Folsom v. Arpaio et al

Filing 5

ORDER granting 2 Plaintiff's Application/Motion for Leave to Proceed In Forma Pauperis, Plaintiff must pay the $350.00 filing fee. The complaint is dismissed with 30 days leave to amend. Clerk must enter dismissal with prejudice that states that the dismissal may count as a "strike" under 28 U.S.C. § 1915(g) if Plaintiff fails to comply. Signed by Judge David G Campbell on 9/8/14.(LSP)

1
2

KAB

WO

3
4
5
6

IN THE UNITED STATES DISTRICT COURT

7

FOR THE DISTRICT OF ARIZONA

8
9

Anthony Fletcher Folsom,

10
11
12

No. CV 14-0778-PHX-DGC (BSB)

Plaintiff,
vs.

ORDER

Joseph M. Arpaio, et al.,

13

Defendants.

14
15

Plaintiff Anthony Fletcher Folsom, who is confined in the Maricopa County

16

Durango Jail, filed a pro se civil rights Complaint pursuant to 42 U.S.C. § 1983 (Doc. 1)

17

and an Application to Proceed In Forma Pauperis (Doc. 2). The Court will grant the

18

Application to Proceed and dismiss the Complaint with leave to amend.

19

I.

Application to Proceed In Forma Pauperis and Filing Fee

20
21

§ 1915(a). Plaintiff must pay the statutory filing fee of $350.00. 28 U.S.C. § 1915(b)(1).

22

The Court will not assess an initial partial filing fee. Id. The statutory filing fee will be

23

collected monthly in payments of 20% of the previous month’s income credited to

24

Plaintiff’s trust account each time the amount in the account exceeds $10.00. 28 U.S.C.

25

§ 1915(b)(2). The Court will enter a separate Order requiring the appropriate government

26

agency to collect and forward the fees according to the statutory formula.

27

....

28

JDDL-K

Plaintiff’s Application to Proceed In Forma Pauperis will be granted. 28 U.S.C.

....

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, that fail to state a claim upon

6

which relief may be granted, or that seek monetary relief from a defendant who is

7

immune from such relief. 28 U.S.C. § 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). While Rule 8 does not demand

10

detailed factual allegations, “it demands more than an unadorned, the-defendant-

11

unlawfully-harmed-me accusation.”

12

“Threadbare recitals of the elements of a cause of action, supported by mere conclusory

13

statements, do not suffice.” Id.

Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009).

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. A claim is plausible “when the plaintiff

16

pleads factual content that allows the court to draw the reasonable inference that the

17

defendant is liable for the misconduct alleged.” Id. “Determining whether a complaint

18

states a plausible claim for relief [is] . . . a context-specific task that requires the

19

reviewing court to draw on its judicial experience and common sense.” Id. at 679. Thus,

20

although a plaintiff’s specific factual allegations may be consistent with a constitutional

21

claim, a court must assess whether there are other “more likely explanations” for a

22

defendant’s conduct. Id. at 681.

23
24

courts must “continue to construe pro se filings liberally.” Hebbe v. Pliler, 627 F.3d 338,

25

342 (9th Cir. 2010). A “complaint [filed by a pro se prisoner] ‘must be held to less

26

stringent standards than formal pleadings drafted by lawyers.’” Id. (quoting Erickson v.

27

Pardus, 551 U.S. 89, 94 (2007) (per curiam)). If the Court determines that a pleading

28

JDDL-K

But as the United States Court of Appeals for the Ninth Circuit has instructed,

could be cured by the allegation of other facts, a pro se litigant is entitled to an

-2-

1

opportunity to amend a complaint before dismissal of the action. See Lopez v. Smith, 203

2

F.3d 1122, 1127-29 (9th Cir. 2000) (en banc). Plaintiff’s Complaint will be dismissed for

3

failure to state a claim, but because it may possibly be amended to state a claim, the

4

Court will dismiss it with leave to amend.

5

III.

6
7

Complaint
In his Complaint, Plaintiff alleges three counts against Defendants Joseph M.

Arpaio and the Maricopa County Sheriff’s Office.1

8

In Count One, Plaintiff alleges as follows: “they say the[ir] servings are 2000

9

calories per day from a survey in 2005”; “2 meals a day with no drink with dinner”; “loss

10

of food during deliveries from other buildings”; “food is always cold”; “never enough

11

portions”; “loss of weight from malnutrition”; “weak from not eating”; “mysterious meat

12

is always greasy”; and “fruit is always rotten.” Plaintiff alleges that he was injured as

13

follows: “no energy, loss of muscle mass, not sure on long term effect, P.T.S.S.,

14

malnutrition.”

