Nordstrom # 86114 v. Ryan et al

Filing 4

ORDER, the 1 Complaint is dismissed for failure to state a claim. Plaintiff has 30 days from the date this order is filed to file a first amended complaint. If plaintiff fails to timely comply, the Clerk of Court must, without further notice, enter a judgment of dismissal of this action with prejudice that states that the dismissal may count as a "strike" under 28 U.S.C. 1915(g). Signed by Judge David G Campbell on 1/17/12. (DMT)

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1 2 KM WO 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 8 9 Scott Douglas Nordstrom, Plaintiff, 10 11 vs. 12 Charles L. Ryan, et al., 13 Defendants. ) ) ) ) ) ) ) ) ) ) No. CV 11-2344-PHX-DGC (MEA) ORDER 14 Plaintiff Scott Douglas Nordstrom, who is confined in the Arizona State Prison 15 Complex-Eyman, has filed a pro se civil rights Complaint pursuant to 42 U.S.C. § 1983 and 16 has paid the filing fee. The Court will dismiss the Complaint with leave to amend. 17 I. Statutory Screening of Prisoner Complaints 18 The Court is required to screen complaints brought by prisoners seeking relief against 19 a governmental entity or an officer or an employee of a governmental entity. 28 U.S.C. 20 § 1915A(a). The Court must dismiss a complaint or portion thereof if a plaintiff has raised 21 claims that are legally frivolous or malicious, that fail to state a claim upon which relief may 22 be granted, or that seek monetary relief from a defendant who is immune from such relief. 23 28 U.S.C. § 1915A(b)(1), (2). 24 A pleading must contain a “short and plain statement of the claim showing that the 25 pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2) (emphasis added). While Rule 8 does not 26 demand detailed factual allegations, “it demands more than an unadorned, the-defendant27 unlawfully-harmed-me accusation.” Ashcroft v. Iqbal, 129 S. Ct. 1937, 1949 (2009). 28 JDDL-K 1 “Threadbare recitals of the elements of a cause of action, supported by mere conclusory 2 statements, do not suffice.” Id. 3 “[A] complaint must contain sufficient factual matter, accepted as true, to ‘state a 4 claim to relief that is plausible on its face.’” Id. (quoting Bell Atlantic Corp. v. Twombly, 5 550 U.S. 544, 570 (2007)). A claim is plausible “when the plaintiff pleads factual content 6 that allows the court to draw the reasonable inference that the defendant is liable for the 7 misconduct alleged.” Id. “Determining whether a complaint states a plausible claim for 8 relief [is] . . . a context-specific task that requires the reviewing court to draw on its judicial 9 experience and common sense.” Id. at 1950. Thus, although a plaintiff’s specific factual 10 allegations may be consistent with a constitutional claim, a court must assess whether there 11 are other “more likely explanations” for a defendant’s conduct. Id. at 1951. 12 But as the United States Court of Appeals for the Ninth Circuit has instructed, courts 13 must “continue to construe pro se filings liberally.” Hebbe v. Pliler, 627 F.3d 338, 342 (9th 14 Cir. 2010). A “complaint [filed by a pro se prisoner] ‘must be held to less stringent standards 15 than formal pleadings drafted by lawyers.’” Id. (quoting Erickson v. Pardus, 551 U.S. 89, 16 94 (2007) (per curiam)). 17 If the Court determines that a pleading could be cured by the allegation of other facts, 18 a pro se litigant is entitled to an opportunity to amend a complaint before dismissal of the 19 action. See Lopez v. Smith, 203 F.3d 1122, 1127-29 (9th Cir. 2000) (en banc). The Court 20 should not, however, advise the litigant how to cure the defects. This type of advice “would 21 undermine district judges’ role as impartial decisionmakers.” Pliler v. Ford, 542 U.S. 225, 22 231 (2004); see also Lopez, 203 F.3d at 1131 n.13 (declining to decide whether the court was 23 required to inform a litigant of deficiencies). The Court will dismiss Plaintiff’s Complaint 24 for failure to state a claim, but because the Complaint may possibly be saved by amendment, 25 will dismiss the Complaint with leave to amend. 