1 WO JL 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 8 9 DeVon Washington, No. CV-24-00398-TUC-SHR 10 Plaintiff, 11 v. ORDER 12 Arizona Department of Corrections, et 13 al., 14 Defendants.
15 16 Plaintiff DeVon Washington, who is confined in the Arizona State Prison Complex- 17 Tucson, has filed a pro se civil rights Complaint pursuant to 42 U.S.C. § 1983 (Doc. 1) and 18 an Application to Proceed In Forma Pauperis (Doc. 2). The Court will dismiss the 19 Complaint with leave to amend. 20 I. Application to Proceed In Forma Pauperis and Filing Fee 21 The Court will grant Plaintiff’s Application to Proceed In Forma Pauperis. 28 22 U.S.C. § 1915(a). Plaintiff must pay the statutory filing fee of $350.00. § 1915(b)(1). The 23 Court will assess an initial partial filing fee of $30.13. The remainder of the fee will be 24 collected monthly in payments of 20% of the previous month’s income credited to 25 Plaintiff’s trust account each time the amount in the account exceeds $10.00. § 1915(b)(2). 26 The Court will enter a separate Order requiring the appropriate government agency to 27 collect and forward the fees according to the statutory formula. 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, fails to state a claim upon which 6 relief may be granted, or seeks monetary relief from a defendant who is immune from such 7 relief. § 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 Atl. Corp. v. Twombly, 550 16 U.S. 544, 570 (2007)). A claim is plausible “when the plaintiff pleads factual content that 17 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 pro se filings liberally.” Hebbe v. Pliler, 627 F.3d 338, 342 25 (9th Cir. 2010). A “complaint [filed by a pro se prisoner] ‘must be held to less stringent 26 standards than formal pleadings drafted by lawyers.’” Id. (quoting Erickson v. Pardus, 551 27 U.S. 89, 94 (2007) (per curiam)). 28 1 If the Court determines a pleading could be cured by the allegation of other facts, a 2 pro se litigant is entitled to an opportunity to amend a complaint before dismissal of the 3 action. See Lopez v. Smith, 203 F.3d 1122, 1127–29 (9th Cir. 2000) (en banc). The Court 4 will dismiss Plaintiff’s Complaint for failure to state a claim, but because it could 5 potentially be amended to state a claim, the Court will dismiss it with leave to amend. 6 III. Complaint 7 In his three-count Complaint, Plaintiff sues the Arizona Department of Corrections, 8 Rehabilitation and Reentry, “Director” Thorton, Warden McAdorey, Assistant Deputy 9 Warden Reyes, Senior Chaplain Ware, and Correctional Officer II Galaz. Plaintiff asserts 10 claims regarding his exercise of his religion. He seeks monetary relief, expungement of all 11 disciplinary reports and sanctions, a shaving waiver, a handwritten apology from all 12 Defendants, and his court costs for this case. 13 Plaintiff designates Count One as a First Amendment claim regarding the exercise 14 of his religion. Plaintiff alleges Defendants are forcing him to disregard his religion to 15 avoid punishment. Plaintiff asserts “[t]hey” have placed a substantial burden on him by 16 enforcing their standard grooming policy when it “differs from what is written in the sacred 17 text of [his] religion.” Plaintiff claims he has explained and shown Defendants “where it 18 says ‘cut the mustache short and leave the beard as it is,’” but “[t]hey” have denied his 19 request for a shaving waiver, stating his “claims are not credible.” As his injury, Plaintiff 20 alleges he received disciplinary reports and sanctions, he is fearful and mentally drained, 21 his visits have been canceled, he was forced to “go against” his religious beliefs, and he 22 has suffered “character def[a]mation.” 23 Plaintiff designates Count Two as a Fourteenth Amendment “basic necessities” 24 claim. Plaintiff alleges that “by forcing their policy on [him, D]efendants are creating laws 25 that abridge [his] privileges as a citizen of the United States and denying [him] equal 26 protection of the laws.” As his injury, Plaintiff claims he is “forced to go against [his] 27 religious beliefs in order to avoid punishment,” and he is receiving disciplinary reports and 28 sanctions. 1 Plaintiff designates Count Three as a First Amendment discrimination claim. 2 Plaintiff alleges all Defendants informed him “only the S[]ikh religion ha[s] the ability to 3 attain a shaving waiver for religious purposes,” although Plaintiff has “explained and 4 shown proof of [his] religious text ordering [him] to ‘cut the mustache short and leave the 5 beard as it is.’” Plaintiff contends Defendants are discriminating against him based on his 6 religion because “they have allowed another religion this liberty while denying [his] the 7 same.” As his injury, Plaintiff claims he has been singled out and treated differently and 8 unfavorably, he has been “made to seem as if [he is] a source of trouble,” he is “disturbed 9 mentally and fearful,” and he is receiving disciplinary reports and sanctions. 