Jack Robert Smith v. Patton State Hospital
Filing
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ORDER DISMISSING COMPLAINT WITH LEAVE TO AMEND by Magistrate Judge Kenly Kiya Kato, re Complaint ( Civil Rights) 1 . (SEE ORDER FOR DETAILS) (Attachments: # 1 CIVIL RIGHTS COMPLAINT FORM, # 2 NOTICE OF DISMISSAL) (dts)
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________________________(Full Name)
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________________________(Address Line 1)
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________________________(Address Line 2)
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________________________(Phone Number)
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Plaintiff in Pro Per
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UNITED STATES DISTRICT COURT
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CENTRAL DISTRICT OF CALIFORNIA
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__________________________,
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Plaintiff,
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vs.
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______________________________
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______________________________
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______________________________
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______________________________
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Defendant(s).
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Case No.: ______________________
(To be supplied by the Clerk)
Civil Rights Complaint Pursuant to
42 U.S.C. § 1983 (non-prisoners)
Jury Trial Demanded: Yes No
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(All paragraphs and pages must be numbered.)
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I. JURISDICTION
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1.
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Federal question jurisdiction arises pursuant to 42 U.S.C. § 1983.
This court has jurisdiction under 28 U.S.C. § 1331 and 28 U.S.C. § 1343.
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II. VENUE
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2.
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__________________________________________________________________
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__________________________________________________________________
Venue is proper pursuant to 28 U.S.C. § 1391 because _________________
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Pro Se Clinic Form
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III. PARTIES
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Plaintiff ______________________________________________resides at:
(your full name)
__________________________________________________________________
__________________________________________________________________.
(your address)
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(You should specifically identify each Defendant you intend to sue in a separate, numbered paragraph.)
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4.
Defendant ____________________________________________ works at
(full name of Defendant)
__________________________________________________________________.
(Defendant’s place of work)
Defendant’s title or position is _________________________________________.
(Defendant’s title or position at place of work)
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This Defendant is sued in his/her (check one or both):
individual capacity
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official capacity
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This Defendant was acting under color of law because: _____________________
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__________________________________________________________________
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__________________________________________________________________
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5.
Defendant ____________________________________________ works at
(full name of Defendant)
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__________________________________________________________________.
(Defendant’s place of work)
Defendant’s title or position is _________________________________________.
(Defendant’s title or position at place of work)
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This Defendant is sued in his/her (check one or both):
individual capacity
official capacity
This Defendant was acting under color of law because: _____________________
__________________________________________________________________
__________________________________________________________________
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Pro Se Clinic Form
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___. Defendant ____________________________________________ works at
(full name of Defendant)
Insert ¶ #
__________________________________________________________________.
(Defendant’s place of work)
Defendant’s title or position is _________________________________________.
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(Defendant’s title or position at place of work)
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This Defendant is sued in his/her (check one or both):
individual capacity
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official capacity
This Defendant was acting under color of law because ______________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
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___. Defendant ____________________________________________ works at
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Insert ¶ #
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__________________________________________________________________.
(full name of Defendant)
(Defendant’s place of work)
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Defendant’s title or position is _________________________________________.
(Defendant’s title or position at place of work)
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This Defendant is sued in his/her (check one or both):
official capacity
individual capacity
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This Defendant was acting under color of law because ______________________
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__________________________________________________________________
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__________________________________________________________________
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__________________________________________________________________
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Pro Se Clinic Form
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IV. STATEMENT OF FACTS
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(Explain what happened in your own words. You do not have to cite legal authority in this section. Be specific about
names, dates, and places. Explain what each Defendant did. Remember to number every paragraph.)
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___. _____________________________________________________________
Insert ¶ #
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___. _____________________________________________________________
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___. _____________________________________________________________
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Pro Se Clinic Form
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Pro Se Clinic Form
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V. CLAIMS
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Claim #1
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___. Plaintiff realleges and incorporates by reference all of the paragraphs above.
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Insert ¶ #
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___. Plaintiff has a claim under 42 U.S.C. §1983 for violation of the following
Insert ¶ # federal constitutional or statutory civil right:
__________________________________________________________________
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___. The above civil right was violated by the following Defendants:
Insert ¶ #
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(You may list facts supporting your claim. Be specific about how each Defendant violated this particular civil right.)
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As a result of the Defendant’s violation of the above civil right, Plaintiff
Insert ¶ # was harmed in the following way:
__________________________________________________________________
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___.
__________________________________________________________________
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Pro Se Clinic Form
Page Number
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Claim #( )
(insert Claim#)
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___. Plaintiff realleges and incorporates by reference all of the paragraphs above.
Insert ¶ #
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(List any other legal claim you have that is related to your civil rights claim.)
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___.
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___. Plaintiff alleges the above claim against the following Defendant(s):
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Insert ¶ #
Insert ¶ #
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(You may list facts supporting your claim. Be specific about how each Defendant
violated the rights giving rise to this claim.)
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___.
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Insert ¶ #
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As a result of the Defendant’s violation of the rights giving rise to this
Insert ¶ # claim, Plaintiff was harmed in the following way:
__________________________________________________________________
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__________________________________________________________________
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Pro Se Clinic Form
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VI. REQUEST FOR RELIEF
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WHEREFORE, the Plaintiff requests:
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Insert ¶ #
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Dated: _____________________________
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Sign: _____________________________
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Print Name: _____________________________
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Pro Se Clinic Form
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DEMAND FOR JURY TRIAL
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Plaintiff hereby requests a jury trial on all issues raised in this complaint.
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Dated: _____________________________
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Sign: _____________________________
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Print Name: _____________________________
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Pro Se Clinic Form
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