Correa v. Glendale Police Department et al

Filing 5

ORDER: Plaintiff's Application to Proceed In Forma Pauperis (Doc. #2 ) is granted. 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. The Complaint (Doc. #1 ) 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 in compliance with this Order. If Plaintiff fails to file an amended complaint within 30 days, the Clerk must enter a judgment of dismissal of this action with prejudice that states that the dismissal may count as a strike. The Clerk shall mail Plaintiff a court-approved form for filing a civil rights complaint by a prisoner. Signed by Senior Judge James A Teilborg on 1/18/2023. (KJ)

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IN THE UNITED STATES DISTRICT COURT

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FOR THE DISTRICT OF ARIZONA

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Jeremy Mozes Correa,

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No.

CV 22-02088-PHX-JAT (DMF)

Plaintiff,

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v.

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Glendale Police Department, et al.,

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ORDER

Defendants.

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Pro se Plaintiff Jeremy Mozes Correa, who is confined in a Maricopa County Jail,

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filed a civil rights Complaint pursuant to 42 U.S.C. § 1983 (Doc. 1) and an Application to

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

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will dismiss the Complaint with leave to amend.

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I.

Application to Proceed In Forma Pauperis and Filing Fee

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The Court will grant Plaintiff’s Application to Proceed In Forma Pauperis. 28

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

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§ 1915(b)(1). The Court will not assess an initial partial filing fee. Id. The statutory filing

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fee will be collected monthly in payments of 20% of the previous month’s income credited

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

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

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

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....

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....

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II.

Statutory Screening of Prisoner Complaints

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The Court is required to screen complaints brought by prisoners seeking relief

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against a governmental entity or an officer or an employee of a governmental entity. 28

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U.S.C. § 1915A(a). The Court must dismiss a complaint or portion thereof if a plaintiff

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has raised claims that are legally frivolous or malicious, that fail to state a claim upon which

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

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such relief. 28 U.S.C. § 1915A(b)(1)–(2).

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A pleading must contain a “short and plain statement of the claim showing that the

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pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2) (emphasis added). While Rule 8 does

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not demand detailed factual allegations, “it demands more than an unadorned, the-

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defendant-unlawfully-harmed-me accusation.”

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(2009). “Threadbare recitals of the elements of a cause of action, supported by mere

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conclusory statements, do not suffice.” Id.

Ashcroft v. Iqbal, 556 U.S. 662, 678

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“[A] complaint must contain sufficient factual matter, accepted as true, to ‘state a

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claim to relief that is plausible on its face.’” Id. (quoting Bell Atlantic Corp. v. Twombly,

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550 U.S. 544, 570 (2007)). A claim is plausible “when the plaintiff pleads factual content

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that allows the court to draw the reasonable inference that the defendant is liable for the

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misconduct alleged.” Id. “Determining whether a complaint states a plausible claim for

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relief [is] . . . a context-specific task that requires the reviewing court to draw on its judicial

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experience and common sense.” Id. at 679. Thus, although a plaintiff’s specific factual

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allegations may be consistent with a constitutional claim, a court must assess whether there

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are other “more likely explanations” for a defendant’s conduct. Id. at 681.

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

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must “continue to construe pro se filings liberally.” Hebbe v. Pliler, 627 F.3d 338, 342

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

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standards than formal pleadings drafted by lawyers.’” Id. (quoting Erickson v. Pardus, 551

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U.S. 89, 94 (2007) (per curiam)).

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If the Court determines that a pleading could be cured by the allegation of other

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facts, a pro se litigant is entitled to an opportunity to amend a complaint before dismissal

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of the action. See Lopez v. Smith, 203 F.3d 1122, 1127-29 (9th Cir. 2000) (en banc).

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Plaintiff’s Complaint will be dismissed for failure to state a claim, but because it may

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possibly be amended to state a claim, the Court will dismiss it with leave to amend.

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III.

Complaint

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In his one-count Complaint, Plaintiff seeks monetary damages, his court costs and

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fees, and his attorney’s fees from Defendants Maricopa County Sheriff Paul Penzone, the

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Glendale Police Department, the Glendale SWAT Team, and the Glendale K-9 Unit.

