Perez v. North Las Vegas

Filing 3

ORDER. ACCORDINGLY, IT IS ORDERED that: The IFP application (ECF No. #1 ) is DENIED WITHOUT PREJUDICE. Plaintiff must either pay the full filing fee OR file a fully complete IFP application by Wednesday July 3, 2024. The IFP application must include: a. A completed application with the inmate's two signatures on page 3; b. A completed financial certificate that is signed by both the inmate and a prison or jail official; and c. A copy of the inmate's trust fund account statement for the previous six-month period. Plaintiff must file a Complaint that complies with the above instructions by Wednesday July 3, 2024. Failure to timely comply with this Order may result in a recommendation that the case be dismissed. The Clerk of Court is directed to send to plaintiff the approved form application to proceed IFP for an inmate and instructions for the same. The Clerk of the Court will send to Plaintiff the approved form for filing a 1983 complaint, instructions for the same, and a copy of this Order. The Clerk of the Court is directed NOT to issue summons. The Court will issue a screening order on the complaint after plaintiff either files a new IFP or pays the filing fee. See 28 U.S.C. 1915(e)(2). Complaint deadline: 7/3/2024. IFP or payment of filing fees due 7/3/2024. Signed by Magistrate Judge Maximiliano D. Couvillier, III on 6/3/2024. (Attachments: #1 Information for Filing an Application to Proceed In Forma Pauperis by an Inmate, #2 Instructions for Filing a Civil Rights Complaint by an Incarcerated Individual)(Copies have been distributed pursuant to the NEF - RJDG)

