Von Greenbrier v. Greenbrier, Greenbrier IA

Filing 4

ORDER granting 1 MOTION for Leave to Proceed in forma pauperis filed by Erriche Anton Von Greenbrier; Order Setting: ( Amended Pleadings due by 5/23/2012.) Signed by Jeremiah C. Lynch on 4/23/2012. (Attachments: # 1 Supplement) (TCL, )

IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF MONTANA
MISSOULA DIVISION
ERRICHE ANTON VON GREENBRIER,

CV 12-53-M-DLC-JCL

Plaintiff,
vs.

AMENDED COMPLAINT

___________________________________
___________________________________
__________________________________,
Defendants.
INSTRUCTIONS
1. Use this form to file an amended civil complaint with the United States District
Court for the District of Montana. You may attach additional pages where
necessary.
2. Your amended complaint must include only counts/causes of action and facts –
not legal arguments or citations.
3. Your amended complaint must be typed or legibly handwritten. All pleadings
and other papers submitted for filing must be on 8 ½" x 11" paper (letter size).
Your signature need not be notarized but it must be an original and not a copy.
You must pay the Clerk for copies of your amended complaint or other court
records, even if you are proceeding in forma pauperis.

Amended Complaint
Plaintiff’s Last Name

Von Greenbrier

4. Complaints submitted by persons proceeding in forma pauperis and complaints
submitted by prisoners suing a governmental entity or employee are reviewed
by the Court before the defendants are required to answer. See 28 U.S.C. §§
1915(e)(2), 1915A(a); 42 U.S.C. § 1997e(c). After the Court completes the
review process, you will receive an Order explaining the findings and any
further action you may or must take. The review process may take a few
months; each case receives the judge’s individual attention.
5. When you have completed your amended complaint, mail the original – copies
are not required – to the Clerk of U.S. District Court, P.O. Box 8537, Missoula,
MT 59807-8537.

AMENDED COMPLAINT
I. PLACE OF CONFINEMENT
A. Are you incarcerated?

Yes G

No G (if No, go to Part II)

B. If yes, where are you currently incarcerated?
__________________________________________________________________
C. If any of the incidents giving rise to your complaint occurred in a different
facility, list that facility:
__________________________________________________________________
II. EXHAUSTION OF ADMINISTRATIVE REMEDIES
A. Non-Prisoners
1. Does any cause of action alleged in this complaint require you to exhaust
administrative remedies before filing in court?
Yes G
No G Don’t Know 9
2. If yes, have you exhausted your administrative remedies?
Yes G
No G
Amended Complaint
Plaintiff’s Last Name

Von Greenbrier

B. Prisoners (If you listed other institutions in I.C above, please answer for each
institution).
1. Is there a grievance procedure in your current institution? Yes G

No G

2. Did you fully exhaust the administrative grievance process within the jail or
prison where the incidents at issue occurred?
Yes G
No G
3. If you did not fully exhaust the grievance process, explain why:
__________________________________________________________________
__________________________________________________________________
III. PARTIES TO CURRENT LAWSUIT
A. Plaintiff ____________________is a citizen of______________________,
(State)
presently residing at______________________________________________.
(Mailing address or place of confinement)
B. Defendant ____________________is a citizen of ______________________,
(State)
employed as _____________________at_______________________________.
(Position and Title, if any)
(Institution/Organization)
Defendant ____________________is a citizen of ______________________,
(State)
employed as _____________________at_______________________________.
(Position and Title, if any)
(Institution/Organization)
Defendant ____________________is a citizen of ______________________,
(State)
employed as _____________________at_______________________________.
(Position and Title, if any)
(Institution/Organization)
(NOTE: If more space is needed to furnish the above information, continue on a
blank sheet labeled “APPENDIX A: PARTIES”).
Amended Complaint
Plaintiff’s Last Name

Von Greenbrier

IV. STATEMENT OF CLAIMS
A. Count I (State your cause of action, e.g., how have your constitutional rights
been violated):
__________________________________________________________________
__________________________________________________________________
Date of incident(s): __________________________________________________
1. Supporting Facts: (Include all facts you consider important, including
names of persons involved, places, and dates. State the facts clearly in
your own words without citing legal arguments, cases, or statutes).
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
2. Defendants Involved: (List the name of each defendant involved in this
claim and specifically describe what each defendant did or did not do to
allegedly cause your injury).
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
(NOTE: For each additional claim, use a blank sheet labeled “APPENDIX B.
STATEMENT OF CLAIMS.” You must set forth two paragraphs for each count,
one consisting of Supporting Facts (following the directions under IV(A)(1)), and
one consisting of Defendants Involved (following the directions under IV(A)(2)).
Amended Complaint
Plaintiff’s Last Name

Von Greenbrier

V. INJURY
Describe the injuries you suffered as a result of each individual defendant’s
actions. (Do no cite legal arguments, cases, or statutes).
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
(NOTE: If more space is needed to furnish the above information, continue on a
blank sheet labeled “APPENDIX C: INJURY”).
VI. REQUEST FOR RELIEF
Describe the relief you request. (Do no cite legal arguments, cases, or statutes).
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
(NOTE: If more space is needed to furnish the above information, continue on a
blank sheet labeled “APPENDIX D: REQUEST FOR RELIEF”).
Amended Complaint
Plaintiff’s Last Name

Von Greenbrier

VII. PLAINTIFF’S DECLARATION
A. I understand I must keep the Court informed of my current mailing address and
my failure to do so may result in dismissal of this Complaint without notice to
me.
B. I understand the Federal Rules of Civil Procedure prohibit litigants filing civil
complaints from using certain information in documents submitted to the
Court. In order to comply with these rules, I understand that:
• social security numbers, taxpayer identification numbers, and financial
account numbers must include only the last four digits (e.g. xxx-xx-5271,
xx-xxx5271, xxxxxxxx3567);
• birth dates must include the year of birth only (e.g. xx/xx/2001); and
• names of persons under the age of 18 must include initials only (e.g. L.K.).
If my documents (including exhibits) contain any of the above listed information, I
understand it is my responsibility to black that information out before sending those
documents to the Court.
I understand I am responsible for protecting the privacy of this information.
C. I declare under penalty of perjury that I am the plaintiff in this action, I have read
this complaint, and the information I set forth herein is true and correct. 28 U.S.C. §
1746; 18 U.S.C. § 1621.
D. (Prisoners Only) This Complaint was deposited in the prison system for legal mail,
postage prepaid or paid by the prison, on
________________________________________, 20_____.
Executed at ________________________on ____________________, 20_____.
(Location)
(Date)
_____________________________________________
Signature of Plaintiff
Amended Complaint
Plaintiff’s Last Name

Von Greenbrier