Stine v. Doe #1 et al

Filing 2

MEMORANDUM OPINION & ORDER: (1) Plas claims are SEVERED into four separate cases. Jeremy Pinson shall remain as sole pla in 7:13-cv-134. (2) Clerk SHALL CREATE three new docket numbers-one for each of other three pla. (3) Plas each fail ed either to pay filing fee or apply for leave to proceed in forma pauperis. By Monday, March 24, 2014, plas must each either pay full filing fee or apply to proceed in forma pauperis using attached forms. If any pla fails to co mply with this order, Court will dismiss his case. a. Clerk SHALL MARK assigned case numbers on a form Civil Rights Complaint [EDKy Form 520]; an Application to Proceed Without Prepayment of Fees and Affidavit [AO Form 240]; and a Certificate of Inmate Account [EDKy Form 523]. Clerk SHALL SEND appropriate documents to each pla. (4) Clerk SHALL FILE in record of each case complaint, R. 1 , and this order. Signed by Judge Amul R. Thapar on 2/20/2014. (Attachments: # 1 EDKy Form 520, # 2 AO Form 240, # 3 EDKy Form 523) (TDA) cc: Stine

UNII’ED ST,\rES DISTRICT C O U R I
E.4STERN DIS’I‘RICTOF K E S r U C K Y
Directions for Completing the
CIVIL RIGHTS COMPLAINT
This form is to be used to file a lawsuit:
*

against state or local officials under the Civil Rights Act, 42 U.S.C. 51983, or

*

against federal officials under 28 U.S.C. $1331 pursuant to Bivens v. Six Unknown
FederuZNurcotics Agents, 403 U.S. 388 (1971).

Complete the entire form. ANSWER ALL QUESTIONS.

Do not include legal arguments or citations. EXPLAIN THE FACTS -- what happened, on what
date, where, and w-ho was involved or was responsible.
You may attach additional sheets if you need more space, but stating simply “see attached” may
result in dismissal o f your complaint without prejudice.

You may draft your own complaint, but it must contain all ofthe information requested in this form.
It must be typed or clearly handwritten.
You are responsible for paying the $350 filing fee once your Complaint is filed, regardless of the
outcome of your case.

If you cannot pay the entire fee when the Complaint is filed, you may file an application to proceed
in forma pauperis. Your in formu pauperis application must include a completed affidavit form.
Prisoners must also include a completed Certificate of Inmate Account.
If the Court grants you pauper status, the Court will permit you to proceed by paying only part of
the fee or no fee at all. Prisoners must always pay the entire amount of the filmg fee, but are
permitted to pay it in installments if granted pauper status.
Keep a copy of all documents you file with the Court for your own records. The Clerk ofthe Court
must charge for copies, regardless of informu pauperis status.
You must advise the Clerk of the Court if you change your address. Your case may be dismissed
if you fail to do so.

Revised 215107

%EDKy 520 (Rev 02/07 Complaint under $1983 or Bivens Action

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF KENTUCKY
Southern
DIVISION at Pikeville
CIVIL ACTION NO.

7:14-cv-19-ART

(Court Clerk will supply)

PLAINTIFF

vs:

Demand for Jury Trial:
Yes (2
No
(do not use “et al.”,
enter full names)

DEFENDANTS
I.

Plaintic.
A.

B.

Prisoner l #:
D

C.

Place of present confinement:

D.

II.

Name (list any aliases):

Address:

Check one: Convicted

Pretrial Detainee

Defendant@):(additional defendants may be listed on a separate sheet of paper)
A.

Defendant’s Name:
Title or Position:
Place of Employment:

B

Defendant’s Name
Title or Position:
Place of Employment:
Page 1 018

QbEDKy 520 (Rev 02/07 Complaint under $1983 or Bivens Action

C.

D.

IV.

Where did these events happen?

What rights under the Constitution, federal law, federal regulations, state law, or
state regulations do you allege the Defendant(s) violated? State the specific
constitutional provision or law if you know it.

Exhaustion of Administrative Remedies

A prisoner must complete all steps of the prison’s grievance process before filing any
lawsuit that relates to prison conditions.

A.