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Plaintiff contends he was subjected to excessive force by Defendant Glendale K-9

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Unit, in violation of his Fourth Amendment rights. Plaintiff alleges that while he was at

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his friend’s house, he and his friend got into an argument, and his friend called Defendant

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Glendale Police Department to have Plaintiff removed from the house. He claims his friend

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advised the 911 dispatcher that Plaintiff was unarmed and in the shower.

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Plaintiff asserts that when Defendants Glendale SWAT Team and Glendale K-9

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Unit arrived at the house and instructed everyone to come out, Plaintiff’s friend and the

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friend’s father came out of the house. Plaintiff claims he got out of the shower, got dressed,

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and walked to the entrance of the house. He alleges that when he saw an angry, barking

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canine, he lifted his shirt to show he was unarmed, turned around slowly to further

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demonstrate he was not armed, and took a few steps forward, with his hands up. Plaintiff

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contends the canine immediately became “super aggressive” and was trying to break free

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from its leash.

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Plaintiff alleges he became “extremely scar[]ed and took one step back,” at which

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point the canine handler “immediately released the dog on Plaintiff.” Plaintiff claims that

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the canine’s first bite “took [him] to the ground” and that after the second bite, Plaintiff’s

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hands “c[a]me down to hold his skin in place” and he inched toward the entrance of the

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house, screaming that he could not put his hands up. Plaintiff contends the dog bit him

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three more times before the handler pulled the canine off Plaintiff. Plaintiff alleges he was

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bleeding “all down his left side torso and right index finger” where the canine had bitten

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him. According to Plaintiff, officers helped him to his feet, handcuffed him, and took him

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to the hospital, where he received stitches for the bites to his torso and finger.

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Plaintiff contends the five canine bites were “objectively unreasonable considering

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the number of officers that were present,” the fact that Plaintiff demonstrated he was

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unarmed, and the fact that he was “not resistant.” He claims the canine’s deployment was

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“not in response to a perceived threat” and “a K-9 deployment under the circumstances has

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no legitimate place in the scheme of law enforcement procedure.” He further alleges that

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“the deployment of a [‘]bite and hold[’] was purely an intentional infliction of a high level

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of pain, serious injury, unnecessary pain and suffering, and wretched psychological stress.”

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Plaintiff indicates he “plans on respectfully requesting . . . that [he] be granted the

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ability to amend his original complaint so[] that he can identify all named defendants . . .

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to [prosecute] his claim against[ the] K-9 handler, all other Glendale Officers that were

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present during this horrific display of excessive force, Glendale Police Officers[’] full

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names, and Glendale SWAT Team Members[’] full names.” Plaintiff also contends he is

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suing Defendant Penzone in his official capacity because he “is the final policymaker for

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the County on law-enforcement matters.” In addition, Plaintiff claims the “constitutional

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injury would not have resulted if municipality properly trained its employe[e]s.”

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IV.

Failure to State a Claim

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Although pro se pleadings are liberally construed, Haines v. Kerner, 404 U.S. 519,

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520-21 (1972), conclusory and vague allegations will not support a cause of action. Ivey

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v. Bd. of Regents, 673 F.2d 266, 268 (9th Cir. 1982). Further, a liberal interpretation of a

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civil rights complaint may not supply essential elements of the claim that were not initially

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pled. Id.

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A.

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Defendant Glendale Police Department is a subpart of the City of Glendale, not a

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separate entity for purposes of suit. Gotbaum v. City of Phx., 617 F. Supp. 2d 878, 886 (D.

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Ariz. 2008); see Braillard v. Maricopa County, 232 P.3d 1263, 1269 (Ariz. Ct. App. 2010)

Defendant Glendale Police Department

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(county sheriff’s office is a nonjural entity); see also Vicente v. City of Prescott, 2012 WL

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1438695, at *3 (D. Ariz. 2012) (city fire department is a nonjural entity); Wilson v. Yavapai

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County Sheriff’s Office, 2012 WL 1067959, at *4 (D. Ariz. 2012) (county sheriff’s office

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and county attorney’s office are nonjural entities). Because Defendant Glendale is not a

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separate entity, it is not capable of being separately sued. Thus, the Court will dismiss

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Defendant Glendale Police Department.

