Riches v. Karr et al

Filing 3

Riches v. Karr et al

Doc. 3

Case 2:07-cv-02103-RTD-JRM

Document 3

Filed 09/20/2007

Page 1 of 4

FORMTO BE USEDBY PRISONERS FILING A COMPLA]NT IN q THE L T N D E R CIVILRIGHTS ACT.42 U.S.C. 1983
I N THE UNITED STATES DISTRICT COURT W E S I E R N DISTRICT OF ARIftNSAS DI\'ISION

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sEP 202007
BY

( E n t e r abovethe full nameof the plaintitf i n this action.)

s $ q l E Lee,Rrc.hsa

cltRlf,.,ro{{sfl{, s o.Ef,l( DEPIIYE,LSI(

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( E n t e r nbovethe fu!! name of thc defendant, o r defendants, this action.) ln L Previousl,awsuits A. Have you begunother lnwsuitsin stateor federulcourt dealingwith the srme f a c t s involved in this action?

Yes

Nr/

I f your nnswerto Aisyer, desrribecachlawsuit in the rpacebelowiucludinq the c x a c t nlaintiffname or aliLs used. (If there is more than one ldwsuit, describe t h e additional Iawsuits$n nnother pieceofptrpcr, using the sameoutlinc,) l. Partieoto this lawsuit Plaintiffs:

Defendrnts:

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Court (lf fcdcral courq namethc districti if strte, nf,methe countyt

-lDockets.Justia.com

Case 2:07-cv-02103-RTD-JRM

Document 3

Filed 09/20/2007

Page 2 of 4

3. 4.
5.

Docket number:
N a m eofjudge to whom cflse wasassigned: D i s p o s i t l o n(for example: War thc casedismissed?Wus it rppealed? I s it still pending?) A p p r o x i m a t e date of lillng lflwsuit: A p p r o x i m te date of disposition:

6.
'7

il.

P I a c eof PresentConfinement;

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III.

T h e r e is a written prisoner grirvanceprocedure in thc Arkansa$f)epartmentof C o r r e c t i o n and ln your couutyjail. Failure to comDlele griev8nceprocedurc mfly the a f f e c t your casein tederal court. A. Did you present the facts relating to your compleint in the state or county w r i t t e n prisonergrievance procedure?

Yes
B.

no -/

I f your answer is YES, Attach copies of the most recent written g r i c v a n c e ( s ) / r e s p o n s e ( rrelating to your clalms showing completion of the ) g r i e v a n c c procedure, FAILURX T(} ATTACH THE REOUIRED CQPIES I N THE A I OI'Y I f your answer is NO, explain why not:

c.

lV.

Parties ( I n item A below,place your namein the first blank and placeyour prc$cntaddress i n the second blank.)

A.

Nameof plaintiff:

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Case 2:07-cv-02103-RTD-JRM

Document 3

Filed 09/20/2007

Page 3 of 4

(In Itcm B below,placethe ful! nameof the defendflntin the lirst blank, his officirl p o s i t i o n in the secondblank, his place of employmentin the third blank, nnd his e d d r e s sin the fourth blrnk,)

B.

Defendrnt: 5o[i" H rtgk k+eR
Position: 'Fqil^ef
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I l e f e n d a n t : Aplte.<& Y1\gl
Fosition: P l a c eof Employment:

Addressr
Defendrrntl Position:

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P l a c e Employmentl of Addrss:

Defendantr Position: P l a c eof Employment:

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So0FNdr{'{',\f1h H ZS

Addressr
Defendant: Position: P l t r c e Employmcntr of

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Case 2:07-cv-02103-RTD-JRM

Document 3

Filed 09/20/2007

Page 4 of 4

v.

S t a t c m c n tof Claim S t a t ehere as bricfly aspossiblethe ftqf of your cflse,Describehow eflchdefendadtis i n v o l v e d . Include also the narne$ other personsinvolved,datesend pl&cc$,Do not of g i v e eny legalargumentsor cltc any cases ststutet, If you intcnd to tllege a numbcr or o f r e l ted chims, number and sct forth eachclaim in fl separate paragraph. (Usetrs as m u c h space you nced, Attach extra sheets nccessary.) if

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VI.

Relief S t a t ebrieflv exdctlvwhat vou lvant the court to d0 fitr you. Makc no legalarguments. C i t c no cases statutes. or

I declare(or certify, verify, or state)urder penalty of perjury {18 U,S.C.$ f6?l)

is th a t the foregoing true and corrcct,

this E x e c u t e d {04

ot aoy

,Tth

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P r i n t e d Nameof Plain

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