26 II. Complaint 27 28 JDDL-K Plaintiff names the following Defendants in the Complaint: Arizona Department of Corrections Director Charles L. Ryan, Warden Ernest Trujillo, Deputy Warden A. Ramos, -2- 1 Assistant Deputy Warden J. Heet, and Correctional Officer II F. Hawthorne. 2 Plaintiff raises one claim for relief in which he claims that his First, Sixth, and 3 Fourteenth Amendment rights were violated when Defendant Hawthorne picked up 4 Plaintiff’s legal mail envelope, removed the two-page letter within, and read the contents of 5 Plaintiff’s correspondence to his attorney. Plaintiff asked Defendant Hawthorne to stop 6 reading his attorney/client correspondence, to which Hawthorne replied “don’t tell me how 7 to do my job; I am authorized to search legal mail for contraband as well as scan the content 8 of the material to ensure it is of legal subject matter.” Defendant Hawthorne returned the 9 envelope to Plaintiff, at which point Plaintiff sealed the envelope and placed it in the door. 10 Plaintiff states that the envelope was gone in the morning, but that mail logs reflected that 11 no legal mail was processed or logged in Plaintiff’s name. Plaintiff concludes that Defendant 12 Hawthorne tampered with or destroyed his legal mail. 13 Plaintiff further alleges that Defendant Heet denied Plaintiff’s grievance regarding the 14 above incident. Defendant Trujillo affirmed denial of the grievance. Defendant Ryan denied 15 the grievance appeal and stated that “staff are not prohibited from reading such documents 16 [legal mail] to the extent necessary to establish the absence of contraband . . . and ensure the 17 content of the mail is of legal subject matter.” 18 19 Plaintiff seeks injunctive relief and money damages. III. Failure to State a Claim 20 A. Defendant Ramos 21 To state a valid claim under § 1983, plaintiffs must allege that they suffered a specific 22 injury as a result of specific conduct of a defendant and show an affirmative link between the 23 injury and the conduct of that defendant. See Rizzo v. Goode, 423 U.S. 362, 371-72, 377 24 (1976). With respect to Defendant Ramos, Plaintiff states only that “Defendant Ramos 25 acknowledges [Plaintiff’s legal] representation and approved confidential legal visits and 26 phone calls.” Plaintiff makes no allegation that Defendant Ramos violated his constitutional 27 rights and has therefore failed to state a claim against Defendant Ramos. 28 JDDL-K -3- 1 B. Defendants Heet, Trujillo, and Ryan 2 The mere denial of a grievance does not give rise to the inference of active 3 unconstitutional behavior. 4 unconstitutional conduct is the denial of administrative grievances, the failure to intervene 5 on a prisoner’s behalf to remedy alleged unconstitutional behavior does not amount to active 6 unconstitutional behavior for purposes of § 1983. Shehee v. Luttrell, 199 F.3d 295, 300 (6th 7 Cir. 1999). 8 Trujillo, and Ryan. 9 C. Where a defendant’s only involvement in the allegedly Accordingly, Plaintiff has failed to state a claim against Defendants Heet, Legal Mail 10 Outgoing legal mail sent by prisoners may only be opened in the presence of the 11 sending inmate, whether the correspondence relates to criminal or civil matters. Ramos v. 12 Lamm, 639 F.2d 559, 582 (10th Cir. 1980). 13 To the extent that Plaintiff claims his right of access to the courts was violated by 14 Defendant Hawthorne’s reading of Plaintiff’s legal mail in Plaintiff’s presence, Plaintiff has 15 failed to allege that Defendant Hawthorne’s conduct resulted in an actual injury. As a matter 16 of standing, for an access-to-courts claim, a plaintiff must show that he suffered an “actual 17 injury” with respect to contemplated litigation. Lewis v. Casey, 518 U.S. 343, 349 (1996); 18 Lewis v. Cook County Bd. of Com’rs, 6 Fed. Appx. 428, 430 (7th Cir. 2001) (plaintiff could 19 not prevail when he did “not describe a single legal case or claim that was in any way 20 thwarted because the mail room staff opened his legal mail.”). Plaintiff does not have a First 21 Amendment right that prohibits a guard from opening his mail in his presence and reading 22 it with an eye to determining if it advances illegal conduct. Stanley v. Vining, 602 F.3d 767, 23 770 (6th Cir. 2010); Lavado v. Keohane, 992 F.2d 601, 609 (6th Cir. 1993) (The law has not 24 ‘established that . . . reading [properly marked legal mail] in inmates’ presence violated 25 constitutional rights in and of itself.”). 