15

In Count Two, Plaintiff alleges as follows: “air conditioning is on at all times”;

16

“air temp is always 65º or lower”; “will not turn heat on”; “will not give extra blankets or

17

thermals”; “improper air ventilation”; “sta[ph] infections”; “dirty air ducts”; “asbestos in

18

buildings”; “multiples inmates always sick”; and “officers wear jackets.” Plaintiff alleges

19

that he was injured as follows: “sick, can’t sleep, P.T.S.S., cold virus, headaches, body

20

aches, always getting sick, long term effect unknown.”

21

In Count Three, Plaintiff alleges as follows: “all county jails across the U.S. have

22

done away with 4 men cells”; “having to eat on bed because there is not enough tables

23

and chairs”; “64 inmates for 2 toilets and 2 showers without disinfectant”; “not enough

24

tables and chairs for all inmates”; “no room between bunks”; and “fire hazard.” Plaintiff

25

alleges that he was injured as follows: “sta[ph] infections, headaches, total effect

26
27
28

JDDL-K

1

Plaintiff lists “Maricopa Co. Sheriffs” as a Defendant. It is unclear whom
Plaintiff is trying to sue. For the purposes of this Order, however, the Court will assume
that Plaintiff intended to name the Maricopa County Sheriff’s Office as a Defendant.
-3-

1

unknown, untold amount of sicknesses, bodily injury from hitting bunks because of lack

2

of space in cells.”

3
4

Plaintiff seeks monetary relief.
IV.

Failure to State a Claim

5

To prevail in a § 1983 claim, a plaintiff must show that (1) acts by the defendants

6

(2) under color of state law (3) deprived him of federal rights, privileges or immunities

7

and (4) caused him damage. Thornton v. City of St. Helens, 425 F.3d 1158, 1163-64 (9th

8

Cir. 2005) (quoting Shoshone-Bannock Tribes v. Idaho Fish & Game Comm’n, 42 F.3d

9

1278, 1284 (9th Cir. 1994)). In addition, a plaintiff must allege that he suffered a specific

10

injury as a result of the conduct of a particular defendant and he must allege an

11

affirmative link between the injury and the conduct of that defendant. Rizzo v. Goode,

12

423 U.S. 362, 371-72, 377 (1976).

13

A.

14

The Maricopa County Sheriff’s Office is not a proper defendant. In Arizona, the

15

responsibility of operating jails and caring for prisoners is placed by law upon the sheriff.

16

See Ariz. Rev. Stat. Ann. § 11-441(A)(5); Ariz. Rev. Stat. Ann. § 31-101. A sheriff’s

17

office is simply an administrative creation of the county sheriff to allow him to carry out

18

his statutory duties and not a “person” amenable to suit pursuant to § 1983. Accordingly,

19

the Maricopa County Sheriff’s Office will be dismissed.

The Maricopa County Sheriff’s Office

20
21

Plaintiff fails to state a claim against Defendant Arpaio. “A plaintiff must allege

22

facts, not simply conclusions, that show that an individual was personally involved in the

23

deprivation of his civil rights.” Barren v. Harrington, 152 F.3d 1193, 1194 (9th Cir.

24

1998). For an individual to be liable in his official capacity, a plaintiff must allege that

25

the official acted as a result of a policy, practice, or custom. See Cortez v. County of Los

26

Angeles, 294 F.3d 1186, 1188 (9th Cir. 2002) (citation omitted). Further, there is no

27

respondeat superior liability under § 1983, so a defendant’s position as the supervisor of

28

JDDL-K

B.

someone who allegedly violated a plaintiff’s constitutional rights does not make him

Sheriff Joseph M. Arpaio

-4-

1

liable. Monell v. N.Y. Dep’t of Soc. Servs., 436 U.S. 658, 691 (1978); Taylor v. List, 880

2

F.2d 1040, 1045 (9th Cir. 1989) (citation omitted).

3

capacity “is only liable for constitutional violations of his subordinates if the supervisor

4

participated in or directed the violations, or knew of the violations and failed to act to

5

prevent them.” Taylor, 880 F.2d at 1045.

A supervisor in his individual

6

Plaintiff does not make any allegations against Arpaio in his Complaint. Plaintiff

7

does not allege that Arpaio directly violated his constitutional rights, directed violations

8

of Plaintiff’s constitutional rights, or knew of violations of Plaintiff’s constitutional rights

9

and failed to act to prevent them. Moreover, Plaintiff does not allege facts to support that

10

Plaintiff’s constitutional rights were violated as a result of a policy or custom

11

promulgated or endorsed by Arpaio. Accordingly, Plaintiff fails to state a claim upon

12

which relief can be granted against Arpaio and he will be dismissed.