UNITED STATES DISTRICT COURT
DISTRICT OF NEVADA
Instructions for Filing a Civil Rights Complaint
by an Incarcerated Individual
Who May Use This Form
If you are incarcerated, you must use the attached form (unless you are challenging your
sentence or conviction, see next paragraph). The attached civil rights complaint form is designed
to help you prepare a complaint seeking relief for alleged violations of your federal civil
rights. These complaints are usually about the conditions of your confinement, but they may relate
to other issues (except for your sentence and conviction, see next paragraph).
Do not use this form if you are challenging the length of your sentence or the validity of
your conviction. If you want to challenge a state conviction or sentence, you should file a
petition under 28 U.S.C. § 2254 for writ of habeas corpus by a person in state custody. If you
want to challenge a federal conviction or sentence, you should file a motion under 28 U.S.C. §
2255 to vacate sentence in the federal court that entered judgment.
Filing a Civil Rights Action
To initiate a civil rights action, you must submit:
1) a completed complaint form
and
2) a check or money order for $405 (which includes the $350 filing fee and the
$55 administrative fee), or an inmate application to proceed in forma pauperis.
If you can pay the full $405 filing fee, please send a check or money order made payable to
“CLERK, U.S. DISTRICT COURT” with your complaint. If you cannot pay the entire filing fee
when you submit your complaint, please complete an inmate’s application to proceed in forma
pauperis, which is available at your institution. You may request the packet titled “Information for
Filing an Application to Proceed In Forma Pauperis by an Inmate under 28 U.S.C. § 1915.”
You must file your complaint in the unofficial division where you are incarcerated. See
Local Rules of Practice for the United States District Court for the District of Nevada (“LR”)
IA 1-6, 1-8. The Clerk of the Court maintains offices in Las Vegas and Reno at these addresses:
Unofficial Southern Division (Clark, Esmeralda, Lincoln, & Nye counties):
U.S. District Court Office of the Clerk
333 Las Vegas Boulevard, South, Room #1334
Las Vegas, NV 89101
Unofficial Northern Division (all other counties):
U.S. District Court Office of the Clerk
400 S. Virginia Street, Room #301
Reno, NV 89501
Please continue to use electronic filing if it is available at your facility or institution.
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Completing the Civil Rights Complaint Form
General Information
• You must complete the form in its entirety. All questions must be answered in order
for your action to proceed. Your responses must be typewritten or legibly handwritten.
You must sign page 6 of the form and declare under penalty of perjury that the facts
stated in the complaint are true and correct.
• Do not write on the back of any of the pages. All information must be clearly and
concisely written in the space provided on the form. Do not write in the margins. If you
attach additional pages to the form, you must identify which section of the complaint is
being continued and number the pages accordingly (e.g., 2-A, 2-B, 3-A, 3-B, etc.).
• All incarcerated litigants are required to follow the Local Rules of Practice for the
United States District Court for the District of Nevada. A copy of the Local Rules is
maintained at each Nevada Department of Corrections Facility.
• All incarcerated litigants are required to follow General Order 2021-05 for the United States
District Court for the District of Nevada.
• A civil cover sheet is not required in prisoner civil rights cases.
Length
• Your complaint or amended complaint may not be more than 30 pages long.
• It is not necessary to attach exhibits or affidavits to the complaint or any amended
complaint. Rather, the complaint or any amended complaint must sufficiently state the facts
and claims without reference to exhibits or affidavits. Failure to state the facts and claims
within the body of the complaint or amended complaint, without reference to any attached
exhibits or affidavits, may result in dismissal.
• If you believe that you need to file a complaint or amended complaint that is longer than 30
pages, you must file a motion seeking permission to exceed the page limit and explain your
reasons for exceeding the 30-page limit. Your motion to exceed the page limit may not be
longer than 3 pages.
Heading/Caption
• Your Name: Print your full name, prison or inmate number, and institutional mailing
address on the lines provided.
• Defendants: If there are five or fewer defendants, print the name of each. If you are
suing more than five defendants, print the name of the first defendant on the first line
and write “see additional pages for defendants” on the second line. On an additional
page, you must list the names of all defendants. Insert this additional page after page 1
and number the page “1-A” at the bottom.
• Identify Complaint: You must mark the box identifying whether the instant complaint is
the original, first amended, or second amended complaint.
• Jury Demand: If you want a jury trial, you must check the box for “Jury Trial Demanded.”
Part A: Jurisdiction
• 42 U.S.C. § 1983 Action: If you are filing a complaint naming a state, county, or city
official as a defendant, mark the box for “28 U.S.C. § 1343(a)(3); 42 U.S.C. § 1983.”
• Bivens Action: If you are filing a complaint naming a federal officer as a defendant, mark
the box for “28 U .S.C. § 1331; Bivens v. Six Unknown Named Agents.”
• Fill in the requested information about your current institution/city and the institution/city
where the violations occurred.
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Part B: Defendants
• Fill in the requested information about each of the defendants in the spaces
provided. If you are naming more than five defendants, you must provide the necessary
information about each additional defendant on separate pages labeled “2-A”, “2-B”, etc.
at the bottom of the page. Insert the additional page(s) immediately behind page 2.
Part C: Nature of the Case
• Briefly give an overview of your case by providing general facts about your case. This is
not the place to provide detailed information about what each defendant did to violate
your rights (see Part D).
Part D: Cause(s) of Action
• This is where you identify what rights you claim the defendant(s) violated. The form
provides three pages for alleging three claims. If you are alleging more than three
claims, then attach an additional page for each additional claim (so that there is only
one claim per page). Number the additional pages “5-A,” “5-B,” etc. and insert the
pages immediately behind page 5. Remember, your complaint may not exceed 30 pages.
o Claims: You must identify which civil right was violated. You may allege the
violation of only one civil right per claim.
o Issues Involved: Check the box that most closely identifies the issue involved
in your claim. You may check only one box per claim. If you mark the box
“Other,” you must identify the specific issue involved.
o Date(s): Identify the date(s) or date range of the alleged violation.
o Supporting Facts: You must state facts supporting the violation. You should
be as specific as possible and describe what each individual defendant did to
violate your rights. You should name the individual defendants and include
dates when possible.
• You must follow the Federal Rules of Civil Procedure when drafting your claims and
allegations.
o Your complaint must contain “a short and plain statement of the claim showing
that [you are] entitled to relief.” Fed. R. Civ. P. 8(a)(2).
o “Each allegation must be simple, concise, and direct.” Fed. R. Civ. P. 8(d)(1).
o “A party must state its claims or defenses in numbered paragraphs, each limited
as far as practicable to a single set of circumstances.” Fed. R. Civ. P. 10(b).
Each claim founded on a separate transaction or occurrence must be stated in a
separate claim. Id.
o You may add multiple claims to a lawsuit when those claims are against the
same defendant. Fed. R. Civ. P. 18(a).
o You may add multiple parties to a lawsuit where the right to relief arises out of
the “same transaction, occurrence, or series of transactions or occurrences.”
Fed. R. Civ. P. 20(a)(2)(A).
o Unrelated claims that involve different defendants must be brought in separate
lawsuits.
Part E: Previous Lawsuits
• You must answer the questions in this section by marking “yes” or “no.”
Part F: Request for Relief
• Print the relief you are seeking in the space provided.
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Signature
• You must sign your name and print the date you signed the complaint. Failure to sign
the complaint will delay the processing of your action. If someone wrote this civil rights
complaint for you (such as an inmate law clerk), that person must write their name on
the line next to your signature.
Amended Complaints
If you need to change any information in the initial complaint, you must file an amended
complaint. The amended complaint must be written on a new, blank copy of the attached civil
rights complaint form. The amended complaint must be complete and may not incorporate by
reference any part of your prior complaint. Any allegations or defendants not included in the
amended complaint are considered abandoned. Please refer to LR 15-1 and Fed. R. Civ. P. 15
for how and when a party may move the court to file an amended complaint.

