Trevino v. Gomez, et al

Filing 62

ORDER Denying Motion To Amend Or Reopen Complaint (Doc. 61 ), signed by District Judge Anthony W. Ishii on 11/21/2014. (Attachments: # 1 1983 Prisoner Complaint Packet) (Fahrney, E)

INSTRUCTIONS  FOR  FILING  A  COMPLAINT  IN  THE  EASTERN  DISTRICT  OF  CALIFORNIA  BY  A 
PRISONER: 
1.

AGAINST  FEDERAL  GOVERNMENT  EMPLOYEES  UNDER  BIVENS  V.  SIX  UNKNOWN  NAMED  AGENTS  OF 
FEDERAL BUREAU OF NARCOTICS, 403 U.S. 388(1971) 
A   Bivens  action is available to challenge violations of the federal Constitution or federal statutes which 
affect  the  conditions  of  your  confinement  or  your  treatment  by  Federal  government  employees.  
Although you may ask for and obtain money damages or an injunction, the court cannot issue an order 
which  could  affect  the  length  of  your  sentence  in  any  way.    Those  types  of  claims  may  be  raised  only 
through a petition for writ of habeas corpus.  If you want to file a petition for writ of habeas corpus, you 
must do so on the correct forms, which are provided by the Clerk of the Court on request. 

2.

 AGAINST  STATE  OR  LOCAL  GOVERNMENT  EMPLOYEES  UNDER  THE  CIVIL  RIGHTS  STATUTE  42  U.S.C. 
1983 
An  action  under  Section  1983  is  available  to  challenge  violations  of  the  federal  constitution  or  federal 
statutes which affect the conditions of your confinement or your treatment by state or local government 
employees.  Although you may ask for and obtain money damages or an injunction under Section 1983, 
the court cannot issue an order which could affect the length of your sentence in any way.  Those types of 
claims may be raised only through a petition for writ of habeas corpus.  If you want to file a petition for 
writ of habeas corpus, you must do so on the correct forms, which are provided by the Clerk of the Court 
on request. 

I.  Exhaustion of Administrative Remedies 

If there is an inmate appeal or administrative grievance process available at your institution, you may not 
file  a  Bivens  Action,  Section  1983,  or  an  action  under  any  other  federal  law,  until  you  have  first  completed 
(exhausted)  the  process  available  at  your  institution.    You  are  required  to  complete  the  inmate  appeal  or 
administrative remedy process before filing suit, regardless of the relief offered by the process.  Booth v. Churner, 
532  U.S.  731,  741  (2001);  McKinney  v.  Carey,  311  F.3d  1198,  1199  (9th  Cir.  2002).    Even  if  you  are  seeking  only 
money  damages  and  the  inmate  appeal  or  administrative  remedy  process  does  not  provide  money,  you  must 
exhaust the process before filing suit. Booth, 532 U.S. at 734. 
II.  Packet 
A copy of a complaint form is attached to this instruction sheet.  Included in the packet is an information sheet for 
prisoners  seeking  leave  to  proceed  in  forma  pauperis  (without  prepayment  of  filing  fees)  and  a  copy  of  an 
application to proceed in forma pauperis.  To file an action, you must send all of the following items to the court:  

1.  An original complaint.  You must keep an additional copy of the complaint for your own records.  All 
copies of the complaint must be identical to the original.  If you wish to have a conformed copy of your complaint 
returned  to  you,  you  must  send,  in  addition  to  the  original,  one  extra  copy  and  provide  the  court  with  a  self‐
addressed postage paid envelope. 

2.  Either a completed in forma pauperis application or the $400.00 filing fee (the filing fee is $350.00 plus 
a $50.00 administrative fee). 

NOTICE:      The $50.00 administrative fee does not apply to persons granted in forma pauperis status.  Leave to 
proceed in forma pauperis allows a case to proceed without pre‐payment of the filing fee.  However, a prisoner 
who brings a civil action in forma pauperis shall nevertheless be required to pay the $350.00 filing fee.  The court 
shall collect the filing fees through deductions from the prisoner’s trust account.  Dismissal of the case does not 
excuse payment of the full filing fee. See 28 U.S.C. 1915. 
III.  Complaint Form 
Your  complaint  must  be  legibly  handwritten  or  typewritten.    You  must  sign  the  complaint  and  declare  under 
penalty of perjury that the facts stated in the complaint are correct.  Your complaint  must be no more than 25 
pages. If you need additional space to answer a question, you should attach an additional blank page.  Please write 
or type on only one side of the paper.  You are required to state facts in support of each claim.  The complaint 
should refer to the provision of the federal constitution or federal law on which you are relying, but should not 
contain legal arguments or citations. 
Your complaint must be concise and should be brief as possible, not to exceed 25 pages.  Fed.R.Civ.P.8. Failure to 
briefly  and  concisely  state  your  claim  may  result  in  an  order  striking  the  complaint.    In  most  cases  the  space 
provided in the attached form should be sufficient. 

