Dennis Dale Catchings v. J. Lewis et al

Filing 5

MEMORANDUM DECISION AND ORDER DISMISSING COMPLAINT WITH LEAVE TO AMEND by Magistrate Judge Suzanne H. Segal. The Complaint is dismissed with leave to amend. If Plaintiff still wishes to pursue this action, he is granted thirty (30) days from the da te of this Memorandum and Order within which to file a First Amended Complaint. Plaintiff is strongly encouraged to utilize the standard civil rights complaint form when filing any amended complaint, a copy of which is attached. Plaintiff is further advised that is he no longer wishes to pursue this action, he may voluntarily dismiss it by filing a Notice of Dismissal in accordance with Federal Rule of Civil Procedure 41(a)(1). A form Notice of Dismissal is attached for Plaintiff's convenience. (See document for further details). (Attachments: # 1 Civil Rights Complaint Form, # 2 Notice of Dismissal Form) (mr)

FULL NAME
COMMITTED NAME (if different)

FULL ADDRESS INCLUDING NAME OF INSTITUTION

PRISON NUMBER (if applicable)

UNITED STATES DISTRICT COURT
CENTRAL DISTRICT OF CALIFORNIA
CASE NUMBER
To be supplied by the Clerk

PLAINTIFF,
v.

DEFENDANT(S).

CIVIL RIGHTS COMPLAINT
PURSUANT TO (Check one)
G 42 U.S.C. § 1983
G Bivens v. Six Unknown Agents 403 U.S. 388 (1971)

A. PREVIOUS LAWSUITS
1. Have you brought any other lawsuits in a federal court while a prisoner: G Yes

G No

2. If your answer to “1.” is yes, how many?
Describe the lawsuit in the space below. (If there is more than one lawsuit, describe the additional lawsuits on an
attached piece of paper using the same outline.)

CIVIL RIGHTS COMPLAINT
CV-66 (7/97)

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a. Parties to this previous lawsuit:
Plaintiff
Defendants
b. Court
c. Docket or case number
d. Name of judge to whom case was assigned
e. Disposition (For example: Was the case dismissed? If so, what was the basis for dismissal? Was it
appealed? Is it still pending?)
f.

Issues raised:

g. Approximate date of filing lawsuit:
h. Approximate date of disposition
B. EXHAUSTION OF ADMINISTRATIVE REMEDIES
1. Is there a grievance procedure available at the institution where the events relating to your current complaint
occurred? G Yes G No
2. Have you filed a grievance concerning the facts relating to your current complaint? G Yes

G No

If your answer is no, explain why not

3. Is the grievance procedure completed? G Yes

G No

If your answer is no, explain why not

4. Please attach copies of papers related to the grievance procedure.
C. JURISDICTION
This complaint alleges that the civil rights of plaintiff
(print plaintiff's name)

who presently resides at

(mailing address or place of confinement)

,

were violated by the actions of the defendant(s) named below, which actions were directed against plaintiff at
(institution/city where violation occurred)

CIVIL RIGHTS COMPLAINT
CV-66 (7/97)

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on (date or dates)
NOTE:

(Claim I)

,

(Claim II)

,

(Claim III)

.

You need not name more than one defendant or allege more than one claim. If you are naming more than
five (5) defendants, make a copy of this page to provide the information for additional defendants.

1. Defendant

resides or works at

(full name of first defendant)
(full address of first defendant)
(defendant's position and title, if any)

The defendant is sued in his/her (Check one or both): G individual

G official capacity.

Explain how this defendant was acting under color of law:

2. Defendant

resides or works at

(full name of first defendant)
(full address of first defendant)
(defendant's position and title, if any)

The defendant is sued in his/her (Check one or both): G individual

G official capacity.

Explain how this defendant was acting under color of law:

3. Defendant

resides or works at

(full name of first defendant)
(full address of first defendant)
(defendant's position and title, if any)

The defendant is sued in his/her (Check one or both): G individual

G official capacity.

Explain how this defendant was acting under color of law:

CIVIL RIGHTS COMPLAINT
CV-66 (7/97)

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4. Defendant

resides or works at

(full name of first defendant)
(full address of first defendant)
(defendant's position and title, if any)

The defendant is sued in his/her (Check one or both): G individual

G official capacity.

Explain how this defendant was acting under color of law:

5. Defendant

resides or works at
(full name of first defendant)
(full address of first defendant)
(defendant's position and title, if any)

The defendant is sued in his/her (Check one or both): G individual

G official capacity.