10 IV. Failure to State a Claim 11 To prevail on a § 1983 claim, a plaintiff must show (1) acts by the defendants 12 (2) under color of state law (3) deprived him of federal rights, privileges, or immunities 13 and (4) caused him damage. Thornton v. City of St. Helens, 425 F.3d 1158, 1163–64 (9th 14 Cir. 2005). In addition, a plaintiff must allege he suffered a specific injury as a result of 15 the conduct of a particular defendant and he must allege an affirmative link between the 16 injury and the conduct of that defendant. Rizzo v. Goode, 423 U.S. 362, 371–72, 377 17 (1976). 18 A. Arizona Department of Corrections, Rehabilitation and Reentry 19 The Arizona Department of Corrections, Rehabilitation and Reentry is not a proper 20 Defendant. Under the Eleventh Amendment to the Constitution of the United States, a 21 state or state agency may not be sued in federal court without its consent. Pennhurst State 22 Sch. & Hosp. v. Halderman, 465 U.S. 89, 100 (1984); Taylor v. List, 880 F.2d 1040, 1045 23 (9th Cir. 1989). Furthermore, “a state is not a ‘person’ for purposes of section 1983. 24 Likewise ‘arms of the State’ such as the Arizona Department of Corrections are not 25 ‘persons’ under section 1983.” Gilbreath v. Cutter Biological, Inc., 931 F.2d 1320, 1327 26 (9th Cir. 1991) (citation omitted). Therefore, the Court will dismiss Defendant Arizona 27 Department of Corrections, Rehabilitation and Reentry. 28 . . . . 1 B. Failure to Connect Allegations to Named Defendants 2 Plaintiff has not made any specific allegations against any named Defendant. 3 Rather, all of Plaintiff’s allegations refer to Defendants collectively, without any factual 4 detail regarding what a particular Defendant did or failed to do. Such allegations are 5 insufficient. A complaint “does not require ‘detailed factual allegations,’” but it must plead 6 enough “factual content that allows the court to draw the reasonable inference that the 7 defendant is liable for the misconduct alleged.” Iqbal, 556 U.S. at 678 (quoting Twombly, 8 550 U.S. at 555). Accordingly, a plaintiff must “allege overt acts with some degree of 9 particularity such that his claim is set forth clearly enough to give defendants fair notice” 10 of the allegations against them. Ortez v. Washington County, 88 F.3d 804, 810 (9th Cir. 11 1996); see also Sebastian Brown Prods., LLC v. Muzooka, Inc., 143 F. Supp. 3d 1026, 1037 12 (N.D. Cal. 2014) (“A plaintiff ‘must identify what action each Defendant took that caused 13 Plaintiffs’ harm, without resort to generalized allegations against Defendants as a whole.” 14 (citation omitted)); Flores v. EMC Mortg. Co., 997 F. Supp. 2d 1088, 1103 (E.D. Cal. 15 2014) (complaint failed to satisfy Rule 8 where it lacked “facts of defendants’ specific 16 wrongdoing to provide fair notice as to what each defendant is to defend”). Courts 17 consistently conclude a complaint “lumping together . . . multiple defendants in one broad 18 allegation fails to satisfy [the] notice requirement of Rule 8(a)(2).” Gen-Probe, Inc. v. 19 Amoco Corp., Inc., 926 F. Supp. 948, 961 (S.D. Cal. 1996) (citing Gauvin v. Trombatore, 20 682 F. Supp. 1067, 1071 (N.D. Cal. 1988)). Plaintiff fails to state a claim in the Complaint, 21 and it will be dismissed. 22 V. Leave to Amend 23 Within 30 days, Plaintiff may submit a first amended complaint to cure the 24 deficiencies outlined above. The Clerk of Court will mail Plaintiff a court-approved form 25 to use for filing a first amended complaint. If Plaintiff fails to use the court-approved form, 26 the Court may strike the amended complaint and dismiss this action without further notice 27 to Plaintiff. 28 Plaintiff must clearly designate on the face of the document that it is the “First 1 Amended Complaint.” The first amended complaint must be retyped or rewritten in its 2 entirety on the court-approved form and may not incorporate any part of the original 3 Complaint by reference. Plaintiff may include only one claim per count. 4 A first amended complaint supersedes the original Complaint. Ferdik v. Bonzelet, 5 963 F.2d 1258, 1262 (9th Cir. 1992); Hal Roach Studios, Inc. v. Richard Feiner & Co., 896 6 F.2d 1542, 1546 (9th Cir. 1990). After amendment, the Court will treat the original 7 Complaint as nonexistent. Ferdik, 963 F.2d at 1262. Any cause of action raised in the 8 original Complaint and voluntarily dismissed or dismissed without prejudice is waived if 9 it is not alleged in a first amended complaint. Lacey v. Maricopa County, 693 F.3d 896, 10 928 (9th Cir. 2012) (en banc). 