Pace v. Bullock et al

Filing 3

MEMORANDUM AND ORDER: IT IS HEREBY ORDERED that the Clerk of Court shall mail to Plaintiff a copy of the Court's Prisoner Civil Rights Complaint form. IT IS FURTHER ORDERED that the Clerk of Court shall mail to Plaintiff a copy of the Court's "Application to Proceed in District Court without Prepaying Fees or Costs" form. IT IS FURTHER ORDERED that Plaintiff must file an amended complaint on the Court's Prisoner Civil Rights Complaint form no later than Thursday, March 21, 2024. IT IS FINALLY ORDERED that Plaintiff must either pay the $405 filing fee or file an application to proceed without prepaying fees and costs no later than Thursday, March 21, 2024. If Plaintiff fails to timely comply with this Order, then the Court will dismiss this action without further notice. (Amended/Supplemental Pleadings due by 3/21/2024.) Signed by District Judge Matthew T. Schelp on 2/5/2024. (Attachments: #1 Attachment Prisoner Civil Rights Complaint, #2 Attachment Application to Proceed in District Court Without Prepaying Fees or Costs)(TMT)

Clear Form

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
DIVISION

(Write the full name of the plaintiff in this action.
Include prisoner registration number.)

v.

(Write the full name of each defendant. The caption
must include the names of all of the parties.
Fed. R. Civ. P. 10(a). Merely listing one party and
writing “et al.” is insufficient. Attach additional
sheets if necessary.)

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Case No: ____________________
(to be assigned by Clerk of District Court)

Plaintiff Requests Trial by Jury
_______Yes _______No

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PRISONER CIVIL RIGHTS COMPLAINT UNDER 42 U.S.C. § 1983
NOTICE:
Federal Rule of Civil Procedure 5.2 addresses the privacy and security concerns resulting from
public access to electronic court files. Under this rule, papers filed with the court should not
contain: an individual’s full social security number or full birth date, the full name of a person
known to be a minor, or a complete financial account number. A filing may include only: the last
four digits of a social security number, the year of an individual’s birth, a minor’s initials, and
the last four digits of a financial account number.
Except as noted in this form, plaintiff should not send exhibits, affidavits, witness statements, or
any other materials to the Clerk’s Office with this complaint.
In order for your complaint to be filed, it must be accompanied by the filing fee or an
application to proceed without prepayment of fees and costs.

I.

The Parties to this Complaint
A.

The Plaintiff

Name: _________________________________________________________________
Other names you have used: ________________________________________________
Prisoner Registration Number: ______________________________________________
Current Institution:

Indicate your prisoner status:
_____ Pretrial detainee

_____ Convicted and sentenced state prisoner

_____ Civilly committed detainee

_____ Convicted and sentenced federal prisoner

_____ Immigration detainee

_____ Other (explain): _____________________

B.

The Defendant(s)

To the best of your knowledge, give the information below for each defendant named in the
caption of this complaint. Make sure the defendant(s) named below are the same as those listed
in the caption of this complaint. Attach additional pages if necessary.
For an individual defendant, include the person’s job title, and check whether you are suing the
individual in his or her individual capacity, official capacity, or both.
Defendant 1
Name: _________________________________________________________________
Job or Title: _____________________________________________________________
Badge/Shield Number: _____________________________________________________
Employer: _______________________________________________________________
Address: ________________________________________________________________
________ Individual Capacity

_________ Official Capacity

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Defendant 2
Name: _________________________________________________________________
Job or Title: _____________________________________________________________
Badge/Shield Number: _____________________________________________________
Employer: _______________________________________________________________
Address: ________________________________________________________________
________ Individual Capacity

_________ Official Capacity

II. Statement of Claim
Type, or neatly print, a short and plain statement of the FACTS that support your claim(s). For
every defendant you have named in this complaint, you must state what he or she personally did
to harm you. If more than one claim is asserted, number each claim and write a short and plain
statement of each claim in a separate paragraph. Do not make legal arguments, or cite court
cases or statutes. You may attach additional pages if necessary.
Your statement of claim must include all of the following information:
1.
2.
3.
4.
5.

What happened to you?
When did it happen?
Where did it happen?
What injuries did you suffer?
What did each defendant personally do, or fail to do, to harm you?

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III.

Injuries

If you sustained injuries related to the events alleged above, describe your injuries and state what
medical treatment, if any, you required and did or did not receive.

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IV.

Relief

State briefly and precisely what you want the Court to do for you. Do not make legal arguments.
Do not cite any cases or statutes. If you are requesting money damages, include the amounts of
any actual damages and/or punitive damages you are claiming. Explain why you believe you are
entitled to recover those damages.

V.

Exhaustion of Administrative Remedies/Administrative Procedures

The Prison Litigation Reform Act (“PLRA”) 42 U.S.C. § 1997e(a), requires that “[n]o action
shall be brought with respect to prison conditions under section 1983 of this title, or any other
Federal law, by a prisoner confined in any jail, prison, or other correctional facility until such
administrative remedies as are available are exhausted.”
Administrative remedies are also known as grievance procedures. Your case may be dismissed
if you have not exhausted your administrative remedies.
A.