13

V.

Leave to Amend

14

For the foregoing reasons, Plaintiff’s Complaint will be dismissed for failure to

15

state a claim upon which relief may be granted. Within 30 days, Plaintiff may submit a

16

first amended complaint to cure the deficiencies outlined above. The Clerk of Court will

17

mail Plaintiff a court-approved form to use for filing a first amended complaint. If

18

Plaintiff fails to use the court-approved form, the Court may strike the amended

19

complaint and dismiss this action without further notice to Plaintiff.

20

Plaintiff must clearly designate on the face of the document that it is the “First

21

Amended Complaint.” The first amended complaint must be retyped or rewritten in its

22

entirety on the court-approved form and may not incorporate any part of the original

23

Complaint by reference. Plaintiff may include only one claim per count.

24
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 that Defendant did or failed to

27

do; (4) how the action or inaction of that Defendant is connected to the violation of

28

JDDL-K

If Plaintiff files an amended complaint, Plaintiff must write short, plain statements

Plaintiff’s constitutional right; and (5) what specific injury Plaintiff suffered because of

-5-

1

that 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 Defendant2 with the

4

specific injury suffered by Plaintiff, the allegations against that Defendant will be

5

dismissed for failure to state a claim. Conclusory allegations that a Defendant or

6

group of Defendants has violated a constitutional right are not acceptable and will

7

be dismissed.

8

Moreover, in amending his Complaint, Plaintiff should be aware that a pretrial

9

detainee’s claim for unconstitutional conditions of confinement arises from the

10

Fourteenth Amendment Due Process Clause rather than from the Eighth Amendment

11

prohibition against cruel and unusual punishment. Bell v. Wolfish, 441 U.S. 520, 535

12

n.16 (1979). Nevertheless, the same standards are applied, requiring proof that the

13

defendant acted with deliberate indifference. See Frost v. Agnos, 152 F.3d 1124, 1128

14

(9th Cir. 1998) (citation omitted).

15

Deliberate indifference is a higher standard than negligence or lack of ordinary

16

due care for the prisoner’s safety. Farmer v. Brennan, 511 U.S. 825, 835 (1994). To

17

state a claim of deliberate indifference, plaintiffs must meet a two-part test. First, the

18

alleged constitutional deprivation must be, objectively, “sufficiently serious”; the

19

official’s act or omission must result in the denial of “the minimal civilized measure of

20

life’s necessities.” Id. at 834 (citations omitted). Second, the prison official must have a

21

“sufficiently culpable state of mind,” i.e., he must act with deliberate indifference to

22
23
24
25
26
27
28

JDDL-K

2

If Plaintiff does not know the names of the individual Defendants, Plaintiff must
list the individual unknown defendants as Defendant John (or Jane) Doe 1, John Doe 2,
and so on in the caption of his first amended complaint, and, in the body of the first
amended complaint, Plaintiff must allege facts to support how each particular Doe
defendant violated Plaintiff’s rights. See Wakefield v. Thompson, 177 F.3d 1160, 1163
(9th Cir. 1999) (where identity is unknown prior to the filing of a complaint, the plaintiff
should be given an opportunity through discovery to identify the unknown defendants,
unless it is clear that discovery would not uncover the identities, or that the complaint
would be dismissed on other grounds) (citing Gillespie v. Civiletti, 629 F.2d 637, 642
(9th Cir. 1980)).
-6-

1

inmate health or safety. Id. (citations omitted). In defining “deliberate indifference” in

2

this context, the Supreme Court has imposed a subjective test: “the official must both be

3

aware of facts from which the inference could be drawn that a substantial risk of serious

4

harm exists, and he must also draw the inference.” Id. at 837 (emphasis added).

5

To state a claim for unconstitutional conditions of confinement, a plaintiff must

6

allege that a defendant’s acts or omissions have deprived the inmate of “the minimal

7

civilized measure of life’s necessities” and that the defendant acted with deliberate

8

indifference to an excessive risk to inmate health or safety. Allen v. Sakai, 48 F.3d 1082,

9

1087 (9th Cir. 1994) (quoting Farmer, 511 U.S. at 834); see Estate of Ford v. Ramirez–

10

Palmer, 301 F.3d 1043, 1049-50 (9th Cir. 2002). Whether conditions of confinement rise

11

to the level of a constitutional violation may depend, in part, on the duration of an

12

inmate’s exposure to those conditions. Keenan v. Hall, 83 F.3d 1083, 1089, 1091 (9th

13

Cir. 1996) (citing Hutto v. Finney, 437 U.S. 678, 686-87 (1978)). “The circumstances,

14

nature, and duration of a deprivation of [ ] necessities must be considered in determining

15

whether a constitutional violation has occurred.” Hearns v. Terhune, 413 F.3d 1036,

16

1042 (9th Cir. 2005) (quoting Johnson v. Lewis, 217 F.3d 726, 731 (9th Cir. 2000)).

