Frixione v. Skolnik et al

Filing 2

ORDER that the Clerk SHALL SEND plaintiff the approved form for an Application to Proceed In Forma Pauperis by a prisoner, as well as the documentInformation and Instructions for Filing a Motion to Proceed In Forma Pauperis. Within 30 days from the date of entry of this order, plaintiff SHALL FILE a completed and signed application to proceed in forma pauperis on the form provided by this Court. Plaintiffs failure to file an applicationto proceed in forma pauperis in compliance with this order may result in the immediate dismissal of the lawsuit without prejudice. IT IS FURTHER ORDERED that the Clerk SHALL SEND to plaintiff the approvedforms for filing a civil rights lawsuit under 42 U.S.C. §1983. IT IS FURTHER ORDERED that if plaintiff chooses to file an Amended Complaint,he shall clearly title the amended complaint as such by placing the words FIRST AMENDED immediately above Civil Rights Complaint Pursuant to 42 U.S.C. § 1983 on page 1 in the caption, and plaintiff shall place the case number, 2:10-CV-01119-RLJ-LRL, above the words FIRST AMENDEDin the space for Case No. IT IS FURTHER ORDERED that if plaintiff chooses to file an Amended Complaint,he shall file it within 30 days from the date that this Order is entered. The amended complaint must be a complete document in and of itself, and will supersede the original complaint in its entirety. Any allegations, parties, or requests for relief from prior papers that are not carried forward in theamended complaint will no longer be before the court. Signed by Magistrate Judge Lawrence R. Leavitt on 7/26/2010. (Attachments: # 1 IFP, # 2 IFP Instructions, # 3 Complaint, # 4 Complaint Instructions)(Copies have been distributed pursuant to the NEF - SD)

Frixione v. Skolnik et al

Doc. 2 Att. 3

Name

Prison Number UNITED STATES DISTRICT COURT DISTRICT OF NEVADA , Plaintiff, vs. , , , , , Defendant(s). ) ) ) ) ) ) ) ) ) ) ) ) ) ) )

CASE NO. (To be supplied by the Clerk) CIVIL RIGHTS COMPLAINT PURSUANT TO 42 U.S.C. § 1983

A. JURISDICTION 1) This complaint alleges that the civil rights of Plaintiff, (Print Plaintiff's name) who presently resides at , were ,

violated by the actions of the below named individuals which were directed against Plaintiff at (institution/city where violation occurred) , (Count I) (Count II) , and (Count III) . on the following dates

Dockets.Justia.com

Make a copy of this page to provide the below information if you are naming more than five (5) defendants 2) Defendant resides at , (full name of first defendant) (address if first defendant) . This defendant is sued in his/her and is employed as (defendant's position and title, if any) individual official capacity. (Check one or both). Explain how this defendant was acting under color of law:

3) Defendant

resides at

,

(full name of first defendant) (address if first defendant) and is employed as . This defendant is sued in his/her (defendant's position and title, if any) individual official capacity. (Check one or both). Explain how this defendant was acting under color of law: 4) Defendant resides at ,

(full name of first defendant) (address if first defendant) and is employed as . This defendant is sued in his/her (defendant's position and title, if any) individual official capacity. (Check one or both). Explain how this defendant was acting under color of law:

5) Defendant

resides at , (full name of first defendant) (address if first defendant) . This defendant is sued in his/her and is employed as (defendant's position and title, if any) individual official capacity. (Check one or both). Explain how this defendant was acting under color of law:

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6) Defendant

resides at

,

(full name of first defendant) (address if first defendant) and is employed as . This defendant is sued in his/her (defendant's position and title, if any) individual official capacity. (Check one or both). Explain how this defendant was acting under color of law:

7) Jurisdiction is invoked pursuant to 28 U.S.C. § 1343 (a)(3) and 42 U.S.C. § 1983. If you wish to assert jurisdiction under different or additional statutes, list them below.

-----------------------------B. NATURE OF THE CASE Briefly state the background of your case.

1)

----------------------------C. CAUSE OF ACTION
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COUNT I The following civil rights has been violated:

Supporting Facts: [Include all fact you consider important. State the facts clearly, in your own words, and without citing legal authority or argument. Be sure you describe exactly what each specific defendant (by name) did to violate your rights].

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COUNT II The following civil rights has been violated:

Supporting Facts: [Include all fact you consider important. State the facts clearly, in your own words, and without citing legal authority or argument. Be sure you describe exactly what each specific defendant (by name) did to violate your rights].

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COUNT III The following civil rights has been violated:

Supporting Facts: [Include all fact you consider important. State the facts clearly, in your own words, and without citing legal authority or argument. Be sure you describe exactly what each specific defendant (by name) did to violate your rights].

---------------------------------D. PREVIOUS LAWSUITS AND ADMINISTRATIVE RELIEF 1) Have you filed other actions in state or federal courts involving the same or similar facts as involved in this action? Yes No. If your answer is "Yes", describe each lawsuit. (If more than one, describe the others on an additional page following the below
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outline). a) b) c) d) Defendants: Name of court and docket number: Disposition (for example, was the case dismissed , appealed or is it still pending?): Issues raised:

e) f) 2)

Approximate date it was filed: Approximate date of disposition:

Have you filed an action in federal court that was dismissed because it was determined to be frivolous, malicious, or failed to state a claim upon which relief could be granted? Yes No. If your answer is "Yes", describe each lawsuit. (If you had more than three actions dismissed based on the above reasons, describe the others on an additional page following the below outline.) Lawsuit #1 dismissed as frivolous, malicious, or failed to state a claim: a) b) c) d) e) f) Defendants: Name of court and case number: The case was dismissed because it was found to be (check one): malicious or Issues raised: Approximate date it was filed: Approximate date of disposition: frivolous . .

failed to state a claim upon which relief could be granted.

Lawsuit #2 dismissed as frivolous, malicious, or failed to state a claim: a) b) Defendants: Name of court and case number: . .

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c) d) e) f)

The case was dismissed because it was found to be (check one): malicious or Issues raised: Approximate date it was filed: Approximate date of disposition:

frivolous

failed to state a claim upon which relief could be granted.

Lawsuit #3 dismissed as frivolous, malicious, or failed to state a claim: a) b) c) d) e) f) Defendants: Name of court and case number: The case was dismissed because it was found to be (check one): malicious or Issues raised: Approximate date it was filed: Approximate date of disposition: frivolous . .

failed to state a claim upon which relief could be granted.

3)

Have you attempted to resolve the dispute stated in this action by seeking relief from the proper administrative officials, e.g., have you exhausted available administrative grievance procedures? Yes No. If your answer is "No", did you not attempt administrative disciplinary hearing; (2) parole . . . state or federal law or regulation; (4) relief because the dispute involved the validity of a: (1) state or federal court decision; (3) board decision; or (5) other

If your answer is "Yes", provide the following information. Grievance Number Date and institution where grievance was filed Response to grievance:

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------------------E. REQUEST FOR RELIEF I believe that I am entitled to the following relief:

I understand that a false statement or answer to any question in this complaint will subject me to penalties of perjury. I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE UNITED STATES OF AMERICA THAT THE FOREGOING IS TRUE AND CORRECT. See 28 U.S.C. § 1746 and 18 U.S.C. § 1621.

(Name of Person who prepared or helped prepare this complaint if not Plaintiff)

(Signature of Plaintiff)

(Date) ---------------------------(Additional space if needed; identify what is being continued)

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