26 27 28 JDDL-K To the extent Plaintiff claims Defendant Hawthorne’s conduct violated his right to counsel, Plaintiff has also failed to state a claim. In order to state a § 1983 cognizable claim for deprivation of right to counsel, there must be some allegation indicating an interference with the prisoner’s -4- 1 relationship with counsel. In order to state such a claim there must be something more than an allegation that a guard ‘read’ his ‘legal mail’ in his presence and that he was offended or believed this act to be a violation of a state prison regulation. 2 3 Stanley, 602 F.3d at 770. 4 Plaintiff makes no specific allegations that Defendant Hawthorne’s conduct interfered 5 with his relationship with counsel. Plaintiff makes only a vague and conclusory allegation 6 that his constitutional rights were violated and that “the prejudicial effects are incalculable 7 as appeals to convictions are active and Plaintiff’s ability to confidentially correspond with 8 attorney or court is divested.” This is insufficient to demonstrate a violation of Plaintiff’s 9 right to counsel. 10 Finally, to the extent that Plaintiff alleges Defendant Hawthorne destroyed his legal 11 mail, Plaintiff has simply not alleged facts sufficient to support this allegation. Plaintiff 12 alleges only that he placed the mail “in the door,” it was gone in the morning, and it was not 13 recorded on the mail logs as having been sent. Nothing in that chain of events suggests 14 Defendant Hawthorne destroyed Plaintiff’s mail. 15 Accordingly, the Complaint will be dismissed for failure to state a claim. 16 IV. Leave to Amend 17 For the foregoing reasons, Plaintiff’s Complaint will be dismissed for failure to state 18 a claim upon which relief may be granted. Within 30 days, Plaintiff may submit a first 19 amended complaint to cure the deficiencies outlined above. The Clerk of Court will mail 20 Plaintiff a court-approved form to use for filing a first amended complaint. If Plaintiff fails 21 to use the court-approved form, the Court may strike the amended complaint and dismiss this 22 action without further notice to Plaintiff. 23 Plaintiff must clearly designate on the face of the document that it is the “First 24 Amended Complaint.” The first amended complaint must be retyped or rewritten in its 25 entirety on the court-approved form and may not incorporate any part of the original 26 Complaint by reference. Plaintiff may include only one claim per count. 27 A first amended complaint supersedes the original complaint. Ferdik v. Bonzelet, 963 28 F.2d 1258, 1262 (9th Cir. 1992); Hal Roach Studios v. Richard Feiner & Co., 896 F.2d 1542, JDDL-K -5- 1 1546 (9th Cir. 1990). After amendment, the Court will treat an original complaint as 2 nonexistent. Ferdik, 963 F.2d at 1262. Any cause of action that was raised in the original 3 complaint is waived if it is not raised in a first amended complaint. King v. Atiyeh, 814 F.2d 4 565, 567 (9th Cir. 1987). 5 V. Warnings 6 A. 7 Plaintiff must file and serve a notice of a change of address in accordance with Rule 8 83.3(d) of the Local Rules of Civil Procedure. Plaintiff must not include a motion for other 9 relief with a notice of change of address. Failure to comply may result in dismissal of this 10 Address Changes action. 11 B. Copies 12 Plaintiff must submit an additional copy of every filing for use by the Court. See 13 LRCiv 5.4. Failure to comply may result in the filing being stricken without further notice 14 to Plaintiff. 15 C. Possible “Strike” 16 Because the Complaint has been dismissed for failure to state a claim, if Plaintiff fails 17 to file an amended complaint correcting the deficiencies identified in this Order, the 18 dismissal may count as a “strike” under the “3-strikes” provision of 28 U.S.C. § 1915(g). 