Did your claim(s) arise while you were confined in a jail, prison, or other
correctional facility?
_____ Yes

______ No

If yes, name the jail, prison or other correctional facility where you were confined at the
time of the events giving rise to your claim(s):
______________________________________________________________________________

B.

Does the jail, prison or other correctional facility where your claim(s) arose have
a grievance procedure?
_____ Yes

C.

______ No

______ Do not know

If yes, does the grievance procedure at the jail, prison or other correctional facility
where your claim(s) arose cover some or all of your claims?
_____ Yes

______ No
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______ Do not know

If yes, which claim(s)?

D.

Did you file a grievance in the jail, prison, or other correctional facility where
your claim(s) arose concerning the facts relating to this complaint?
_____ Yes

______ No

If no, did you file a grievance about the events described in this complaint at any other
jail, prison, or other correctional facility?
_____ Yes

______ No

E.

If you did file a grievance:

1.

Where did you file the grievance?

______________________________________________________________________________
2.

What did you claim in your grievance? (Attach a copy of your grievance, if
available)

3.

What was the result, if any? (Attach a copy of any written response to your
grievance, if available)

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4.

What steps, if any, did you take to appeal that decision? Is the grievance process
completed? If not, explain why not. (Describe all efforts to appeal to the highest
level of the grievance process.)

F.

If you did not file a grievance:

1.

If there are any reasons why you did not file a grievance, state them here:

2.

If you did not file a grievance but you did inform officials of your claim, state
who you informed, when and how, and their response, if any:

G.

Please set forth any additional information that is relevant to the exhaustion of
your administrative remedies.

(Note: You may attach as exhibits to this complaint any documents related to the exhaustion of
your administrative remedies.)

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VI.

Previous Lawsuits

The “three strikes rule” bars a prisoner from bringing a civil action or an appeal in federal court
without paying the filing fee if that prisoner has “on three or more prior 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.

To the best of your knowledge, have you ever had a case dismissed on the basis of
this “three strikes rule”?
_____ Yes

______ No

If yes, state which court dismissed your case and when it was dismissed. Attach a
copy of the court’s order, if possible.

Have you filed other lawsuits in state or federal court dealing with the same facts
involved in this action?
_____ Yes

______ No

B.

If your answer to A is yes, describe each lawsuit by answering questions 1
through 7 below. (If there is more than one lawsuit, describe the additional
lawsuits on another page, using the same format.)

1.

Parties to the previous lawsuit
Plaintiff ________________________________________________________
Defendant(s) _______________________________________________________

2.

Court (if federal court, name the district; if state court, name the state and county)

3.

Docket or case number ______________________________________________

4.

Name of Judge assigned to your case ___________________________________

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5.

Approximate date of filing lawsuit _____________________________________

6.

Is the case still pending?
_____ Yes
______ No (If no, give the approximate date of disposition):_________________

7.

What was the result of the case? (For example: Was the case dismissed? Was
judgment entered in your favor? Was the case appealed?)

C.

Have you filed other lawsuits in state or federal court otherwise relating to the
conditions of your imprisonment?
_____ Yes

______ No

D.

If your answer to C is yes, describe each lawsuit by answering questions 1
through 7 below. (If there is more than one lawsuit, describe the additional
lawsuits on another page, using the same format.)

1.

Parties to the previous lawsuit
Plaintiff___________________________________________________________
Defendant(s) _______________________________________________________

2.

Court (if federal court, name the district; if state court, name the state and county)

3.

Docket or case number ______________________________________________

4.

Name of Judge assigned to your case ___________________________________

5.

Approximate date of filing lawsuit _____________________________________

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6.

Is the case still pending?
_____ Yes
______ No (If no, give the approximate date of disposition):_________________

7.

What was the result of the case? (For example: Was the case dismissed? Was
judgment entered in your favor? Was the case appealed?)

VII. Certification and Closing
Under Federal Rule of Civil Procedure 11, by signing below, I certify to the best of my
knowledge, information, and belief that this complaint: (1) is not being presented for an
improper purpose, such as to harass, cause unnecessary delay, or needlessly increase the cost
of litigation; (2) is supported by existing law or by a nonfrivolous argument for extending,
modifying, or reversing existing law; (3) the factual contentions have evidentiary support or,
if specifically so identified, will likely have evidentiary support after a reasonable
opportunity for further investigation or discovery; and (4) the complaint otherwise complies
with the requirements of Rule 11.
I agree to provide the Clerk’s Office with any changes to my address where case-related papers
may be served. I understand that my failure to keep a current address on file with the Clerk’s
Office may result in the dismissal of my case.

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

Signed this ______ day of ________________________, 20______.

Signature of Plaintiff

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