is not alleged in a second amended complaint. Lacey v. Maricopa 17 County, 693 F.3d 896, 928 (9th Cir. 2012) (en banc). 18 V. Motions 19 In her Motion for Removal and Motion for Emergency Injunction, Plaintiff alleges 20 she has been placed in a suicide watch cell and seeks an order requiring her to be removed 21 from this type of cell. Plaintiff’s Motions are essentially requests for preliminary injunctive 22 relief. A party seeking preliminary injunctive relief “must necessarily establish a 23 relationship between the injury claimed in the party’s motion and the conduct asserted in 24 the complaint.” Devose v. Herrington, 42 F.3d 470, 471 (8th Cir. 1994) (per curiam) 25 (Eighth Amendment claim cannot provide basis for preliminary injunction against alleged 26 acts in retaliation for filing claim). In other words, Plaintiff must seek injunctive relief 27 related to the merits of her underlying claim. Because there presently is no complaint 28 1 pending, and no Defendants have been served, Plaintiff=s requests are not properly before 2 the Court at this time. The Court will deny Plaintiff’s Motions. 3 VI. Warnings 4 A. Release 5 If Plaintiff is released while this case remains pending, and the filing fee has not 6 been paid in full, Plaintiff must, within 30 days of her release, either (1) notify the Court 7 that she intends to pay the unpaid balance of her filing fee within 120 days of her release 8 or (2) file a non-prisoner application to proceed in forma pauperis. Failure to comply may 9 result in dismissal of this action. 10 B. Address Changes 11 Plaintiff must file and serve a notice of a change of address in accordance with Rule 12 83.3(d) of the Local Rules of Civil Procedure. Plaintiff must not include a motion for other 13 relief with a notice of change of address. Failure to comply may result in dismissal of this 14 action. 15 C. Possible “Strike” 16 Because the First Amended Complaint has been dismissed for failure to state a 17 claim, if Plaintiff fails to file a second amended complaint correcting the deficiencies 18 identified in this Order, the dismissal may count as a “strike” under the “3-strikes” 19 provision of 28 U.S.C. § 1915(g). Under the 3-strikes provision, a prisoner may not bring 20 a civil action or appeal a civil judgment in forma pauperis under 28 U.S.C. § 1915 “if the 21 prisoner has, on 3 or more prior occasions, while incarcerated or detained in any facility, 22 brought an action or appeal in a court of the United States that was dismissed on the 23 grounds that it is frivolous, malicious, or fails to state a claim upon which relief may be 24 granted, unless the prisoner is under imminent danger of serious physical injury.” 28 25 U.S.C. § 1915(g). 26 D. 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 Motion for Leave to File Amended Complaint (Doc. 19) is granted. 6 (2) The First Amended Complaint (Doc. 20) is dismissed for failure to state a claim. Plaintiff has 30 days from the date this Order is filed to file a second amended 8 | complaint in compliance with this Order. 9 (3) — If Plaintiff fails to file a second amended complaint within 30 days, the Clerk of Court must, without further notice, enter a judgment of dismissal of this action with 11 | prejudice that states that the dismissal may count as a “strike” under 28 U.S.C. § 1915(g) and deny any pending unrelated motions as moot. 13 (4) Plaintiff's February 13, 2020 Motion for Emergency Removal (Doc. 21) and Motion for Emergency Injunction (Doc. 22) are denied. 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 2nd day of March, 2020. 18 Micha To Siburde Michael T. Liburdi 21 United States District Judge 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.