1 WO JL 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 8 9 Berry Williams, No. CV-24-00328-TUC-SHR 10 Plaintiff, 11 v. ORDER 12 Unknown Galaz, et al., 13 Defendants.
15 On July 8, 2024, Plaintiff Berry Williams, who is confined in the Arizona State 16 Prison Complex-Tucson (ASPC-Tucson), filed a pro se civil rights Complaint pursuant to 17 42 U.S.C. § 1983 (Doc. 1) and an Application to Proceed In Forma Pauperis (Doc. 2). In 18 a July 23, 2024 Order, the Court denied the deficient Application to Proceed with leave to 19 refile within 30 days. 20 On July 29, 2024, Plaintiff filed a new Application to Proceed In Forma 21 Pauperis (Doc. 8). The Court will grant the Application to Proceed and dismiss the 22 Complaint with leave to amend. 23 I. Application to Proceed In Forma Pauperis and Filing Fee 24 The Court will grant Plaintiff’s Application to Proceed In Forma Pauperis. 28 25 U.S.C. § 1915(a). Plaintiff must pay the statutory filing fee of $350.00. § 1915(b)(1). The 26 Court will not assess an initial partial filing fee. Id. The statutory filing fee will be 27 collected monthly in payments of 20% of the previous month’s income credited to 28 Plaintiff’s trust account each time the amount in the account exceeds $10.00. § 1915(b)(2). 1 The Court will enter a separate Order requiring the appropriate government agency to 2 collect and forward the fees according to the statutory formula. 3 II. Statutory Screening of Prisoner Complaints 4 The Court is required to screen complaints brought by prisoners seeking relief 5 against a governmental entity or an officer or employee of a governmental entity. 28 6 U.S.C. § 1915A(a). The Court must dismiss a complaint or portion thereof if a plaintiff 7 has raised claims that are legally frivolous or malicious, fail to state a claim upon which 8 relief may be granted, or seek monetary relief from a defendant who is immune from such 9 relief. § 1915A(b). 10 A pleading must contain a “short and plain statement of the claim showing that the 11 pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2) (emphasis added). While Rule 8 does 12 not demand detailed factual allegations, “it demands more than an unadorned, the- 13 defendant-unlawfully-harmed-me accusation.” Ashcroft v. Iqbal, 556 U.S. 662, 678 14 (2009). “Threadbare recitals of the elements of a cause of action, supported by mere 15 conclusory statements, do not suffice.” Id. 16 “[A] complaint must contain sufficient factual matter, accepted as true, to ‘state a 17 claim to relief that is plausible on its face.’” Id. (quoting Bell Atl. Corp. v. Twombly, 550 18 U.S. 544, 570 (2007)). A claim is plausible “when the plaintiff pleads factual content that 19 allows the court to draw the reasonable inference that the defendant is liable for the 20 misconduct alleged.” Id. “Determining whether a complaint states a plausible claim for 21 relief [is] . . . a context-specific task that requires the reviewing court to draw on its judicial 22 experience and common sense.” Id. at 679. Thus, although a plaintiff’s specific factual 23 allegations may be consistent with a constitutional claim, a court must assess whether there 24 are other “more likely explanations” for a defendant’s conduct. Id. at 681. 25 But as the United States Court of Appeals for the Ninth Circuit has instructed, courts 26 must “continue to construe pro se filings liberally.” Hebbe v. Pliler, 627 F.3d 338, 342 27 (9th Cir. 2010). A “complaint [filed by a pro se prisoner] ‘must be held to less stringent 28 standards than formal pleadings drafted by lawyers.’” Id. (quoting Erickson v. Pardus, 551 1 U.S. 89, 94 (2007) (per curiam)). 2 If the Court determines a pleading could be cured by the allegation of other facts, a 3 pro se litigant is entitled to an opportunity to amend a complaint before dismissal of the 4 action. See Lopez v. Smith, 203 F.3d 1122, 1127–29 (9th Cir. 2000) (en banc). Here, the 5 Court will dismiss Plaintiff’s Complaint for failure to state a claim, but because it may 6 possibly be amended to state a claim, the Court will dismiss it with leave to amend. 7 III. Complaint 8 In his single-count Complaint, Plaintiff seeks monetary relief from ASPC-Tucson 9 Winchester Unit Lieutenant Keefe and Correctional Officers (COs) II Galaz and Rivera. 