IV.  Venue 
The Fresno Division of the Eastern District of California is comprised of the following counties:  Fresno, 
Calaveras, Inyo, Kern,  Kings, Madera,  Mariposa, Merced, Stanislaus, Tulare,  and  Tuolumne.   If you are 
filing  your  case  in  the  Fresno  Division,  mail  all  completed  forms  described  in  part  II  to  the  following 
address: 

Clerk of the U.S. District Court 
for the Eastern District of California 
2500 Tulare Street, Room 1501 
Fresno, CA  93721 

The  Sacramento  Division  of  the  Eastern  District  of  California  is  comprised  of  the  following  counties:  
Alpine,  Amador,  Butte,  Colusa,  El  Dorado,  Glenn,  Lassen,  Modoc,  Mono,  Nevada,  Placer,  Plumas, 
Sacramento, San Joaquin, Shasta, Sierra, Siskiyou, Solano, Sutter, Tehama, Trinity, Yolo, Yuba.  If you are 
filing your case in the Sacramento Division, mail all completed forms described in part II to the following 
address: 

Clerk of the U.S. District Court 

for the Eastern District of California 

501 “I” Street, Suite 4200 

Sacramento, CA  95814 

V.  After the Complaint is Filed 

Once the complaint is filed, the court will review it and decide whether to order service of the complaint 
on the defendants.  You will be sent a copy of every order the court issues.  Because of the large volume 
of cases filed by inmates pending in this court, the court WILL NOT ANSWER INQUIRIES concerning the 
status of your complaint. 

YOU  MUST KEEP THE COURT INFORMED OF ANY CHANGE OF ADDRESS.  IF  YOU FAIL TO DO 
SO,  THE  CLERK  CANNOT  BE  RESPONSIBLE  FOR  YOUR  FAILURE  TO  RECEIVE  COURT  ORDERS.    THIS 
COULD RESULT IN THE DISMISSAL OF YOUR SUIT. 

The Clerk of the Court cannot provide copies of documents to litigants, except at a charge of fifty cents 
($0.50)  per  page.    This  charge  also  applies  to  litigants  proceeding  in  forma  pauperis.    Therefore  you 
must keep copies of all documents submitted to the court for your own records. 

VI.  Submission of Original Paper Exhibits 

The Eastern District of California converted to an electronic filing service, and storage system, effective 
January 3, 2005.  Pro Se litigants are exempt from the electronic filing requirement and must submit all 
documents to the court in paper.  Local Rule 5‐133(b)(2).  Paper documents submitted by pro se litigants 
for filing will be scanned into the electronic court file by the Clerk’s Office.   Local Rule 39‐138(d).  For 
this  reason,  pro  se  litigants  are  cautioned  not  to  send  original  exhibits  to  the  court.    If  pro  se  litigants 
choose  to  submit  exhibits  to  the  court,  the  litigants  shall  retain  their  original  exhibits  and  send 
photocopies to the court.  Please keep in mind that your pleadings are taken as true at the initial state of 
the litigation, so there is no need to attach exhibits to show the truth of your allegations. 

Plaintiff’s Name____________________________ 
Inmate No.________________________________ 
Address __________________________________ 
_________________________________________ 
                _________________________________________ 

IN THE UNITED STATES DISTRICT COURT 
FOR THE EASTERN DISTRICT OF CALIFORNIA 

                (Name of Plaintiff) 

vs. 

CIVIL RIGHTS COMPLAINT UNDER:   

      42 U.S.C. 1983 (State Prisoner) 

      Bivens Action [403 U.S. 388 (1971)] (Federal Prisoner) 

 ________________________________________   

_________________________________________   

_________________________________________ 

_________________________________________ 

_________________________________________ 

_________________________________________                
(Names of all Defendants) 

(Case Number) 

I. Previous Lawsuits (list all other previous or pending lawsuits on additional page): 

A.  Have you brought any other lawsuits while a prisoner?   Yes____  No____ 

B.  If your answer to A is yes, how many? _________ 

     Describe previous or pending lawsuits in the space below.  (If more than one, attach additional page to continue 
outlining all lawsuits in same format.) 

