Taylor v. Pike County Jail

Filing 2

MEMORANDUM AND ORDER - IT IS HEREBY ORDERED that the Clerk shall mail to plaintiff a copy of the Court's form Prisoner Civil Rights Complaint. IT IS FURTHER ORDERED that the Clerk shall mail to plaintiff a copy of the Court's Motion to P roceed in Forma Pauperis - Prisoner Cases. IT IS FURTHER ORDERED that plaintiff shall file an amended complaint on the Courtprovided form within (30) days of the date of this Order. IT IS FURTHER ORDERED that plaintiff shall either pay the $400 filing fee or submit a motion to proceed in forma pauperis within thirty (30) days of the date of this Order. IT IS FURTHER ORDERED that if plaintiff submits a motion to proceed in forma pauperis, he must also submit a certified copy of his prison a ccount statement for the six month period immediately preceding the filing of his complaint. IT IS FURTHER ORDERED that if plaintiff fails to comply with this Order, the court will dismiss this action without prejudice. If the case is dismissed, the dismissal will not constitute a "strike" under 28 U.S.C. § 1915(g). Signed by Magistrate Judge Nannette A. Baker on 6/12/15. (**Mailed plaintiff a copy of the Court's form Prisoner Civil Rights Complaint and a copy of the Court's Motion to Proceed in Forma Pauperis - Prisoner Cases, along with this order**)(KJS)

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
NORTHERN DIVISION
MICHAEL A. TAYLOR,

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Plaintiff,
v.
PIKE COUNTY JAIL,
Defendant.

No. 2:15-CV-0041-NAB

MEMORANDUM AND ORDER
This matter is before the Court on plaintiff's pro se complaint. The complaint is defective
because it has not been drafted on a Court-provided form, see Local Rule 2.06(A), and because
plaintiff has neither paid the filing fee nor submitted a motion to proceed in forma pauperis along
with a prison account statement, see 28 U.S.C. § 1915(a).
Accordingly,
IT IS HEREBY ORDERED that the Clerk shall mail to plaintiff a copy of the Court's
form Prisoner Civil Rights Complaint.
IT IS FURTHER ORDERED that the Clerk shall mail to plaintiff a copy of the Court's
Motion to Proceed in Forma Pauperis - Prisoner Cases.
IT IS FURTHER ORDERED that plaintiff shall file an amended complaint on the Courtprovided form within (30) days of the date of this Order.
IT IS FURTHER ORDERED that plaintiff shall either pay the $400 filing fee or submit a
motion to proceed in forma pauperis within thirty (30) days of the date of this Order.
IT IS FURTHER ORDERED that if plaintiff submits a motion to proceed in forma

pauperis, he must also submit a certified copy of his prison account statement for the six month
period immediately preceding the filing of his complaint.
IT IS FURTHER ORDERED that if plaintiff fails to comply with this Order, the court
will dismiss this action without prejudice. If the case is dismissed, the dismissal will not constitute
a "strike" under 28 U.S.C. § 1915(g).
Dated this 12th day of June, 2015.

_/s/ Nannette A. Baker_______
NANNETTE A. BAKER
UNITED STATES MAGISTRATE JUDGE

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Reset

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
DIVISION

(Enter above the full name of the Plaintiff[s]
in this action.)

- vs -

(Enter above the full name of ALL Defendant[s] in this action. Fed. R. Civ. P. 10(a)
requires that the caption of the complaint
include the names of all the parties. Merely
listing one party and "et al." is insufficient.
Please attach additional sheets if necessary.

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Case No.
(To be assigned by Clerk
of District Court)

COMPLAINT
I.

State the grounds for filing this case is Federal Court (include federal statutes and/or U.S.
Constitutional provisions, if you know them):

II.

Plaintiff,

resides at
,

,

street address

city

,
state

,
zip code

,
county

.
telephone number

(if more than one plaintiff, provide the same information for each plaintiff below)

III.

Defendant,

lives at, or its business is located at
,

,

street address

city
,

state

,
county

.
zip code

(if more than one defendant, provide the same information for each defendant below)

2

IV.

Statement of claim (State as briefly as possible the facts of your case. Describe how each
defendant is involved. You must state exactly what each defendant personally did, or
failed to do, which resulted in harm to you. Include also the names of other persons
involved, dates, and places. Be as specific as possible. You may use additional paper
if necessary):

3

V.

