Nguyen v. Sisto et al
ORDER OF DISMISSAL WITH LEAVE TO AMEND. The complaint is DISMISSED with leave to amend, as indicated above. Within thirty (30) days of the date this order is filed, plaintiff shall file an amended complaint. The amended complaint must include the cap tion and civil case number used in this order and the words AMENDED COMPLAINT on the first page and write in the case number for this action, Case No. C 10-02147 JW (PR). Because an amended complaint completely replaces the original complaint, plaint iff must include in it all the claims he wishes to present. Plaintiff may not incorporate material from the original complaint by reference. Failure to respond in accordance with this order in the time provided will result in the dismissal of this action without prejudice and without further notice to plaintiff. Signed by Judge James Ware on 9/13/2010. (Attachments: # 1 Prisoner Complaint)(ecg, COURT STAFF) (Filed on 9/14/2010)
Nguyen v. Sisto et al
Doc. 6 Att. 1
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COMPLAINT BY A PRISONER UNDER THE CIVIL RIGHTS ACT, 42 U.S.C §§ 1983 Name _________________________________________________________________
(Last) (First) (Initial)
Prisoner Number ________________________________________________________ Institutional Address _____________________________________________________ _______________________________________________________________________ ===================================================================== UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF CALIFORNIA _____________________________________
( E n t e r the full name o f plaintiff in this actio n . )
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
( E n t er the full name of the defendant(s) in this action)
) ) ) ) ) ) ) ) ) ) ) ) ) )
Case No. _____________________
( T o be provided by the C l e r k of C o u r t )
COMPLAINT UNDER THE CIVIL RIGHTS ACT, Title 42 U.S.C § 1983
[All questions on this complaint form must be answered in order for your action to proceed..] I. Exhaustion of Administrative Remedies. [Note: You must exhaust your administrative remedies before your claim can go forward. The court will dismiss any unexhausted claims.] A. B. Place of present confinement _______________________________ Is there a grievance procedure in this institution? YES ( ) C. NO ( )
Did you present the facts in your complaint for review through the grievance procedure? YES ( ) NO ( )
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 a certain level of appeal, ex pl ain why.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 B. II. F. ex pl ain why. E.
1. Informal appeal
2. First formal level
3. Second formal level
4. Third formal level
Is the last level to which you appealed the highest level of appeal available to you? YES ( ) NO ( )
If you did not present your claim for review through the grievance procedure,
Parties. A. Write your name and your present address. Do the same for additional plaintiffs, if any.
Write the full name of each defendant, his or her official position, and his or her place of employment.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 IV. Relief. Your complaint cannot go forward unless you request specific relief. State briefly exactly what you want the court to do for you. Make no legal arguments; cite no cases or statutes. III. Statement of Claim. State here as briefly as possible 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.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 _____________________________________________
( P l a i nt i ff 's signature)
I declare under penalty of perjury that the foregoing is true and correct.
Signed this ___________ day of ____________________, 20_____
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