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Moreover, even if Plaintiff had sued the City of Glendale, his allegations do not

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support a claim. A municipality may not be sued solely because an injury was inflicted by

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its employees or agents. Long v. County of Los Angeles, 442 F.3d 1178, 1185 (9th Cir.

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2006). The actions of individuals may support municipal liability only if the employees

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were acting pursuant to an official policy or custom of the municipality. Botello v.

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Gammick, 413 F.3d 971, 978-79 (9th Cir. 2005). A § 1983 claim against a municipal

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defendant “cannot succeed as a matter of law” unless a plaintiff: (1) contends that the

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municipal defendant maintains a policy or custom pertinent to the plaintiff’s alleged injury;

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and (2) explains how such policy or custom caused the plaintiff’s injury. Sadoski v. Mosley,

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435 F.3d 1076, 1080 (9th Cir. 2006) (affirming dismissal of a municipal defendant pursuant

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to Fed. R. Civ. P. 12(b)(6)). Plaintiff has failed to allege facts to support that the City of

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Glendale maintained a specific policy or custom that resulted in a violation of Plaintiff’s

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federal constitutional rights and has failed to explain how his injuries were caused by any

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municipal policy or custom.

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B.

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The acts described in the Complaint involve members of the City of Glendale Police

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Department. Defendant Penzone is the Maricopa County Sheriff, is not responsible for

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training City of Glendale employees, and does not create law enforcement policy for the

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City of Glendale. Thus, the Court will dismiss Defendant Penzone.

Defendant Penzone

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C.

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The claims against Defendants Glendale SWAT Team and Glendale K-9 Unit

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consist solely of vague and conclusory allegations against groups of Defendants, without

Defendants Glendale SWAT Team and K-9 Unit

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any factual specificity as to what any particular Defendant did or failed to do. This is

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insufficient. See Marcilis v. Twp. of Redford, 693 F.3d 589, 596 (6th Cir. 2012) (upholding

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dismissal of Bivens complaint that referred to all defendants “generally and categorically”

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because the plaintiff had failed to “‘allege, with particularity, facts that demonstrate what

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each defendant did to violate the asserted constitutional right.’” (quoting Lanman v.

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Hinson, 529 F.3d 673, 684 (6th Cir. 2008))); Robbins v. Oklahoma, 519 F.3d 1242, 1250

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(10th Cir. 2008) (“Given the complaint’s use of either the collective term ‘Defendants’ or

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a list of the defendants named individually but with no distinction as to what acts are

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attributable to whom, it is impossible for any of these individuals to ascertain what

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particular unconstitutional acts they are alleged to have committed.”).

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Plaintiff’s allegations against the canine handler are more specific, he has failed to

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separately name that individual as a Defendant. Thus, the Court will dismiss without

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prejudice Defendants Glendale SWAT Team and K-9 Unit.

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V.

And while

Leave to Amend

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For the foregoing reasons, the Court will dismiss Plaintiff’s Complaint for failure to

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

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

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

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

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dismiss this action without further notice to Plaintiff.

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

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

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

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

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

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

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1542, 1546 (9th Cir. 1990). After amendment, the Court will treat the original Complaint

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

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original Complaint and that was voluntarily dismissed or was dismissed without prejudice

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is waived if it is not alleged in a first amended complaint. Lacey v. Maricopa County, 693

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

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

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telling the Court: (1) the constitutional right Plaintiff believes was violated; (2) the name

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of the Defendant who violated the right; (3) exactly what that Defendant did or failed to

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

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

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that Defendant’s conduct. See Rizzo v. Goode, 423 U.S. 362, 371-72, 377 (1976).

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Plaintiff must repeat this process for each person he names as a Defendant. If

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Plaintiff fails to affirmatively link the conduct of each named Defendant with the specific

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

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failure to state a claim.

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Defendants has violated a constitutional right are not acceptable and will be

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dismissed.

