Davis v. U.S. Attorney General, et al

Filing 79

MINUTE ORDER: The 77 Motion Requesting To: Refiled filed 6/23/2014 and the 78 Letter filed by plaintiff on 11/17/2014 is GRANTED in part. If plaintiff seeks to assert new claims in a lawsuit, he must file a new case and may not assert such claims in the above-captioned closed case. Otherwise, the relief requested in the Motion Requesting To: Refiled and the letter filed 11/17/2014 is DENIED. By Judge Robert E. Blackburn on 2/27/2015. (Attachments: # 1 1983 Form, # 2 IFP Form)(alowe)

IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLORADO

Civil Action No.
(To be supplied by the court)

, Plaintiff,
v.

,

,

,

,

,

,

,

, Defendant(s).
(List each named defendant on a separate line.)

PRISONER COMPLAINT

(Rev. 1/30/07)

A. PARTIES
1.
(Plaintiff’s name, prisoner identification number, and complete mailing address)

2.
(Name, title, and address of first defendant)
At the time the claim(s) alleged in this complaint arose, was this defendant acting under
Yes
No (CHECK ONE). Briefly explain your answer:
color of state law?

3.
(Name, title, and address of second defendant)
At the time the claim(s) alleged in this complaint arose, was this defendant acting under
color of state law?
Yes
No (CHECK ONE). Briefly explain your answer:

4.
(Name, title, and address of third defendant)
At the time the claim(s) alleged in this complaint arose, was this defendant acting under
color of state law?
Yes
No (CHECK ONE). Briefly explain your answer:

(If you are suing more than three defendants, use extra paper to provide the information
requested above for each additional defendant. The information about additional defendants
should be labeled “A. PARTIES.”)
(Rev. 1/30/07)

2

B. JURISDICTION
1.

I assert jurisdiction over my civil rights claim(s) pursuant to: (check one if applicable)
28 U.S.C. § 1343 and 42 U.S.C. § 1983 (state prisoners)
28 U.S.C. § 1331 and Bivens v. Six Unknown Named Agents of Fed. Bureau of
Narcotics, 403 U.S. 388 (1971) (federal prisoners)

2.

I assert jurisdiction pursuant to the following additional or alternative statutes (if any):

C. NATURE OF THE CASE
BRIEFLY state the background of your case. If more space is needed to describe the nature of
the case, use extra paper to complete this section. The additional allegations regarding the nature
of the case should be labeled “C. NATURE OF THE CASE.”

(Rev. 1/30/07)

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D. CAUSE OF ACTION
State concisely every claim that you wish to assert in this action. For each claim, specify the
right that allegedly has been violated and state all supporting facts that you consider important,
including the date(s) on which the incident(s) occurred, the name(s) of the specific person(s)
involved in each claim, and the specific facts that show how each person was involved in each
claim. You do not need to cite specific cases to support your claim(s). If additional space is
needed to describe any claim or to assert more than three claims, use extra paper to continue that
claim or to assert the additional claim(s). The additional pages regarding the cause of action
should be labeled “D. CAUSE OF ACTION.”
1.

Claim One:
Supporting Facts:

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4

2.

Claim Two:
Supporting Facts:

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5

3.

Claim Three:
Supporting Facts:

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6

E. PREVIOUS LAWSUITS
Have you ever filed a lawsuit, other than this lawsuit, in any federal or state court while you
were incarcerated?
Yes
No (CHECK ONE). If your answer is "Yes," complete this
section of the form. If you have filed more than one lawsuit in the past, use extra paper to
provide the necessary information for each additional lawsuit. The information about additional
lawsuits should be labeled "E. PREVIOUS LAWSUITS."
1.

Name(s) of defendant(s) in prior
lawsuit:

2.

Docket number and court name:

3.

Claims raised in prior lawsuit:

4.

Disposition of prior lawsuit (for
example, is the prior lawsuit still
pending? Was it dismissed?):

5.

If the prior lawsuit was dismissed,
when was it dismissed and why?

6.

Result(s) of any appeal in the prior
lawsuit:

F. ADMINISTRATIVE RELIEF
1.

Is there a formal grievance procedure at the institution in which you are confined?
Yes

2.

No (CHECK ONE).

Did you exhaust available administrative remedies?

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Yes

No (CHECK ONE).

G. REQUEST FOR RELIEF
State the relief you are requesting. If you need more space to complete this section, use extra
paper. The additional requests for relief should be labeled “G. REQUEST FOR RELIEF.”

DECLARATION UNDER PENALTY OF PERJURY
I declare under penalty of perjury that I am the plaintiff in this action, that I have read this
complaint, and that the information in this complaint is true and correct. See 28 U.S.C. §
1746; 18 U.S.C. § 1621.
Executed on
(Date)

(Prisoner’s Original Signature)

(Rev. 1/30/07)

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