11 If Plaintiff files an amended complaint, he must write short, plain statements telling 12 the Court: (1) the constitutional right Plaintiff believes was violated; (2) the name of the 13 Defendant who violated the right; (3) exactly what the Defendant did or failed to do; 14 (4) how the action or inaction of the Defendant is connected to the violation of Plaintiff’s 15 constitutional right; and (5) what specific injury Plaintiff suffered because of that 16 Defendant’s conduct. See Rizzo, 423 U.S. at 371–72, 377. 17 Plaintiff must repeat this process for each person he names as a Defendant. If 18 Plaintiff fails to affirmatively link the conduct of each named Defendant with the specific 19 injury suffered by Plaintiff, the allegations against that Defendant will be dismissed for 20 failure to state a claim. Conclusory allegations that a Defendant or group of 21 Defendants has violated a constitutional right are not acceptable and will be 22 dismissed. 23 Plaintiff should note the Religious Land Use and Institutionalized Persons Act 24 (RLUIPA), 42 U.S.C. §§ 2000cc–2000cc-5, prohibits the government from imposing a 25 substantial burden on the religious exercise of an institutionalized person unless the 26 government establishes the burden furthers a “compelling governmental interest” and does 27 so by “the least restrictive means.” 42 U.S.C. § 2000cc-1(a)(1)–(2). Therefore, to state a 28 claim under RLUIPA, a plaintiff must allege facts showing government action has 1 substantially burdened the exercise of the plaintiff’s religion without a compelling 2 government interest and by the least restrictive means. See Guam v. Guerrero, 290 F.3d 3 1210, 1222 (9th Cir. 2002). “[A] ‘substantial burden’ on ‘religious exercise’ must impose 4 a significantly great restriction or onus upon such exercise.” Warsoldier v. Woodford, 418 5 F.3d 989, 995 (9th Cir. 2005) (citation omitted). Thus, an institutionalized person’s 6 religious exercise is substantially burdened “where the state . . . denies [an important 7 benefit] because of conduct mandated by religious belief, thereby putting substantial 8 pressure on an adherent to modify his behavior and to violate his beliefs.” Id. (alteration 9 in original) (quoting Thomas v. Rev. Bd. of the Ind. Emp. Sec. Div., 450 U.S. 707, 717–18 10 (1981). 11 In addition, “[i]nmates clearly retain protections afforded by the First Amendment, 12 including its directive that no law shall prohibit the free exercise of religion.” O’Lone v. 13 Est. of Shabazz, 482 U.S. 342, 348 (1987) (citation omitted). However, free exercise rights 14 are “necessarily limited by the fact of incarceration, and may be curtailed in order to 15 achieve legitimate correctional goals or to maintain prison security.” McElyea v. Babbitt, 16 833 F.2d 196, 197 (9th Cir. 1987). To state a First Amendment free exercise claim, a 17 plaintiff must allege a defendant substantially burdened his religious practice without 18 justification reasonably related to legitimate penological interests. Shakur v. Schriro, 514 19 F.3d 878, 885 (9th Cir. 2008); Malik v. Brown, 16 F.3d 330, 334 (9th Cir. 1994); 20 Warsoldier, 418 F.3d at 995 (pressure on exercise must be substantial). The religious 21 practice or exercise at issue must be rooted in sincerely held religious belief and not in 22 “‘purely secular’ philosophical concerns.” Malik, 16 F.3d at 333 (citation omitted). 23 Plaintiff should also note that generally, “[t]o state a claim . . . for a violation of the 24 Equal Protection Clause,” a “plaintiff must show that the defendants acted with an intent 25 or purpose to discriminate against the plaintiff based upon membership in a protected 26 class.” Barren v. Harrington, 152 F.3d 1193, 1194 (9th Cir. 1998). 27 The United States Supreme Court has also recognized “successful equal protection 28 claims brought by a ‘class of one,’ where the plaintiff alleges that []he has been 1 intentionally treated differently from others similarly situated and that there is no rational 2 basis for the difference in treatment.” Village of Willowbrook v. Olech, 528 U.S. 562, 564 3 (2000); see also SeaRiver Maritime Fin. Holdings, Inc. v. Mineta, 309 F.3d 662, 679 (9th 4 Cir. 2002). 