Federal Prisoners answer the following:
1.

Did you file a grievance regarding the facts in this Complaint under

Bureau of Prisons regulations? YES
2.

L NO (
)
2

If so, did you (check ALL that apply):

__ file a request or appeal to the Warden

date

__ appeal to the Regional Director

date

~

3.

appeal to the Office of General Counsel
ATTACH a copy of each grievance or appeal form you filed and the

prison’s response(s) to each grievance or appeal.
Page 4 of 8

date

%EDICY520 (Rev 02/07 Complaint under $1983 or Bivens Action

4.

What was the result?

5.

If you did not file a grievance, why not?

State Prisoners answer the following:
1.

Did you file a grievance regarding these facts under Kentucky Department
of Corrections CPP 14.6 or an appeal of a disciplinary decision to the
YES
NO
wardenunder CPP 15.6?

2.

If you filed a grievance under CPP 14.6, did you (check ALL that apply):

__ file a grievance and seek an informal resolution
request a hearing from the Grievance Committee
appeal to the Warden
__ appeal to the Commissioner

date
date
date
date

Did you file an appeal of a disciplinary decision to the warden under CPP 15.6?
YES
NO
date
3.

ATTACH a copy of each grievance or appeal form you filed and the
prison’s response(s) to each grievance or appeal.

4.

What was the result?

5.

If you did not file a grievance, why not?

Page 5 of 8

%EDICY520 (Rev 02/07 Complzint under 51983 or Bivens Action

C.

County or City Prisoners answer the following:
1.
2.

Is there a grievance/appeal policy at your jail? YES (2
NO
ATTACH a copy of the grievanceiappeal policy to your Complaint, if
available. If not, briefly describe the grievance/appeal policy below.

3.

Did you file a grievance regarding these facts? YES

4.

If you filed a grievance:

NO

a. What steps did you take to use the grievance process?

b. What was the result?

c. Ifunsuccessful, did you file an appeal?

YES

NO

(A

d. What was the result?

e. Did you take any further steps in the grievance process?

ms(A

NO(

NO MORE AVAILABLE

f What was the result?

5.

If you did not file a grievance, why not?:

Page 6 of 8

%EDKy 520 (Rev 02/07) Complaint under $1983 or Bivens Action

V.

OTHER LAWSUITS

A.

Have you filed any other lawsuit dealing with the same facts raised in this action?
YES(
NO(

B.

If your answer to question A is YES, describe the lawsuit in the space below.
If you filed more than one other lawsuit, provide the same information for each
other lawsuit on additional sheets of paper.
1. PARTIES:

Plaintiff.
Defendant(s):

2. COURT: (name the district for a federal court, or the county for a state court)

3. CASENO.:

DATE FILED:

4. OUTCOME: (is the case still pending? was it dismissed? being appealed?)

5 . DATE OF JUDGMENT, DISMISSAL, or APPEAL:

C

List any other lawsuits that you have filed in any state or federal court:
1. Plaintiff

vs. Defendant(s)

Court Name:

Case No.:

Nature of Claim:

Date Filed:

Outcome:

Date:

2. Plaintiff

vs. Defendant(s)

Court Name:

-

Case No.:

Nature of Claim:

Date Filed:

Outcome:

Date:
Page 7 of 8

%EDKy 520 (Rev 02/07) Complaint under %I983 Bivens Action
or

3. Plaintiff

vs. Defendant(s)

Court Name:
Nature of Claim:

Date Filed:

Outcome:

VI.

Case No.:
Date:

Relief:

State exactly what you want the Court to do for you. You don’t need to make legal
arguments or refer to any cases or statutes, just explain what you want to happen if you prevail
on your claim.

VII.

Review this Form

Please take a moment to go back and review your responses to each of the questions.
Immediately below you are required to certify under penalty of perjury that the information
you have provided in this form is correct to the best of your knowledge, so please make sure
that your responses fully and accurately explain your claim.

CERTIFICATION
Pursuant to 28 U.S.C. $1746, I declare under penalty of perjury that the foregoing is
true and correct.

Signature of Plaintiff

Prison ID#

Plaintiffs Address:

Page 8 of 8

Date