Redfox v. Jones et al

Filing 10

SCREENING ORDER: Complaint re 1 is DISMISSED without prejudice. Amended Complaint on Court form PSO1 due by 5/27/2021. MOTION for Leave to Proceed in forma pauperis re 2 is DEFERRED. Clerk of Court is directed to sen d Mr. Redfox a copy of Docket 4; the District Court's handbook, "REPRESENTING YOURSELF IN ALASKA'S FEDERAL COURT"; and other forms as mentioned. See attached Order for further details and deadlines. Signed by Judge Matthe w McCrary Scoble on 4/27/2021. (Attachments: # 1 PSO1 - Form, # 2 PS01 - Instructions, # 3 PS09 - Voluntary Dismissal, # 4 PS23 - Notice of Change of Address)(JBO, CHAMBERS STAFF) (Main Document 10 replaced on 4/27/2021) (BJK, COURT STAFF).

____________________________________
Name

____________________________________
Prison Number

____________________________________
Place of confinement

____________________________________
Mailing address

____________________________________
City, State, Zip

____________________________________
Telephone

IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF ALASKA

,
(Enter full name of plaintiff in this action)

Case No. ________________________
Plaintiff,

(To be supplied by Court)

vs.

,
,

PRISONER'S
COMPLAINT UNDER
THE CIVIL RIGHTS ACT
42 U.S.C. § 1983

,
(Enter full names of defendant(s) in this action.
Do NOT use et al.)

Defendant(s).
A. Jurisdiction
Jurisdiction is invoked under 28 U.S.C. § 1343(a)(3).
B. Parties
1. Plaintiff: This complaint alleges that the civil rights of

_,
(print your name)

who presently resides at

___,
(mailing address or place of confinement)

were violated by the actions of the individual(s) named below.

2. Defendants (Make a copy of this page and provide same information if you are naming more than 3
defendants):
is a citizen of

Defendant No. 1,
(name)

, and is employed as a

.

(state)

(defendant’s government position/title)

This defendant personally participated in causing my injury, and I want money
damages.
OR
The policy or custom of this official’s government agency violates my rights, and I
seek injunctive relief (to stop or require someone do something).
Defendant No. 2,

is a citizen of
(name)

, and is employed as a

.

(state)

(defendant’s government position/title)

This defendant personally participated in causing my injury, and I want money
damages.
OR
The policy or custom of this official’s government agency violates my rights, and I
seek injunctive relief (to stop or require someone do something).
Defendant No. 3,

is a citizen of
(name)

, and is employed as a
(state)

.
(defendant’s government position/title)

This defendant personally participated in causing my injury, and I want money
damages.
OR
The policy or custom of this official’s government agency violates my rights, and I
seek injunctive relief (to stop or require someone do something).
***REMINDER***
You must exhaust your administrative remedies before your claim can go forward.
THE COURT MAY DISMISS ANY UNEXHAUSTED CLAIMS.

C. Causes of Action (You may attach additional pages alleging other causes of action and facts
supporting them if necessary. Make copies of page 5 and rename them pages 5A, 5B, etc. and rename
the claims, “Claim 4,” “Claim 5, etc.”).
Prisoner § 1983 - 2
PS01, Nov. 2013

Claim 1: On or about

, my civil right to
(Date)

______________________________________________________________________
(Medical care, access to the courts, due process, freedom of religion, free speech, freedom of association, freedom
from cruel and unusual punishment, etc. List only one violation.)

was violated by _________________________________________________________
(Name of the specific Defendant who violated this right)

Supporting Facts (Briefly describe facts you consider important to Claim 1. State what
happened briefly and clearly, in your own words. Do not cite legal authority or argument.
Describe exactly what each defendant, by name, did to violate the right alleged in Claim 1.):
____________________________________________________________________________
____________________________________________________________________________
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___________________________________________________________________________
Prisoner § 1983 - 3
PS01, Nov. 2013

Claim 2: On or about

, my civil right to
(Date)

______________________________________________________________________
(Medical care, access to the courts, due process, freedom of religion, free speech, freedom of association, freedom
from cruel and unusual punishment, etc. List only one violation.)

was violated by _________________________________________________________
(Name of the specific Defendant who violated this right)