17

Allegations of overcrowding, without more, do not state a claim under the Eighth

18

and Fourteenth Amendments. See Hoptowit v. Ray, 682 F.2d 1237, 1248-49 (9th Cir.

19

1982). A plaintiff may, however, state a cognizable claim where he or she alleges that

20

overcrowding results in some unconstitutional condition. See, e.g., Akao v. Shimoda, 832

21

F.2d 119, 120 (9th Cir. 1987) (reversing district court’s dismissal of claim that

22

overcrowding caused increased stress, tension and communicable disease among inmate

23

population); see also Toussaint v. Yockey, 722 F.2d 1490, 1492 (9th Cir. 1984) (affirming

24

that an Eighth Amendment violation may occur as a result of overcrowded prison

25

conditions causing increased violence, tension and psychiatric problems).

26
27

only that prisoners receive food that is adequate to maintain health; it need not be tasty or

28

JDDL-K

With respect to meals, “[t]he Eighth [and Fourteenth] Amendment[s] require[]

aesthetically pleasing.” LeMaire v. Maass, 12 F.3d 1444, 1456 (9th Cir. 1993) (citation

-7-

1

omitted); see Frost, 152 F.3d at 1128 (applying Eighth Amendment standard to a pretrial

2

detainee’s Fourteenth Amendment claims regarding his conditions of confinement).

3

“The fact that the food occasionally contains foreign objects or sometimes is served cold,

4

while unpleasant, does not amount to a constitutional deprivation.” LeMaire, 12 F.3d at

5

1456 (citations omitted). An inmate may, however, state a claim where he alleges that he

6

is served meals with insufficient calories for long periods of time. Id.

7

A first amended complaint supersedes the original complaint. Ferdik v. Bonzelet,

8

963 F.2d 1258, 1262 (9th Cir. 1992); Hal Roach Studios v. Richard Feiner & Co., 896

9

F.2d 1542, 1546 (9th Cir. 1990). After amendment, the Court will treat an original

10

complaint as nonexistent. Ferdik, 963 F.2d at 1262. Any cause of action that was raised

11

in the original complaint and that was voluntarily dismissed or was dismissed without

12

prejudice is waived if it is not alleged in a first amended complaint. Lacey v. Maricopa

13

County, 693 F.3d 896, 928 (9th Cir. 2012) (en banc).

14

VI.

Warnings

15

A.

16

Plaintiff must pay the unpaid balance of the filing fee within 120 days of his

17

release. Also, within 30 days of his release, he must either (1) notify the Court that he

18

intends to pay the balance or (2) show good cause, in writing, why he cannot. Failure to

19

comply may result in dismissal of this action.

Release

20

B.

21

Plaintiff must file and serve a notice of a change of address in accordance with

22

Rule 83.3(d) of the Local Rules of Civil Procedure. Plaintiff must not include a motion

23

for other relief with a notice of change of address. Failure to comply may result in

24

dismissal of this action.

Address Changes

25
26

Plaintiff must submit an additional copy of every filing for use by the Court. See

27

LRCiv 5.4. Failure to comply may result in the filing being stricken without further

28

JDDL-K

C.

notice to Plaintiff.

Copies

-8-

1

D.

2

Because the Complaint has been dismissed for failure to state a claim, if Plaintiff

3

fails to file an amended complaint correcting the deficiencies identified in this Order, the

4

dismissal may count as a “strike” under the “3-strikes” provision of 28 U.S.C. § 1915(g).

5

Under the 3-strikes provision, a prisoner may not bring a civil action or appeal a civil

6

judgment in forma pauperis under 28 U.S.C. § 1915 “if the prisoner has, on 3 or more

7

prior occasions, while incarcerated or detained in any facility, brought an action or appeal

8

in a court of the United States that was dismissed on the grounds that it is frivolous,

9

malicious, or fails to state a claim upon which relief may be granted, unless the prisoner

10

Possible “Strike”

is under imminent danger of serious physical injury.” 28 U.S.C. § 1915(g).

11

E.