1. Parties to this previous lawsuit: 

    Plaintiff _______________________________________________________________________ 

    Defendants ____________________________________________________________________ 

 ______________________________________________________________________________ 

2.  Court (if Federal Court, give name of District; if State Court, give name of County) 
_________________________________________________________________________________ 

3.  Docket Number _____________________         4.  Assigned Judge _________________________ 

5. Disposition  (Was the case dismissed? Appealed?  Is it still pending?) 

_________________________________________________________________________________ 

6.  Filing Date (approx.) _________________          7.  Disposition Date (approx.) ________________ 

II.  Exhaustion of Administrative Remedies 
NOTICE:            Pursuant to the Prison Litigation Reform Act of 1995, A[n]o action shall be brought with respect to prison conditions     
under [42 U.S.C. ' 1983], or any other Federal law, by a prisoner confined in any jail, prison, or other correctional facility until such 
administrative remedies as are available are exhausted.@  42 U.S.C. ' 1997e(a).  Prior to filing suit, inmates are required to exhaust 
the available administrative remedy process, Jones v. Bock, 549 U.S. 199, 211, 127 S.Ct. 910, 918‐19 (2007); McKinney v. Carey, 311 
F.3d 1198, 1999 (9th Cir. 2002), and neither futility nor the unavailability of money damages will excuse the failure to exhaust, Porter 
v. Nussle, 534 U.S. 516, 524, 122 S.Ct. 983, 988 (2002).  If the court determines that an inmate failed to exhaust prior to filing suit, 
the unexhausted claims will be dismissed, without prejudice.  Jones, 549 U.S. at 223‐24, 127 S.Ct. at 925‐26.
A.  Is there an inmate appeal or administrative remedy process available at your institution?    

      Yes_______  No______
B.  Have you filed an appeal or grievance concerning ALL of the facts contained in this complaint? 

      Yes______      No______ 

C.  Is the process completed? 

     Yes______ 

If your answer is yes, briefly explain what happened at each level. 

____________________________________________________________________________________________________________  
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 

     No______ 

If your answer is no, explain why not. 

____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
III.  Defendants 
List each defendant’s full name, official position, and place of employment and address in the spaces below.  If you need additional 
space please provide the same information for any additional defendants on separate sheet of paper. 

A.  Name _________________________________  is employed as ______________________________________________ 

     Current Address/Place of Employment ___________________________________________________________________ 

B.  Name _________________________________ is employed as _______________________________________________ 

  Current Address/Place of Employment ___________________________________________________________________ 

C.  Name _________________________________ is employed as _______________________________________________ 

Current Address/Place of Employment ___________________________________________________________________ 

D.  Name ________________________________ is employed as ________________________________________________ 

Current Address/Place of Employment ___________________________________________________________________ 

E.  Name ________________________________ is employed as ________________________________________________ 

Current Address/Place of Employment ___________________________________________________________________ 

IV. Causes of Action (You may attach additional pages alleging other causes of action and the facts supporting them if necessary. 
Must be in same format outlined below.) 
Claim 1:  The following civil right has been violated (e.g. right to medical care, access to courts, due process, free speech, freedom of 
religion, freedom of association, freedom from cruel and unusual punishment, etc.):   
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
Supporting Facts (Include all facts you consider important to Claim 1. State what happened clearly and in your own words.  You need 
not cite legal authority or argument. Be certain to describe exactly what each defendant, by name, did to violate the right alleged in 
Claim 1.):  
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 

____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
Claim 2:  The following civil right has been violated (e.g. right to medical care, access to courts, due process, free speech, freedom of 
religion, freedom of association, freedom from cruel and unusual punishment, etc.):   
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
Supporting Facts (Include all facts you consider important to Claim 2. State what happened clearly and in your own words.  You need 
not cite legal authority or argument. Be certain to describe exactly what each defendant, by name, did to violate the right alleged in 
Claim 2.):  
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 

____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
V. Relief 
State briefly exactly what you want the court to do for you.  Make no legal arguments.  Cite no cases or statues. 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 
____________________________________________________________________________________________________________ 

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

Date: ___________________         Signature of Plaintiff: _______________________________________________ 

(Revised 4/4/14) 

INFORMATION TO PRISONERS SEEKING LEAVE TO
PROCEED WITH A CIVIL ACTION IN FEDERAL COURT
IN FORMA PAUPERIS PURSUANT TO 28 U.S.C. § 1915