10 Plaintiff asserts an excessive force claim, purportedly under the Fourth Amendment. He 11 alleges he was selected for a random cell search, which Defendants Galaz and Rivera 12 conducted. Plaintiff asserts that as he began to step out of his cell, Defendant Galaz “began 13 to get more aggressive” and yelled at Plaintiff to “cuff up.” Plaintiff claims he asked why 14 he needed to be cuffed for a random cell search, and Defendant Galaz reached for Plaintiff’s 15 left arm and tightly squeezed it while telling Plaintiff to “cuff up.” Plaintiff alleges he 16 asked Defendant Galaz if he could put on his shoes. Plaintiff asserts Defendant Galaz 17 grabbed Plaintiff’s right hand and squeezed the left handcuff, cutting off circulation to his 18 left hand. Plaintiff claims he yelled at Defendant Galaz, “[T]he handcuffs are to[o] tight,” 19 and Defendant Rivera replied, “[Q]uit crying.” Plaintiff alleges non-party Officer 20 Bustamonte told Defendants Galaz and Rivera he would take Plaintiff to the yard office. 21 Plaintiff asserts Officer Bustamonte loosened the handcuffs, noticed bruises on Plaintiff’s 22 left hand, and requested medical assistance. 23 IV. Failure to State a Claim 24 To prevail in a § 1983 claim, a plaintiff must show (1) acts by the defendants 25 (2) under color of state law (3) deprived him of federal rights, privileges or immunities and 26 (4) caused him damage. Thornton v. City of St. Helens, 425 F.3d 1158, 1163–64 (9th Cir. 27 2005) (citing Shoshone-Bannock Tribes v. Idaho Fish & Game Comm’n, 42 F.3d 1278, 28 1284 (9th Cir. 1994)). In addition, a plaintiff must allege he suffered a specific injury as a 1 result of the conduct of a particular defendant and he must allege an affirmative link 2 between the injury and the conduct of that defendant. Rizzo v. Goode, 423 U.S. 362, 371– 3 72, 377 (1976). 4 A. Defendant Keefe 5 Plaintiff does not connect any of the allegations in the Complaint to Defendant 6 Keefe. Plaintiff fails to state a claim against Defendant Keefe, who will be dismissed. 7 B. Defendant Rivera 8 Plaintiff’s only allegation against Defendant Rivera is that after Plaintiff yelled at 9 Defendant Galaz that the handcuffs were too tight, Rivera told Plaintiff to “quit crying.” 10 That is insufficient to state a claim for any constitutional violation. Moreover, Plaintiff 11 does not allege he suffered any injury due to any conduct by Rivera. The Court will 12 therefore dismiss Defendant Rivera. 13 C. Defendant Galaz 14 Plaintiff’s excessive force claim arises under the Eighth Amendment, not the Fourth 15 Amendment, as he asserts. When a prisoner claims prison officials violated his Eighth 16 Amendment rights by using excessive physical force, the relevant inquiry is “whether force 17 was applied in a good-faith effort to maintain or restore discipline, or maliciously and 18 sadistically to cause harm.” Hudson v. McMillian, 503 U.S. 1, 7 (1992). However, the 19 Supreme Court has made it clear that not every use of physical force violates the Eighth 20 Amendment: 21 That is not to say that every malevolent touch by a prison guard 22 gives rise to a federal cause of action. See Johnson v. Glick, 481 F.2d [1028, 1033 (2nd Cir. 1973)] (“Not every push or 23 shove, even if it may later seem unnecessary in the peace of a judge’s chambers, violates a prisoner’s constitutional rights”). 24 25 Id. at 9. 26 Plaintiff’s allegations are too vague to state an Eighth Amendment excessive force 27 claim against Defendant Galaz. First, Plaintiff does not state when the alleged incident 28 occurred. Second, Plaintiff’s allegations suggest he was uncooperative with Defendant 1 Galaz’s orders to “cuff up” for the random cell search. Plaintiff does not state whether he 2 resisted efforts to handcuff him. As presented, the Court cannot discern whether any force 3 Defendant Galaz used was applied in good faith to maintain or restore discipline or was 4 used maliciously and sadistically to cause harm. Plaintiff therefore fails to state an Eighth 5 Amendment excessive force claim against Defendant Galaz, who will be dismissed. 6 V. Leave to Amend 7 For the foregoing reasons, the Court will dismiss Plaintiff’s Complaint for failure to 8 state a claim upon which relief may be granted. Within 30 days, Plaintiff may submit a 9 first amended complaint to cure the deficiencies outlined above. The Clerk of Court will 10 mail Plaintiff a court-approved form to use for filing a first amended complaint. If Plaintiff 11 fails to use the court-approved form, the Court may strike the amended complaint and 12 dismiss this action without further notice to Plaintiff. 13 Plaintiff must clearly designate on the face of the document that it is the “First 14 Amended Complaint.” The first amended complaint must be retyped or rewritten in its 15 entirety on the court-approved form and may not incorporate any part of the original 16 Complaint by reference. Plaintiff may include only one claim per count. 