Supporting Facts (Briefly describe facts you consider important to Claim 2. State what
happened briefly and clearly, in your own words. Do not cite legal authority or argument.
Describe exactly what each defendant, by name, did to violate the right alleged in Claim 2.):
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
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____________________________________________________________________________
Prisoner § 1983 - 4
PS01, Nov. 2013

Claim 3: On or about

, my civil right to
(Date)

______________________________________________________________________
(Medical care, access to the courts, due process, freedom of religion, free speech, freedom of association, freedom
from cruel and unusual punishment, etc. List only one violation.)

was violated by _________________________________________________________
(Name of the specific Defendant who violated this right)

Supporting Facts (Briefly describe facts you consider important to Claim 3. State what
happened briefly and clearly, in your own words. Do not cite legal authority or argument.
Describe exactly what each defendant, by name, did to violate the right alleged in Claim 3.):
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
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____________________________________________________________________________
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Prisoner § 1983 - 5
PS01, Nov. 2013

D. Previous Lawsuits
1. Have you begun other lawsuits in state or federal court dealing with the same facts
involved in this action, or otherwise relating to your imprisonment?
Yes
No

2. If your answer is “Yes,” describe each lawsuit.
a. Lawsuit 1:
Plaintiff(s):

_________

Defendant(s): _________________________________________________________
Name and location of court: ______________________________________________
__ Name of judge: _______________________________

Docket number:

Approximate date case was filed:

_ Date of final decision: _____________

Disposition:

Appealed

Dismissed

Still pending

Issues Raised:__________________________________________________________
b. Lawsuit 2:
_________

Plaintiff(s):

Defendant(s): _________________________________________________________
Name and location of court: ______________________________________________
__ Name of judge: _______________________________

Docket number:

Approximate date case was filed:

_ Date of final decision: _____________

Disposition:

Appealed

Dismissed

Still pending

Issues Raised:__________________________________________________________
3. Have you filed an action in federal court that was dismissed because it was
determined to be frivolous, malicious, or failed to state a claim upon which relief could
be granted?
Yes

No

If your answer is “Yes,” describe each lawsuit on the next page.

Prisoner § 1983 - 6
PS01, Nov. 2013

Lawsuit #1 dismissed as frivolous, malicious, or failed to state a claim:
a. Defendant(s):________________________________________________________
Case number: ___________________

b. Name of federal court
c. The case was dismissed as:

frivolous,

malicious and/or

failed to state a claim

d. Issue(s) raised: _______________________________________________________
e. Approximate date case was filed:

Date of final decision: ___________

Lawsuit #2 dismissed as frivolous, malicious, or failed to state a claim:
a. Defendant(s):________________________________________________________
Case number: ___________________

b. Name of federal court
c. The case was dismissed as:

frivolous,

malicious and/or

failed to state a claim

d. Issue(s) raised: _______________________________________________________
e. Approximate date case was filed:

Date of final decision: ___________

Lawsuit #3 dismissed as frivolous, malicious, or failed to state a claim:
a. Defendant(s):________________________________________________________
b. Name of federal court
c. The case was dismissed as:

Case number: ___________________
frivolous,

malicious and/or

failed to state a claim

d. Issue(s) raised: _____________________ _________________________________
e. Approximate date case was filed:

Date of final decision: ___________

4. Are you in imminent danger of serious physical injury?

Yes

No

If your answer is “Yes,” please describe how you are in danger, without legal
argument/authority: ______________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Prisoner § 1983 - 7
PS01, Nov. 2013

F. Request for Relief
Plaintiff requests that this Court grant the following relief:
1. Damages in the amount of $___________________
2. Punitive damages in the amount of $ ___________________
3. An order requiring defendant(s) to _______________________________________
4. A declaration that ________________________ ___________________________
5. Other: _____________________________________________________________
Plaintiff demands a trial by jury.

Yes

No

DECLARATION UNDER PENALTY OF PERJURY
The undersigned declares under penalty of perjury that s/he is the plaintiff in the
above action, that s/he has read the above civil rights complaint and that the
information contained in the complaint is true and correct.

Executed at

on _________________________
(Location)

(Date)

_____________________________________________
(Plaintiff’s Signature)

__________________________
Original Signature of Attorney (if any)

(Date)

_______________________________
_______________________________
_______________________________
Attorney’s Address and Telephone Number

Prisoner § 1983 - 8
PS01, Nov. 2013