In accordance with 1996 amendments to the in forma pauperis (IFP) statute, AS A
PRISONER YOU WILL BE OBLIGATED TO PAY THE FULL FILING FEE OF $400.00
FOR A CIVIL RIGHTS ACTION, $5.00 FOR A HABEAS CORPUS PETITION, OR
$505.00 FOR AN APPEAL.
If you have the money to pay the filing fee, you should send a cashier’s check or money
order to the court with your complaint, petition, or notice of appeal.
If you do not have enough money to pay the full filing fee when your action is filed, you
can file the action without prepaying the filing fee. The court will order the agency that has
custody of you to take the filing fee out of your prison or jail trust account if there are available
funds, and to forward the money to the court. Until the amount of the filing fee is paid in full,
EACH MONTH YOU WILL OWE 20 PERCENT OF YOUR PRECEDING MONTH’S
INCOME TOWARD THE BALANCE. The agency that has custody of you will collect that
money and send payments to the court any time the amount in the account exceeds $10.00. The
balance of the filing fee will be collected even if the action is later dismissed, summary judgment
is granted against you, or you fail to prevail at trial.
In order to proceed with an action in forma pauperis you must complete the attached form
and return it to the court with your complaint, habeas corpus petition, or appeal. You must attach
to the form a certified copy of your prison or jail account statement for the last six months. If
you submit an incomplete form or do not submit a prison or jail account statement with the form,
your request to proceed in forma pauperis will be denied.
Regardless of whether some or all of the filing fee has been paid, the court is required to
screen your complaint and to dismiss the complaint if
1.
2.
3.
4.

Your allegation of poverty is untrue;
The action is frivolous or malicious;
Your complaint does not state a claim on which relief can be granted, or
You sue a defendant for money damages and that defendant is immune from
liability for money damages.

If you file more than three actions or appeals while you are a prisoner which are
dismissed as frivolous or malicious or for failure to state a claim on which relief can be granted,
you will be prohibited from bringing any other actions in forma pauperis unless you are in
imminent danger of serious physical injury.

(Revised 04/2014)

Name:___________________________________
CDC No:_________________________________
Address:_________________________________
_________________________________________

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF CALIFORNIA
FRESNO DIVISION

CASE NUMBER:
Plaintiff/Petitioner,
vs.

APPLICATION TO PROCEED
IN FORMA PAUPERIS
BY A PRISONER
Defendants/Respondent.
/

I,
, declare that I am the plaintiff in the above-entitled proceeding;
that, in support of my request to proceed without prepayment of fees under 28 U.S.C. section 1915, I declare
that I am unable to pay the fees for these proceedings or give security therefor and that I am entitled to the
relief sought in the complaint.
In support of this application, I answer the following questions under penalty of perjury:
1.

Are you currently incarcerated?

Yes

No (If “no” DO NOT USE THIS FORM)

State the place of your incarceration.
2.

Are you currently employed (includes prison employment)?

Yes

No

a.
b.

3.

If the answer is “yes” state the amount of your pay.
If the answer is “no” state the date of your last employment, the amount of your take-home
salary or wages and pay period, and the name and address of your last employer.

Have you received any money from the following sources over the last twelve months?
a.

Business, profession, or other self-employment:

Yes

No

b.

Rent payments, interest or dividends:

Yes

No

-1-

c.

Pensions, annuities or life insurance payments:

Yes

No

d.

Disability or workers compensation payments:

Yes

No

e..

Gifts or inheritances:

Yes

No

f.

Any other sources:

Yes

No

If the answer to any of the above is “yes,” describe by that item each source of money. Also state
the amount received and what you expect you will continue to receive (attach an additional sheet if
necessary).

4.

Do you have cash (includes balance of checking or savings accounts)?

Yes

No

If “yes” state the total amount:
5.

Do you own any real estate, stocks, bonds, securities, other financial instruments, automobiles or
other valuable property?
Yes
No
If “yes” describe the property and state its value:

6.

Do you have any other assets?

Yes

No

If “yes,” list the asset(s) and state the value of each asset listed:

7.

List all persons dependent on you for support, stating your relationship to each person listed and
how much you contribute to their support.

IMPORTANT:

This form must be dated and signed below in order for the court to
consider your application.

I hereby authorize the agency having custody of me to collect from my trust account and forward
to the Clerk of the United States District Court payments in accordance with 28 U.S.C. section 1915(b)(2).

DATE

NOTE:

SIGNATURE OF APPLICANT

Within sixty days from the date of this application you must forward to the court a
certified copy of your prison trust account statement showing transactions for the
past six months.
(Revised 04/2014)

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