5 VI. Warnings 6 A. Release 7 If Plaintiff is released while this case remains pending, and the filing fee has not 8 been paid in full, Plaintiff must, within 30 days of his release, either (1) notify the Court 9 he intends to pay the unpaid balance of his filing fee within 120 days of his release or (2) 10 file a non-prisoner application to proceed in forma pauperis. Failure to comply may result 11 in dismissal of this action. 12 B. Address Changes 13 Plaintiff must file and serve a notice of a change of address in accordance with Rule 14 83.3(d) of the Local Rules of Civil Procedure. Plaintiff must not include a motion for other 15 relief with a notice of change of address. Failure to comply may result in dismissal of this 16 action. 17 C. Possible “Strike” 18 Because the Complaint has been dismissed for failure to state a claim, if Plaintiff 19 fails to file an amended complaint correcting the deficiencies identified in this Order, the 20 dismissal may count as a “strike” under the “3-strikes” provision of 28 U.S.C. § 1915(g). 21 Under the 3-strikes provision, a prisoner may not bring a civil action or appeal a civil 22 judgment in forma pauperis under 28 U.S.C. § 1915 “if the prisoner has, on 3 or more prior 23 occasions, while incarcerated or detained in any facility, brought an action or appeal in a 24 court of the United States that was dismissed on the grounds that it is frivolous, malicious, 25 or fails to state a claim upon which relief may be granted, unless the prisoner is under 26 imminent danger of serious physical injury.” 28 U.S.C. § 1915(g). 27 D. Possible Dismissal 28 If Plaintiff fails to timely comply with every provision of this Order, including these 1 | warnings, the Court may dismiss this action without further notice. See Ferdik, 963 F.2d 2| at 1260-61 (a district court may dismiss an action for failure to comply with any order of 3 | the Court). 4| ITIS ORDERED: 5 (1) Plaintiff's Application to Proceed In Forma Pauperis (Doc. 2) is granted. 6 (2) As required by the accompanying Order to the appropriate government agency, Plaintiff must pay the $350.00 filing fee and is assessed an initial partial filing fee 8 | of $30.13. 9 (3) |The Complaint (Doc. 1) is dismissed for failure to state a claim. Plaintiff 10 | has 30 days from the date this Order is filed to file a first amended complaint in compliance 11 | with this Order. 12 (4) — If Plaintiff fails to file an amended complaint within 30 days, the Clerk of 13 | Court must, without further notice, enter a judgment of dismissal of this action with prejudice stating the dismissal may count as a “strike” under 28 U.S.C. § 1915(g) and deny 15 | any pending unrelated motions as moot. 16 (5) The Clerk of Court must mail Plaintiffa court-approved form for filing a civil 17 | rights complaint by a prisoner. 18 Dated this 19th day of November, 2024. 19 20 /) Aa: hel 22 Honorable Scott H, Rash _/ United States District Judge 23 24 25 26 27 28
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Instructions for a Prisoner Filing a Civil Rights Complaint in the United States District Court for the District of Arizona
1. Who May Use This Form. The civil rights complaint form is designed to help incarcerated persons prepare a complaint seeking relief for a violation of their federal civil rights. These complaints typically concern, but are not limited to, conditions of confinement. This form should not be used to challenge your conviction or sentence. If you want to challenge a state conviction or sentence, you should file a petition under 28 U.S.C. ' 2254 for a writ of habeas corpus by a person in state custody. If you want to challenge a federal conviction or sentence, you should file a motion under 28 U.S.C. § 2255 to vacate sentence in the federal court that entered the judgment. 2. The Form. Local Rule of Civil Procedure (LRCiv) 3.4 provides that complaints by incarcerated persons must be filed on the court-approved form. The form must be typed or neatly handwritten. The form must be completely filled in to the extent applicable. All questions must be answered clearly and concisely in the appropriate space on the form. If needed, you may attach additional pages, but no more than fifteen additional pages, of standard letter-sized paper. You must identify which part of the complaint is being continued and number all pages. If you do not fill out the form properly, you will be asked to submit additional or corrected information, which may delay the processing of your action. You do not need to cite law. 3. Your Signature. You must tell the truth and sign the form. If you make a false statement of a material fact, you may be prosecuted for perjury. 4. The Filing and Administrative Fees. The total fees for this action are $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.