Roman v Pfister et al

Filing 13

MERIT REVIEW OPINION - Entered by Judge Harold A. Baker on 12/16/2016. The plaintiff's complaint is hereby dismissed with leave to plead over. The plaintiff may file an amended complaint, within thirty (30) days of this order, plainly stating h ow his constitutional rights were violated and who was involved in the alleged deprivation. If the plaintiff fails to file an amended complaint or follow the court's specific instructions, as outlined above, his case may be dismissed. The clerk is directed to provide the plaintiff with a blank complaint form to assist him. Plaintiff's motions 6 and 8 are DENIED. (Attachments: # 1 Blank Complaint Form) (LN, ilcd)

E-FILED

Friday, 16 December, 2016 03:04:01 PM
Clerk, U.S. District Court, ILCD

United States District Court
CENTRAL DISTRICT OF ILLINOIS
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Plaintiff
vs.

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Defendant(s)

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Case No.
(The case number will be assigned by the clerk)

(List the full name of ALL plaintiffs and defendants in the caption above. If you need more room, attach a
separate caption page in the above format).
COMPLAINT*
Indicate below the federal legal basis for your complaint, if known. This form is designed primarily for pro se
prisoners challenging the constitutionality of their conditions of confinement, claims which are often brought
under 42 U.S.C. § 1983 (against state, county, or municipal defendants) or in a "Bivens" action (against federal
defendants). However, 42 U.S.C. § 1983 and “Bivens” do not cover all prisoners' claims. Many prisoners’
legal claims arise from other federal laws. Your particular claim may be based on different or additional
sources of federal law. You may adapt this form to your claim or draft your own complaint.
42 U.S.C. §1983 (state, county or municipal defendants)
Action under Bivens v. Six Unknown Federal Narcotics Agents, 403 U.S. 388 (1971)(federal defendants)
Other federal law:
Unknown

I. FEDERAL JURISDICTION

*Please refer to the instructions when filling out this complaint. Prisoners are not required to
use this form or to answer all the questions on this form in order to file a complaint. This is not
the form to file a habeas corpus petition.

Jurisdiction is based on 28 U.S.C. § 1331, a civil action arising under the United States Constitution or
other federal law. (You may assert a different jurisdictional basis, if appropriate).
II. PARTIES
A. Plaintiff:
Full Name:
Prison Identification Number:
Current address:

For additional plaintiffs, provide the information in the same format as above on a separate page. If there is
more than one plaintiff, each plaintiff must sign the Complaint, and each plaintiff is responsible for paying his
or her own complete, separate filing fee.
B. Defendants
Defendant #1:
Full Name:
Current Job Title:
Current Work Address

Defendant #2:
Full Name:
Current Job Title:
Current Work Address

Defendant #3:
Full Name:
Current Job Title:
2

Current Work Address

Defendant #4:
Full Name:
Current Job Title:
Current Work Address

Defendant #5:
Full Name:
Current Job Title:
Current Work Address

For additional defendants, provide the information in the same format as above on a separate page.

III. LITIGATION HISTORY
The “three strikes rule” bars a prisoner from bringing a civil action or appeal in forma pauperis in
federal court if that prisoner has "on 3 or more occasions, while incarcerated or detained in any facility, brought
an action or appeal in a court of the United States that was dismissed on the grounds that it is frivolous,
malicious, or fails to state a claim upon which relief may be granted, unless the prisoner is under imminent
danger of serious physical injury." 28 U.S.C. § 1915(g).
A. Have you brought any other lawsuits in state or federal court dealing with the same facts involved
in this case?

Yes

No

If yes, please describe

B. Have you brought any other lawsuits in federal court while incarcerated?
Yes

No

C. If your answer to B is yes, how many? _______ Describe the lawsuit(s) below.
3

1. Name of Case, Court and Docket Number
______________________________________________________________________________
2. Basic claim made
3. Disposition (That is, how did the case end? Was the case dismissed? Was it appealed? Is it still
pending?)
For additional cases, provide the above information in the same format on a separate page.

IV. EXHAUSTION OF ADMINISTRATIVE REMEDIES
Prisoners must exhaust available administrative remedies before filing an action in federal court about
prison conditions. 42 U.S.C. § 1997e(a). You are not required to allege or prove exhaustion of administrative
remedies in the complaint. However, your case must be dismissed if the defendants show that you have not
exhausted your administrative remedies, or if lack of exhaustion is clear from the complaint and its attachments.
You may attach copies of materials relating to exhaustion, such as grievances, appeals, and official responses.
These materials are not required to file a complaint, but they may assist the court in understanding your claim.
A. Is there a grievance procedure available at your institution? Yes

No

B. Have you filed a grievance concerning the facts relating to this complaint?
Yes

No

If your answer is no, explain why not
C. Is the grievance process completed?

Yes

No

V. STATEMENT OF CLAIM
Place(s) of the occurrence
4

Date(s) of the occurrence
State here briefly the FACTS that support your case. Describe what each defendant did to violate your federal
rights. You do not need to give any legal arguments or cite cases or statutes. Number each claim in a separate
paragraph. Unrelated claims should be raised in a separate civil action.
THE COURT URGES YOU TO USE ONLY THE SPACE PROVIDED. Federal Rule of Civil Procedure 8(a)
requires only a “short and plain statement” of your claim showing that you are entitled to relief. It is best to
include only the basic, relevant facts, including dates, places, and names.

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6

RELIEF REQUESTED
(State what relief you want from the court.)

7

JURY DEMAND

Yes

No

Signed this _______________ day of ___________________________ , 20_______.

( Signature of Plaintiff)

Name of Plaintiff:

Inmate Identification Number:

Address:

Telephone Number:

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