Parks v. Montgomery et al
Filing
8
ORDER that Plaintiff's 2 APPLICATION to Proceed In Forma Pauperis is granted. Plaintiff must pay the $350.00 filing fee. Plaintiff's 6 APPLICATION to Proceed In Forma Pauperis is denied as moot. The 5 First Amende d Complaint is dismissed for failure to state a claim. Plaintiff has 30 days from the date this Order is filed to file a second amended complaint in compliance with this Order. If Plaintiff fails to comply, the Clerk of Court must, without f urther 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). The Clerk must mail Plaintiff a court-approved form for filing a civil rights complaint by a prisoner. Signed by Judge David G Campbell on 1/13/2015. (LFIG)
ASH
WO
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF ARIZONA
Damiano Vidal Parks,
No. CV 14-2387-PHX-DGC (JZB)
Plaintiff,
v.
ORDER
William G. Montgomery, et al.,
Defendants.
On October 27, 2014, Plaintiff Damiano Vidal Parks, who is confined in the
Maricopa County Fourth Avenue Jail, filed a pro se civil rights Complaint pursuant to 42
U.S.C. § 1983 (Doc. 1) and an Application to Proceed In Forma Pauperis (Doc. 2).
Subsequently, on November 11, 2014, Plaintiff filed a First Amended Complaint (Doc. 5)
and a second Application to Proceed In Forma Pauperis (Doc. 6). The Court will
dismiss the First Amended Complaint with leave to amend.
I.
Application to Proceed In Forma Pauperis and Filing Fee
Plaintiff’s Application to Proceed In Forma Pauperis (Doc. 2) will be granted. 28
U.S.C. § 1915(a). Plaintiff’s second Application to Proceed In Forma Pauperis (Doc. 6)
will be denied as moot. Plaintiff must pay the statutory filing fee of $350.00. 28 U.S.C.
§ 1915(b)(1). The Court will not assess an initial partial filing fee. Id. The fee will be
collected monthly in payments of 20% of the previous month’s income credited to
Plaintiff’s trust account each time the amount in the account exceeds $10.00. 28 U.S.C.
§ 1915(b)(2). The Court will enter a separate Order requiring the appropriate government
agency to collect and forward the fees according to the statutory formula.
II.
Statutory Screening of Prisoner Complaints
The Court is required to screen complaints brought by prisoners seeking relief
against a governmental entity or an officer or an employee of a governmental entity. 28
U.S.C. § 1915A(a). The Court must dismiss a complaint or portion thereof if a plaintiff
has raised claims that are legally frivolous or malicious, that fail to state a claim upon
which relief may be granted, or that seek monetary relief from a defendant who is
immune from such relief. 28 U.S.C. § 1915A(b)(1)–(2).
A pleading must contain a “short and plain statement of the claim showing that the
pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2) (emphasis added). While Rule 8
does not demand detailed factual allegations, “it demands more than an unadorned, thedefendant-unlawfully-harmed-me accusation.”
Ashcroft v. Iqbal, 556 U.S. 662, 678
(2009). “Threadbare recitals of the elements of a cause of action, supported by mere
conclusory statements, do not suffice.” Id.
“[A] complaint must contain sufficient factual matter, accepted as true, to ‘state a
claim to relief that is plausible on its face.’” Id. (quoting Bell Atlantic Corp. v. Twombly,
550 U.S. 544, 570 (2007)). A claim is plausible “when the plaintiff pleads factual
content that allows the court to draw the reasonable inference that the defendant is liable
for the misconduct alleged.” Id. “Determining whether a complaint states a plausible
claim for relief [is] . . . a context-specific task that requires the reviewing court to draw
on its judicial experience and common sense.” Id. at 679. Thus, although a plaintiff’s
specific factual allegations may be consistent with a constitutional claim, a court must
assess whether there are other “more likely explanations” for a defendant’s conduct. Id.
at 681.
But as the United States Court of Appeals for the Ninth Circuit has instructed,
courts must “continue to construe pro se filings liberally.” Hebbe v. Pliler, 627 F.3d 338,
342 (9th Cir. 2010). A “complaint [filed by a pro se prisoner] ‘must be held to less
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stringent standards than formal pleadings drafted by lawyers.’” Id. (quoting Erickson v.
Pardus, 551 U.S. 89, 94 (2007) (per curiam)).
If the Court determines that a pleading could be cured by the allegation of other
facts, a pro se litigant is entitled to an opportunity to amend a complaint before dismissal
of the action. See Lopez v. Smith, 203 F.3d 1122, 1127-29 (9th Cir. 2000) (en banc).