12

If Plaintiff fails to timely comply with every provision of this Order, including

13

these warnings, the Court may dismiss this action without further notice. See Ferdik, 963

14

F.2d at 1260-61 (a district court may dismiss an action for failure to comply with any

15

order of the Court).

16

IT IS ORDERED:

Possible Dismissal

17

(1)

Plaintiff’s Application to Proceed In Forma Pauperis (Doc. 2) is granted.

18

(2)

As required by the accompanying Order to the appropriate government

19

agency, Plaintiff must pay the $350.00 filing fee and is not assessed an initial partial

20

filing fee.

21

(3)

The Complaint (Doc. 1) is dismissed for failure to state a claim. Plaintiff

22

has 30 days from the date this Order is filed to file a first amended complaint in

23

compliance with this Order.

24

(4)

If Plaintiff fails to file an amended complaint within 30 days, the Clerk of

25
26

prejudice that states that the dismissal may count as a “strike” under 28 U.S.C. § 1915(g).

27

....

28

JDDL-K

Court must, without further notice, enter a judgment of dismissal of this action with

....

-9-

1
2
3

(5)

The Clerk of Court must mail Plaintiff a court-approved form for filing a

civil rights complaint by a prisoner.
Dated this 8th day of September, 2014.

4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

JDDL-K

- 10 -

Instructions for a Prisoner Filing a Civil Rights Complaint
in the United States District Court for the District of Arizona
1. Who May Use This Form. The civil rights complaint form is designed to help incarcerated
persons prepare a complaint seeking relief for a violation of their federal civil rights. These
complaints typically concern, but are not limited to, conditions of confinement. This form should
not be used to challenge your conviction or sentence. If you want to challenge a state conviction
or sentence, you should file a petition under 28 U.S.C. § 2254 for a writ of habeas corpus by a
person in state custody. If you want to challenge a federal conviction or sentence, you should file
a motion under 28 U.S.C. § 2255 to vacate sentence in the federal court that entered the judgment.

2. The Form. Local Rule of Civil Procedure (LRCiv) 3.4(a) provides that complaints by
incarcerated persons must be filed on the court-approved form. The form must be typed or
neatly handwritten. The form must be completely filled in to the extent applicable. All questions
must be answered clearly and concisely in the appropriate space on the form. If needed, you may
attach additional pages, but no more than fifteen additional pages, of standard letter-sized paper.
You must identify which part of the complaint is being continued and number all pages. If you do
not fill out the form properly, you will be asked to submit additional or corrected information, which
may delay the processing of your action. You do not need to cite law.
3. Your Signature. You must tell the truth and sign the form. If you make a false statement of a
material fact, you may be prosecuted for perjury.
4. The Filing and Administrative Fees. The total fees for this action are $400.00 ($350.00 filing fee
plus $50.00 administrative fee). If you are unable to immediately pay the fees, you may request
leave to proceed in forma pauperis. Please review the “Information for Prisoners Seeking Leave
to Proceed with a (Non-Habeas) Civil Action in Federal Court In Forma Pauperis Pursuant to 28
U.S.C. § 1915” for additional instructions.
5. Original and Judge’s Copy. You must send an original plus one copy of your complaint and of
any other documents submitted to the Court. You must send one additional copy to the Court if you
wish to have a file-stamped copy of the document returned to you. All copies must be identical to
the original. Copies may be legibly handwritten.
6. Where to File. You should file your complaint in the division where you were confined when
your rights were allegedly violated. See LRCiv 5.1(a) and 77.1(a). If you were confined in
Maricopa, Pinal, Yuma, La Paz, or Gila County, file in the Phoenix Division. If you were confined
in Apache, Navajo, Coconino, Mohave, or Yavapai County, file in the Prescott Division. If you
were confined in Pima, Cochise, Santa Cruz, Graham, or Greenlee County, file in the Tucson
Division. Mail the original and one copy of the complaint with the $400 filing and
administrative fees or the application to proceed in forma pauperis to:

Revised 5/1/2013

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 court-approved
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 “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,” “2B,” 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,
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 5/1/2013

1

550/555

B. DEFENDANTS
1.

Name of first Defendant:

. The first Defendant is employed as:
at

.

(Position and Title)
2.

(Institution)
. The second Defendant is employed as:

Name of second Defendant:
at

.

(Position and Title)
3.

(Institution)

Name of third Defendant:

. The third Defendant is employed as:
at

.

(Position and Title)
4.

(Institution)

Name of fourth Defendant:
at
(Position and Title)

. The fourth Defendant is employed as:
.
(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 at your
G Yes G No
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 at your
G Yes G No
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