Relief: State briefly and exactly what you want the Court to do for you.

VI.

MONEY DAMAGES:
A)

Do you claim either actual or punitive monetary damages for the acts alleged in
this complaint?
YES

B)

VII.

NO

If your answer to "A" is YES, state below the amount claimed and the reason or
reasons you believe you are entitled to recover such money damages:

Do you maintain that the wrongs alleged in the complaint are continuing to occur at the
present time?
YES

NO

I declare under penalty of perjury that the foregoing is true and correct.
Signed this

day of

, 20

Signature of Plaintiff(s)
4

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
,
Plaintiff(s),
v.
,
Defendant(s).

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No.

MOTION TO PROCEED IN FORMA PAUPERIS
AND FINANCIAL AFFIDAVIT

I,

, hereby apply for leave to proceed in

this action without prepayment of fees or costs and without giving security therefor. In support
of this application, I declare that the following facts are true:
(1)

I am the plaintiff in this case and I believe I am entitled to relief.

(2)
Because of my poverty I am unable to prepay the costs of this
proceeding or to give security therefor.
(3)
The nature of my action, defense, or appeal is briefly stated as
follows:

I declare under penalty of perjury that the foregoing is true and correct. Executed on
, 20

.

Signature of plaintiff

CJA 23

FINANCIAL AFFIDAVIT

Rev. 5/98

IN SUPPORT OF REQUEST FOR ATTORNEY, EXPERT OR OTHER COURT SERVICES WITHOUT PAYMENT OF FEE
G MAGISTRATE

IN UNITED STATES

G DISTRICT

G APPEALS COURT or

G OTHER PANEL (Specify below)

IN THE CASE OF

LOCATION NUMBER
FOR



V.S.
AT

1 G Defendant—Adult
2 G Defendant - Juvenile

PERSON REPRESENTED (Show your full name)



DOCKET NUMBERS
Magistrate

3 G Appellant
4 G Probation Violator
CHARGE/OFFENSE (describe if applicable & check box )



5 G Parole Violator
6 G Habeas Petitioner

G Felony
G Misdemeanor

District Court
Court of Appeals

7 G 2255 Petitioner
8 G Material Witness
9 G Other (Specify)

ANSWERS TO QUESTIONS REGARDING ABILITY TO PAY
Are you now employed? G Yes
Name and address of employer:
EMPLOYMENT

G No

G Am Self-Employed

IF YES, how much do you
earn per month? $

IF NO, give month and year of last employment
How much did you earn per month? $

G Yes

If married is your Spouse employed?
IF YES, how much does your
Spouse earn per month? $

G No
If a minor under age 21, what is your Parents or
Guardian’s approximate monthly income? $

Have you received within the past 12 months any income from a business, profession or other form of self-employment, or in the form of
the form of rent payments, interest, dividends, retirement or annuity payments, or other sources?
G Yes
G No
ASSETS

OTHER
INCOME

CASH

RECEIVED

IF YES, GIVE THE AMOUNT
RECEIVED & IDENTIFY
THE SOURCES

SOURCES

$

G

Have you any cash on hand or money in savings or checking accounts?

Yes

G No

IF YES, state total amount $

Do you own any real estate, stocks, bonds, notes, automobiles, or other valuable property (excluding ordinary household furnishings and
clothing)? G Yes
G No
PROPERTY

OBLIGATIONS &
DEBTS



VALUE

DESCRIPTION

IF YES, GIVE THE VALUE AND $
DESCRIBE IT

DEPENDENTS

DEBTS &
MONTHLY
BILLS
(LIST ALL CREDITORS,
INCLUDING BANKS,
LOAN COMPANIES,
CHARGE ACCOUNTS,
ETC.)





Total
No. of
Dependents

MARITAL STATUS
SINGLE



MARRIED
WIDOWED
SEPARATED OR
DIVORCED
APARTMENT
OR HOME:

Creditors

(OR PERSON REPRESENTED)

Total Debt

Monthly Paymt.

$
$

$

$



$

$

I certify under penalty of perjury that the foregoing is true and correct. Executed on (date)
SIGNATURE OF DEFENDANT

List persons you actually support and your relationship to them

$

$