Plaintiff’s First Amended Complaint will be dismissed for failure to state a claim, but
because it may possibly be amended to state a claim, the Court will dismiss it with leave
to amend.
Additionally, because an amended complaint supersedes the original Complaint,
Ferdik v. Bonzelet, 963 F.2d 1258, 1262 (9th Cir. 1992), the Court will treat Plaintiff’s
original Complaint as nonexistent. Id. at 1262. Accordingly, any cause of action that
was raised in the original complaint and that was not raised in Plaintiff’s First Amended
Complaint will be considered waived. Lacey v. Maricopa County, 693 F.3d 896, 928
(9th Cir. 2012) (en banc).
III.
First Amended Complaint
In his one count First Amended Complaint, Plaintiff names Maricopa County
Attorney William G. Montgomery and Deputy Maricopa County Attorney Kurt N. Mills
as Defendants. Plaintiff requests that his pending state criminal charges be dismissed,
and seeks monetary relief.
Plaintiff alleges that on September 11, 2014, he was supposed to receive a hearing
in Maricopa County Superior Court in an underlying criminal case.
According to
Plaintiff, it had been agreed upon by himself, his attorney, and the Defendants that if the
State’s witnesses did not appear at the hearing, that Plaintiff would be released from
custody, although his charges would not be dropped or dismissed if the witnesses failed
to appear. Plaintiff alleges that the witnesses failed to appear, but that he was not
released, but instead had his hearing vacated in light of a supervening indictment.
IV.
Failure to State a Claim
To prevail in a § 1983 claim, a plaintiff must show that (1) acts by the defendants
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(2) under color of state law (3) deprived him of federal rights, privileges or immunities
and (4) caused him damage. Thornton v. City of St. Helens, 425 F.3d 1158, 1163-64 (9th
Cir. 2005) (quoting Shoshone-Bannock Tribes v. Idaho Fish & Game Comm’n, 42 F.3d
1278, 1284 (9th Cir. 1994)). In addition, a plaintiff must allege that he suffered a specific
injury as a result of the conduct of a particular defendant and he must allege an
affirmative link between the injury and the conduct of that defendant. Rizzo v. Goode,
423 U.S. 362, 371-72, 377 (1976).
A.
Defendants are Immune
Prosecutors are absolutely immune from liability under § 1983 for their conduct in
“initiating a prosecution and in presenting the State’s case” insofar as that conduct is
“intimately associated with the judicial phase of the criminal process.” Buckley v.
Fitzsimmons, 509 U.S. 259, 270 (1993) (citing Imbler v. Pachtman, 424 U.S. 409, 430
(1976)); Burns v. Reed, 500 U.S. 478, 486 (1991) (quoting Imbler v. Pachtman, 424 U.S.
409, 430-431 (1976)); Ashelman v. Pope, 793 F.2d 1072, 1076 (9th Cir. 1986). None of
Plaintiff’s allegations appear to concern any conduct by Defendants that would fall
outside of those duties typically associated with “initiating a prosecution and presenting
the State’s case.” Buckley, 509 U.S. at 270. Accordingly, Defendants are absolutely
immune from suit, and will be dismissed.
B.
Abstention Doctrine
The abstention doctrine set forth in Younger v. Harris, 401 U.S. 37 (1971),
prevents a federal court in most circumstances from directly interfering with ongoing
criminal proceedings in state court.
Further, the Younger abstention doctrine bars
requests for declaratory and monetary relief for constitutional injuries arising out of a
plaintiff’s current state criminal prosecution. Mann v. Jett, 781 F.2d 1448, 1449 (9th Cir.
1986) (per curiam). The Younger abstention doctrine also applies while the case works
its way through the state appellate process. New Orleans Pub. Serv., Inc. v. Council of
City of New Orleans, 491 U.S. 350, 369 (1989) (“[f]or Younger purposes, the State’s
trial-and-appeals process is treated as a unitary system”); Huffman v. Pursue, Ltd., 420
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U.S. 592, 608 (1975) (“Virtually all of the evils at which Younger is directed would
inhere in federal intervention prior to completion of state appellate proceedings, just as
surely as they would if such intervention occurred at or before trial.”) . Additionally, this
Court only has jurisdiction to adjudicate issues that are currently in controversy and
thereby ripe for review. 18 Unnamed John Smith Prisoners v. Meese, 871 F.2d 881, 883
(9th Cir. 1989). Thus, if Plaintiff's criminal proceedings have not concluded, the issue of
interference with the right to counsel would not be ripe for review. If relief is available to
Plaintiff in connection with these proceedings, it lies in the state court.
