Barrett v. Dickerson et al

Filing 4

ORDER OF DISMISSAL WITH PARTIAL LEAVE TO AMEND. Signed by Judge Jon S. Tigar on July 23, 2014. (Attachments: # 1 Blank civil rights form, # 2 Certificate/Proof of Service)(wsn, COURT STAFF) (Filed on 7/24/2014)

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UNITED STATES DISTRICT COURT

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NORTHERN DISTRICT OF CALIFORNIA

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INSTRUCTIONS FOR FILING A COMPLAINT BY A PRISONER
UNDER THE CIVIL RIGHTS ACT, 42 U.S.C. § 1983

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I.

42 U.S.C. § 1983

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You may file an action under 42 U.S.C. § 1983 to challenge federal constitutional or
statutory violations by state actors which affect the conditions of your confinement.

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A § 1983 action may not be used to challenge the length of your sentence or the validity
of your conviction. Such claims must be addressed in a petition for a writ of habeas corpus, on
the correct forms provided by the clerk of the court.

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II.

Filing a § 1983 Action

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To file a § 1983 action, you must submit: (1) an original complaint and (2) a check or
money order for $400.00 or an original Prisoner’s In Forma Pauperis Application.

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This packet includes a complaint form and a Prisoner’s In Forma Pauperis Application.
When these forms are fully completed, mail the originals to:

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Clerk’s Office
United States District Court
Northern District of California
450 Golden Gate Avenue Box 36060
San Francisco, CA 94102

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III.

Filing Fees

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The fee for filing a § 1983 action is $400.00 ($350 filing fee plus $50 administrative fee),
to be paid at the time of filing. If you are unable to pay the full fee when you file your complaint,
you may petition the court to proceed in forma pauperis, using the Prisoner’s In Forma Pauperis
Application in this packet. Even if you are granted leave to proceed in forma pauperis, you must
still pay the $350 filing fee (not the $50 administrative fee), but the filing fee will be paid in
several installments.
You must fully complete the Prisoner’s In Forma Pauperis Application and sign and
declare under penalty of perjury that the facts stated therein are true and correct. Each plaintiff
must submit his or her own Prisoner’s In Forma Pauperis Application. You must use the
Prisoner’s In Forma Pauperis Application provided with this packet and not any other version.

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IV.

Complaint Form

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You must complete the entire complaint form. All questions must be answered in order
for your action to proceed. Your responses must be typewritten or legibly handwritten and you
must sign and declare under penalty of perjury that the facts stated in the complaint are true and
correct.
Under 42 U.S.C. § 1997e, you are required to exhaust available administrative remedies
before filing a § 1983 action; you must indicate clearly in the space provided on the complaint
form whether you have done so.
PrisonerCiv05-13.wpd

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V.

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In order to encourage the just, speedy and inexpensive determination of § 1983 cases
filed in this district, the parties may waive their right to proceed before a district judge and
consent to proceed before a magistrate judge for all purposes. In accordance with 28 U.S.C. §
636(c), upon the consent of all the parties to proceed before a magistrate judge for all purposes,
the magistrate judge assigned to this case will conduct all proceedings, decide all dispositive and
non-dispositive matters, and order the entry of the final judgment. The party who does not
prevail may appeal directly to the Ninth Circuit Court of Appeals in the same manner as an
appeal from the final judgment of a district judge.

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Consent to Magistrate Judge Jurisdiction

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Magistrate judges are selected through a statutorily prescribed merit selection process
and are appointed by the judges of this court. The court encourages the parties to consent to
magistrate judge jurisdiction as it may result in an earlier resolution of the matter. Because of
different calendar pressures, magistrate judges may be able to set hearings and trials sooner than
district judges. But you are free to decline consent to magistrate judge jurisdiction. Please
indicate on the last page of the complaint form whether you consent or decline to consent to
magistrate judge jurisdiction.

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VI.

After Complaint Is Filed

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You will be notified as soon as the court issues any order in your case. It is your
responsibility to keep the court informed of any changes of address to ensure you receive court
orders. Failure to so do may result in dismissal of your action.