17 A first amended complaint supersedes the original Complaint. Ferdik v. Bonzelet, 18 963 F.2d 1258, 1262 (9th Cir. 1992); Hal Roach Studios, Inc. v. Richard Feiner & Co., 896 19 F.2d 1542, 1546 (9th Cir. 1990). After amendment, the Court will treat the original 20 Complaint as nonexistent. Ferdik, 963 F.2d at 1262. Any cause of action raised in the 21 original Complaint and voluntarily dismissed or dismissed without prejudice is waived if 22 it is not alleged in a first amended complaint. Lacey v. Maricopa County, 693 F.3d 896, 23 928 (9th Cir. 2012) (en banc). 24 If Plaintiff files an amended complaint, Plaintiff must write short, plain statements 25 telling the Court: (1) the constitutional right Plaintiff believes was violated; (2) the name 26 of the Defendant who violated the right; (3) exactly what the Defendant did or failed to do; 27 (4) how the action or inaction of the Defendant is connected to the violation of Plaintiff’s 28 constitutional right; and (5) what specific injury Plaintiff suffered because of the 1 Defendant’s conduct. See Rizzo, 423 U.S. at 371–72, 377. 2 Plaintiff must repeat this process for each person he names as a Defendant. If 3 Plaintiff fails to affirmatively link the conduct of each named Defendant with the specific 4 injury suffered by Plaintiff, the allegations against that Defendant will be dismissed for 5 failure to state a claim. Conclusory allegations that a Defendant or group of 6 Defendants has violated a constitutional right are not acceptable and will be 7 dismissed. 8 VI. Warnings 9 A. Release 10 If Plaintiff is released while this case remains pending, and the filing fee has not 11 been paid in full, Plaintiff must, within 30 days of his release, either (1) notify the Court 12 he intends to pay the unpaid balance of his filing fee within 120 days of his release or (2) 13 file a non-prisoner application to proceed in forma pauperis. Failure to comply may result 14 in dismissal of this action. 15 B. Address Changes 16 Plaintiff must file and serve a notice of a change of address in accordance with Rule 17 83.3(d) of the Local Rules of Civil Procedure. Plaintiff must not include a motion for other 18 relief with a notice of change of address. Failure to comply may result in dismissal of this 19 action. 20 C. Possible “Strike” 21 Because the Complaint has been dismissed for failure to state a claim, if Plaintiff 22 fails to file an amended complaint correcting the deficiencies identified in this Order, the 23 dismissal may count as a “strike” under the “3-strikes” provision of 28 U.S.C. § 1915(g). 24 Under the 3-strikes provision, a prisoner may not bring a civil action or appeal a civil 25 judgment in forma pauperis under 28 U.S.C. § 1915 “if the prisoner has, on 3 or more prior 26 occasions, while incarcerated or detained in any facility, brought an action or appeal in a 27 court of the United States that was dismissed on the grounds that it is frivolous, malicious, 28 or fails to state a claim upon which relief may be granted, unless the prisoner is under 1 | imminent danger of serious physical injury.” 28 U.S.C. § 1915(g). 2 D. Possible Dismissal 3 If Plaintiff fails to timely comply with every provision of this Order, including these 4) warnings, the Court may dismiss this action without further notice. See Ferdik, 963 F.2d 5 | at 1260-61 (a district court may dismiss an action for failure to comply with any order of the Court). 7| ITIS ORDERED: 8 (1) Plaintiff’s Application to Proceed In Forma Pauperis (Doc. 8) is granted. 9 (2) As required by the accompanying Order to the appropriate government 10| agency, Plaintiff must pay the $350.00 filing fee and is not assessed an initial partial filing fee. 12 (3) |The Complaint (Doc. 1) is dismissed for failure to state a claim. Plaintiff 13 | has 30 days from the date this Order is filed to file a first amended complaint in compliance with this Order. 15 (4) — If Plaintiff fails to file an amended complaint within 30 days, the Clerk of Court must, without further notice, enter a judgment of dismissal of this action with 17 | prejudice stating the dismissal may count as a “strike” under 28 U.S.C. § 1915(g) and deny 18 | any pending unrelated motions as moot. 19 (5) The Clerk of Court must mail Plaintiff a court-approved form for filing a civil 20 | rights complaint by a prisoner. 21 Dated this 11th day of October, 2024. 22 23 / f} Ait le) 5 Honorable Scott H. Rash _/ United States District Judge 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 $455.00 ($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 $455 filing and administrative fees or the application to proceed in forma pauperis to:
1 Revised 12/1/23 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.