19 Under the 3-strikes provision, a prisoner may not bring a civil action or appeal a civil 20 judgment in forma pauperis under 28 U.S.C. § 1915 “if the prisoner has, on 3 or more prior 21 occasions, while incarcerated or detained in any facility, brought an action or appeal in a 22 court of the United States that was dismissed on the grounds that it is frivolous, malicious, 23 or fails to state a claim upon which relief may be granted, unless the prisoner is under 24 imminent danger of serious physical injury.” 28 U.S.C. § 1915(g). 25 26 If Plaintiff fails to timely comply with every provision of this Order, including these 27 warnings, the Court may dismiss this action without further notice. See Ferdik, 963 F.2d at 28 JDDL-K D. Possible Dismissal 1260-61 (a district court may dismiss an action for failure to comply with any order of the -6- 1 Court). 2 IT IS ORDERED: 3 (1) The Complaint (Doc. 1) is dismissed for failure to state a claim. Plaintiff has 4 30 days from the date this Order is filed to file a first amended complaint in compliance with 5 this Order. 6 (2) If Plaintiff fails to file an amended complaint within 30 days, the Clerk of 7 Court must, without further notice, enter a judgment of dismissal of this action with prejudice 8 that states that the dismissal may count as a “strike” under 28 U.S.C. § 1915(g). 9 10 11 (3) The Clerk of Court must mail Plaintiff a court-approved form for filing a civil rights complaint by a prisoner. DATED this 17th day of January, 2012. 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 JDDL-K -7- 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 Fee. The filing fee for this action is $350.00. If you are unable to immediately pay the filing fee, 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. 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 $350 filing fee or the application to proceed in forma pauperis to: Revised 3/9/07 1 Phoenix & Prescott Divisions: OR U.S. District Court Clerk U.S. Courthouse, Suite 130 401 West Washington Street, SPC 10 Phoenix, Arizona 85003-2119 Tucson Division: U.S. District Court Clerk U.S. Courthouse, Suite 1500 405 West Congress Street 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. 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 courtapproved civil rights complaint form. You may file one amended complaint without leave (permission) of Court before any defendant has answered your original complaint. See Fed. R. Civ. P. 15(a). After any defendant has filed an answer, 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 “1A” 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,” “2B,” 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, vs. (1) (Full Name of Defendant) (2) (3) (4) Defendant(s). G Check if there are additional Defendants and attach page 1-A listing them. ) , ) ) ) ) CASE NO. ) (To be supplied by the Clerk) , ) ) , ) CIVIL RIGHTS COMPLAINT ) , ) BY A PRISONER ) , ) G Original Complaint G First Amended Complaint ) ) G Second Amended Complaint A. JURISDICTION 1. 2. 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: . Institution/city where violation occurred: . Revised 3/9/07 1 550/555 B. DEFENDANTS 1. Name of first Defendant: at . The first Defendant is employed as: . (Position and Title) 2. (Institution) Name of second Defendant: at . The second Defendant is employed as: . (Position and Title) 3. (Institution) Name of third Defendant: at . The third Defendant is employed as: . (Position and Title) 4. (Institution) Name of fourth Defendant: at . The fourth Defendant is employed as: . (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? 2. If yes, how many lawsuits have you filed? G Yes G No . 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: v. 1. Parties: 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 1. COUNT I 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 G Yes G No at your institution? 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 1. COUNT II 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 1. COUNT III 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 G Yes G No at your institution? 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. 6

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