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VII.

Repeat Filers

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If you are seeking leave to proceed in forma pauperis and, while incarcerated or detained,
you have filed § 1983 actions on three or more prior occasions which were dismissed as
frivolous, malicious, or for failure to state a claim upon which relief may be granted, you may
not file a new § 1983 action unless you are under imminent danger of serious physical injury. 28
U.S.C. § 1915(g).

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VIII. Inquiries and Copying Requests
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Because of the large volume of cases filed by inmates in this court and very limited court
resources, the court cannot answer questions concerning the status of your case or provide copies
of documents, except at a charge of fifty cents ($0.50) per page. You should keep a copy of each
document submitted to the court for your own records.

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PrisonerCiv05-13.wpd

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COMPLAINT BY A PRISONER UNDER THE CIVIL RIGHTS ACT, 42 U.S.C. § 1983
Name:

(Last)

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__________________________________________________________________
(First)

(Middle)

Prisoner Number: _____________________________
Institutional Address:

_____________________________________________________
_____________________________________________________

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UNITED STATES DISTRICT COURT

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NORTHERN DISTRICT OF CALIFORNIA

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_____________________________________
(Enter your full name.)

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vs.
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_____________________________________
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_____________________________________
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(Enter the full name(s) of the defendant(s) in this action.)

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Case No. __________________
(Leave blank; to be provided by Clerk of Court)

COMPLAINT UNDER THE
CIVIL RIGHTS ACT,
42 U.S.C. § 1983

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I. Exhaustion of Administrative Remedies.

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Note: You must exhaust available administrative remedies before your claim can go forward. The court will dismiss any
unexhausted claims.

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A.

Place of present confinement ________________________________

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B.

Is there a grievance procedure in this institution?

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C.

If so, did you present the facts in your complaint for review through the grievance
procedure?

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D.

YES G

YES G

_______________

NO G

NO G

If your answer is YES, list the appeal number and the date and result of the appeal at each
level of review. If you did not pursue any available level of appeal, explain why.
1. Informal appeal:

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COMPLAINT Page 1 of 4

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2. First formal level:

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3. Second formal level:

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4. Third formal level:

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E.

YES G

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Is the last level to which you appealed the highest level of appeal available to you?

F.

NOG

If you did not present your claim for review through the grievance procedure, explain why.

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II. Parties.

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A.

Write your name and present address. Do the same for additional plaintiffs, if any.

B.

For each defendant, provide full name, official position and place of employment.

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COMPLAINT Page 2 of 4

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III. Statement of Claim.

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State briefly the facts of your case. Be sure to describe how each defendant is involved and
to include dates, when possible. Do not give any legal arguments or cite any cases or statutes. If
you have more than one claim, each claim should be set forth in a separate numbered paragraph.

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IV. Relief.

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Your complaint must include a request for specific relief. State briefly exactly what you
want the court to do for you. Do not make legal arguments and do not cite any cases or statutes.

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I DECLARE UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.

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Signed this ___ day of ______________, 20___

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___________________________________
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(Plaintiff’s signature)

Please continue to the next page.

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COMPLAINT Page 3 of 4

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MAGISTRATE JUDGE JURISDICTION
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Please indicate below by checking one of the two boxes whether you choose to consent or
decline to consent to magistrate judge jurisdiction in this matter. Sign this form below your
selection.
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Consent to Magistrate Judge Jurisdiction

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In accordance with the provisions of 28 U.S.C. § 636(c), I voluntarily consent to have a
United States magistrate judge conduct all further proceedings in this case, including trial and
entry of final judgment.

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OR
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Decline Magistrate Judge Jurisdiction

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In accordance with the provisions of 28 U.S.C. § 636(c), I decline to have a United States
magistrate judge conduct all further proceedings in this case, including trial and entry of final
judgment.

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Signed this ___ day of ______________, 20___

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____________________________________
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(Plaintiff’s signature)

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COMPLAINT Page 4 of 4