V.
Leave to Amend
Because Plaintiff has failed to state a claim against any named Defendant for
which relief could be granted, Plaintiff’s First Amended Complaint will be dismissed.
Within 30 days, Plaintiff may submit a second amended complaint to cure the
deficiencies outlined above. The Clerk of Court will mail Plaintiff a court-approved form
to use for filing a second amended complaint. If Plaintiff fails to use the court-approved
form, the Court may strike the second amended complaint and dismiss this action without
further notice to Plaintiff.
Plaintiff must clearly designate on the face of the document that it is the “Second
Amended Complaint.” The second amended complaint must be retyped or rewritten in
its entirety on the court-approved form and may not incorporate any part of the original
Complaint or First Amended Complaint by reference. Plaintiff may include only one
claim per count.
As noted previously, a second amended complaint supersedes the original
Complaint and First Amended Complaint. Ferdik v. Bonzelet, 963 F.2d 1258, 1262 (9th
Cir. 1992); Hal Roach Studios v. Richard Feiner & Co., 896 F.2d 1542, 1546 (9th Cir.
1990). After amendment, the Court will treat the original Complaint and First Amended
Complaint as nonexistent. Ferdik, 963 F.2d at 1262. Any cause of action that was raised
in the original complaint or first amended complaint and that was voluntarily dismissed
-5-
or was dismissed without prejudice is waived if it is not alleged in a second amended
complaint. Lacey v. Maricopa County, 693 F.3d 896, 928 (9th Cir. 2012) (en banc).
VI.
Warnings
A.
Release
If Plaintiff is released from custody while this case remains pending, and the filing
fee has not been paid in full, Plaintiff must, within 30 days of his release, either (1) notify
the Court that he intends to pay the unpaid balance of his filing fee within 120 days of his
release or (2) file a non-prisoner application to proceed in forma pauperis. Failure to
comply may result in dismissal of this action.
B.
Address Changes
Plaintiff must file and serve a notice of a change of address in accordance with
Rule 83.3(d) of the Local Rules of Civil Procedure. Plaintiff must not include a motion
for other relief with a notice of change of address. Failure to comply may result in
dismissal of this action.
C.
Copies
Plaintiff must submit an additional copy of every filing for use by the Court. See
LRCiv 5.4. Failure to comply may result in the filing being stricken without further
notice to Plaintiff.
D.
Possible “Strike”
Because the First Amended Complaint has been dismissed for failure to state a
claim, if Plaintiff fails to file a second amended complaint correcting the deficiencies
identified in this Order, the dismissal may count as a “strike” under the “3-strikes”
provision of 28 U.S.C. § 1915(g). Under the 3-strikes provision, a prisoner may not bring
a civil action or appeal a civil judgment in forma pauperis under 28 U.S.C. § 1915 “if the
prisoner has, on 3 or more prior occasions, while incarcerated or detained in any facility,
brought an action or appeal in a court of the United States that was dismissed on the
grounds that it is frivolous, malicious, or fails to state a claim upon which relief may be
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granted, unless the prisoner is under imminent danger of serious physical injury.” 28
U.S.C. § 1915(g).
E.
Possible Dismissal
If Plaintiff fails to timely comply with every provision of this Order, including
these warnings, the Court may dismiss this action without further notice. See Ferdik, 963
F.2d at 1260-61 (a district court may dismiss an action for failure to comply with any
order of the Court).
IT IS ORDERED:
(1)
Plaintiff’s Application to Proceed In Forma Pauperis (Doc. 2) is granted.
Plaintiff’s second Application to Proceed In Forma Pauperis (Doc. 6) is denied as moot.
(2)
As required by the accompanying Order to the appropriate government
agency, Plaintiff must pay the $350.00 filing fee and is not assessed an initial partial
filing fee.
(3)
The First Amended Complaint (Doc. 5) is dismissed for failure to state a
claim. Plaintiff has 30 days from the date this Order is filed to file a second amended
complaint in compliance with this Order.
(4)
If Plaintiff fails to file a second amended complaint within 30 days, 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).
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(5)
The Clerk of Court must mail Plaintiff a court-approved form for filing a
civil rights complaint by a prisoner.
Dated this 13th day of January, 2015.
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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(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
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