Conclusory allegations that a Defendant or group of

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If Plaintiff does not know the names of individual Defendants, he must list the

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individual unknown Defendants as Defendant John (or Jane) Doe 1, John Doe 2, and so on

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in the caption of his amended complaint. In the body of the amended complaint, Plaintiff

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must allege facts to support how each particular Doe Defendant violated Plaintiff’s

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rights. It is insufficient to simply list categories of Defendants (such as “SWAT Team”

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and “K-9 Unit”) and make conclusory allegations against them as a group.

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VI.

Warnings

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A.

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If Plaintiff is released while this case remains pending, and the filing fee has not

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been paid in full, Plaintiff must, within 30 days of his release, either (1) notify the Court

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that he intends to pay the unpaid balance of his filing fee within 120 days of his release or

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(2) file a non-prisoner application to proceed in forma pauperis. Failure to comply may

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result in dismissal of this action.

Release

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B.

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

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

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relief with a notice of change of address. Failure to comply may result in dismissal of this

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action.
Possible “Strike”

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C.

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

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

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

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

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

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

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

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

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

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D.

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

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warnings, the Court may dismiss this action without further notice. See Ferdik, 963 F.2d

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at 1260-61 (a district court may dismiss an action for failure to comply with any order of

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the Court).

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IT IS ORDERED:

Possible Dismissal

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(1)

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

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(2)

As required by the accompanying Order to the appropriate government

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

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fee.

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Address Changes

(3)

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

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

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with this Order.

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(4)

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

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

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

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and deny any pending unrelated motions as moot.

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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 18th day of January, 2023.

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Instructions for a Prisoner Filing a Civil Rights Complaint
in the United States District Court for the District of Arizona
1. Who May Use This Form. The civil rights complaint form is designed to help incarcerated
persons prepare a complaint seeking relief for a violation of their federal civil rights. These
complaints typically concern, but are not limited to, conditions of confinement. This form
should not be used to challenge your conviction or sentence. If you want to challenge a state
conviction or sentence, you should file a petition under 28 U.S.C. ' 2254 for a writ of habeas
corpus by a person in state custody. If you want to challenge a federal conviction or sentence,
you should file a motion under 28 U.S.C. § 2255 to vacate sentence in the federal court that entered
the judgment.
2. The Form. Local Rule of Civil Procedure (LRCiv) 3.4 provides that complaints by
incarcerated persons must be filed on the court-approved form. The form must be typed or
neatly handwritten. The form must be completely filled in to the extent applicable. All questions
must be answered clearly and concisely in the appropriate space on the form. If needed, you may
attach additional pages, but no more than fifteen additional pages, of standard letter-sized paper.
You must identify which part of the complaint is being continued and number all pages. If you do
not fill out the form properly, you will be asked to submit additional or corrected information,
which may delay the processing of your action. You do not need to cite law.
3. Your Signature. You must tell the truth and sign the form. If you make a false statement of
a material fact, you may be prosecuted for perjury.
4. The Filing and Administrative Fees. The total fees for this action are $402.00 ($350.00 filing
fee plus $52.00 administrative fee). If you are unable to immediately pay the fees, you may
request leave to proceed in forma pauperis. Please review the “Information for Prisoners Seeking
Leave to Proceed with a (Non-Habeas) Civil Action in Federal Court In Forma Pauperis Pursuant
to 28 U.S.C. ' 1915” for additional instructions.
5. Original and Judge=s Copy. You must send an original plus one copy of your complaint and
of any other documents submitted to the Court. You must send one additional copy to the Court
if you wish to have a file-stamped copy of the document returned to you. All copies must be
identical to the original. Copies may be legibly handwritten. This section does not apply to
inmates housed at an Arizona Department of Corrections facility that participates in
electronic filing.
6. Where to File. You should file your complaint in the division where you were confined
when your rights were allegedly violated. See LRCiv 5.1(a) and 77.1(a). If you were confined
in Maricopa, Pinal, Yuma, La Paz, or Gila County, file in the Phoenix Division. If you were
confined in Apache, Navajo, Coconino, Mohave, or Yavapai County, file in the Prescott Division.
If you were confined in Pima, Cochise, Santa Cruz, Graham, or Greenlee County, file in the Tucson
Division. Mail the original and one copy of the complaint with the $402 filing and
administrative fees or the application to proceed in forma pauperis to:
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Revised 12/1/20