Explain how this defendant was acting under color of law:

CIVIL RIGHTS COMPLAINT
CV-66 (7/97)

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D. CLAIMS*
CLAIM I
The following civil right has been violated:

Supporting Facts: Include all facts you consider important. State the facts clearly, in your own words, and without
citing legal authority or argument. Be certain you describe, in separately numbered paragraphs, exactly what each
DEFENDANT (by name) did to violate your right.

*If there is more than one claim, describe the additional claim(s) on another attached piece of paper using the same
outline.
CIVIL RIGHTS COMPLAINT
CV-66 (7/97)

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E. REQUEST FOR RELIEF
I believe that I am entitled to the following specific relief:

(Date)

(Signature of Plaintiff)

CIVIL RIGHTS COMPLAINT
CV-66 (7/97)

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UNITED STATES DISTRICT COURT
CENTRAL DISTRICT OF CALIFORNIA
CASE NUMBER

PRISONER/PLAINTIFF,
v.

DEFENDANT(S).

REQUEST TO PROCEED WITHOUT
PREPAYMENT OF FILING FEES WITH
DECLARATION IN SUPPORT

, declare under penalty of perjury, that the following is
I,
true and correct; that I am the prisoner-plaintiff in the above entitled case; that in support of my request to proceed
without prepayment of fees under 28 U.S.C. Section 1915, I declare that because of my poverty I am unable to pay the
full costs of said proceedings or to give security therefore and that I am entitled to redress.
I further declare under penalty of perjury that the responses which I have made to the questions and instructions below are
true, correct and complete.
1. Are you presently employed in prison? GYes

GNo

a. If the answer is yes, state the number of hours you work per week and the hourly rate of pay:

b. State the place of your incarceration
Have the institution fill out the Certificate portion of this application and attach a certified copy of your prison
trust account statement showing transactions for the past six months.

.

2. Have you received, within the past twelve months, any money from any of the following sources?
a. Business, profession or form of self-employment?
GYes GNo
b. Rent payments, interest or dividends?
GYes GNo
c. Pensions, annuities or life insurance payments?
GYes GNo
d. Gifts or inheritances?
GYes GNo
e. Any other income (other than listed above)?
GYes GNo
f. Loans?
GYes GNo
If the answer to any of the above is yes, describe such source of money and state the amount received from each
source during the past twelve (12) months:

REQUEST TO PROCEED WITHOUT PREPAYMENT OF FILING FEES WITH DECLARATION IN SUPPORT
CV-60P (04/06)

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3. Do you own any cash, or do you have money in a checking or savings account? (Include any funds in prison
accounts, if applicable.) G Yes G No
If the answer is yes, identify each account and separately state the amount of money held in each account for each of
the six (6) months prior to the date of this declaration.

4. Do you own any real estate, stocks, bonds, notes, automobiles, or other valuable property (excluding ordinary
household furnishings and clothing)? G Yes
G No
If the answer is yes, describe the property and state it approximate value:

5. In what year did you last file an Income Tax Return?
Approximately how much income did your last tax return reflect?
6. List the persons who are dependent upon your for support, state your relationship to those persons, and indicate how
much you contribute toward their support:

I understand that a false statement or answer to any question in this declaration will subject me to penalties for
perjury. I further understand that perjury is punishable by a term of imprisonment of up to five (5) years and/or a fine
of $250,000 (18 U.S.C. Sections 1621, 3571).

State

I,

County (or City)

, declare under penalty of perjury that the foregoing is true and correct.

Date

Prisoner/Plaintiff (Signature)

REQUEST TO PROCEED WITHOUT PREPAYMENT OF FILING FEES WITH DECLARATION IN SUPPORT
CV-60P (04/06)

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PRISONER AUTHORIZATION
If my request to proceed without prepayment of filing fees is granted, I understand that I am required by statute to pay the
full amount of the filing fees for this case, regardless of my forma pauperis status and the disposition of this case. I
further authorize the prison officials at this institution to assess, collect and forward to the Court the full amount of these
fees, in monthly payments based on the average of deposits to or balance in my prison trust account in accordance with 28
U.S.C. Section 1915.

Prisoner-Plaintiff (Signature)

CERTIFICATE OF AUTHORIZED OFFICER
I hereby certify that the Prisoner-Plaintiff herein has credit in the sum of $
on account at
the
institution where Prisoner-Plaintiff is confined.
I further certify that during the past six months the applicant's average monthly balance was $
certify that during the past six months the average of monthly deposits to the applicant's account was$

. I further
.

A certified copy of the prisoner-plaintiff's trust account statement for the last six (6) months is attached.

Date

Authorized Officer of Institution (Signature)

REQUEST TO PROCEED WITHOUT PREPAYMENT OF FILING FEES WITH DECLARATION IN SUPPORT
CV-60P (04/06)

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