Phoenix & Prescott Divisions:
U.S. District Court Clerk
U.S. Courthouse, Suite 130
401 West Washington Street, SPC 10
Phoenix, Arizona 85003-2119

OR

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. This section does not apply to inmates housed at an Arizona Department
of Corrections facility that participates in electronic filing.
A certificate of service should be in the following form:
I hereby certify that a copy of the foregoing document was mailed
this
(month, day, year) to:
Name:
Address:
Attorney for Defendant(s)
(Signature)
9. Amended Complaint. If you need to change any of the information in the initial complaint,
you must file an amended complaint. The amended complaint must be written on the courtapproved civil rights complaint form. You may file one amended complaint without leave
(permission) of Court within 21 days after serving it or within 21 days after any defendant has
filed an answer, whichever is earlier. See Fed. R. Civ. P. 15(a). Thereafter, you must file a
motion for leave to amend and lodge (submit) a proposed amended complaint. LRCiv 15.1. In
addition, an amended complaint may not incorporate by reference any part of your prior complaint.
LRCiv 15.1(a)(2). Any allegations or defendants not included in the amended complaint are
considered dismissed. All amended complaints are subject to screening under the Prison
Litigation Reform Act; screening your amendment will take additional processing time.
10. Exhibits. You should not submit exhibits with the complaint or amended complaint.
Instead, the relevant information should be paraphrased. You should keep the exhibits to use to
support or oppose a motion to dismiss, a motion for summary judgment, or at trial.
11. Letters and Motions. It is generally inappropriate to write a letter to any judge or the staff
of any judge. The only appropriate way to communicate with the Court is by filing a written
pleading or motion.
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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,” “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.
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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.

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___________________________________________
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,
CASE NO. __________________________________
(To be supplied by the Clerk)

v.
(1) _______________________________________ ,
(Full Name of Defendant)

CIVIL RIGHTS COMPLAINT
BY A PRISONER

(2) _______________________________________ ,
(3) _______________________________________ ,

G Original Complaint
G First Amended Complaint
G Second Amended Complaint

(4) _______________________________________ ,
Defendant(s).

G Check if there are additional Defendants and attach page 1-A listing them.
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 12/1/20

1

550/555

B. DEFENDANTS
1. Name of first Defendant:
. The first Defendant is employed
as: ______________________________________________ at_______________________________________.
(Position and Title)

(Institution)

2. Name of second Defendant:
. The second Defendant is employed as:
as: ______________________________________________ at_______________________________________.
(Position and Title)

(Institution)

3. Name of third Defendant:
. The third Defendant is employed
as: ______________________________________________ at_______________________________________.
(Position and Title)

(Institution)

4. Name of fourth Defendant:
. The fourth Defendant is employed
as: ______________________________________________ at_______________________________________.
(Position and Title)

(Institution)

If you name more than four Defendants, answer the questions listed above for each additional Defendant on a separate page.

C. PREVIOUS LAWSUITS
1.

Have you filed any other lawsuits while you were a prisoner?

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:
1. Parties:
v.
2. Court and case number:
3. Result: (Was the case dismissed? Was it appealed? Is it still pending?)

.
.

c. Third prior lawsuit:
1. Parties:
v.
2. Court and case number:
3. Result: (Was the case dismissed? Was it appealed? Is it still pending?)

.
.

If you filed more than three lawsuits, answer the questions listed above for each additional lawsuit on a separate page.

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 institution?
G Yes
G No
b. Did you submit a request for administrative relief on Count I?
G Yes
G No
c. Did you appeal your request for relief on Count I to the highest level?
G Yes
G No
d. If you did not submit or appeal a request for administrative relief at any level, briefly explain why you
did not.
.

3

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 institution?
G Yes
G No
b. Did you submit a request for administrative relief on Count III?
G Yes
G No
c. Did you appeal your request for relief on Count III to the highest level?
G Yes
G No
d. If you did not submit or appeal a request for administrative relief at any level, briefly explain why you
did not.
.

If you assert more than three Counts, answer the questions listed above for each additional Count on a separate page.

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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.

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