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______________________________
Name and Inmate Booking Number

______________________________
Place of Confinement

______________________________
Mailing Address
___________________________________________
City, State, Zip Code

UNITED STATES DISTRICT COURT
DISTRICT OF NEVADA

___________________________________ ,
Plaintiff

Case No. ___________________
(To be supplied by Clerk of Court)

vs.
(1) ________________________________ ,
(2) ________________________________ ,
(3) ________________________________ ,

CIVIL RIGHTS COMPLAINT
BY AN INMATE

□ Original Complaint
□ First Amended Complaint
□ Second Amended Complaint

(4) ________________________________ ,
(5) ________________________________ ,
Defendant(s).

A.
1)

□ Jury Trial Demanded

JURISDICTION

This Court has jurisdiction over this action pursuant to:
□ 28 U.S.C. § 1343(a)(3); 42 U.S.C. § 1983

□ 28 U.S.C. § 1331; Bivens v. Six Unknown Named Agents, 403 U.S. 388 (1971)
□ Other: ________________________________________________________________
2)

Institution/city where Plaintiff currently resides: _______________________________________

3)

Institution/city where violation(s) occurred: ___________________________________________

B.

DEFENDANTS

1. Name of first Defendant: _____________________________. The first Defendant is employed as:
_________________________________________ at ____________________________________.
(Position of Title)

(Institution)

2. Name of second Defendant: _________________________. The second Defendant is employed as:
_________________________________________ at ____________________________________.
(Position of Title)

(Institution)

3. Name of third Defendant: ____________________________. The third Defendant is employed as:
_________________________________________ at ____________________________________.
(Position of Title)

(Institution)

4. Name of fourth Defendant: __________________________. The fourth Defendant is employed as:
_________________________________________ at ____________________________________.
(Position of Title)

(Institution)

5. Name of fifth Defendant: __________________________. The fifth Defendant is employed as:
_________________________________________ at ____________________________________.
(Position of Title)

(Institution)

If you name more than five Defendants, answer the questions listed above for each additional Defendant on a separate page.

C.

NATURE OF THE CASE

Briefly state the background of your case.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

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D.

CAUSE(S) OF ACTION
CLAIM 1

1. State the constitutional or other federal civil right that was violated: __________________________
_________________________________________________________________________________
2. Claim 1. Identify the issue involved. Check only one. State additional issues in separate
claims.

□ Basic necessities
□ Disciplinary proceedings
□ Access to the court
□ Threat to safety

□ Medical care
□ Mail
□ Exercise of religion
□ Property
□ Excessive force by officer □ Retaliation
□ Other: ___________________________________________.

3. Date(s) or date range of when the violation occurred: ______________________________.
4. Supporting Facts: State as briefly as possible the FACTS supporting Claim 1. Describe
exactly what each specific defendant (by name) did to violate your rights. State the facts
clearly in your own words without citing legal authority or argument.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
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____________________________________________________________________________________
____________________________________________________________________________________
3

CLAIM 2
1. State the constitutional or other federal civil right that was violated: __________________________
_________________________________________________________________________________
2. Claim 2. Identify the issue involved. Check only one. State additional issues in separate
claims.

□ Basic necessities
□ Disciplinary proceedings
□ Access to the court
□ Threat to safety

□ Medical care
□ Mail
□ Exercise of religion
□ Property
□ Excessive force by officer □ Retaliation
□ Other: ___________________________________________.

3. Date(s) or date range of when the violation occurred: ______________________________.
4. Supporting Facts: State as briefly as possible the FACTS supporting Claim 2. Describe
exactly what each specific defendant (by name) did to violate your rights. State the facts
clearly in your own words without citing legal authority or argument.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
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____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

4

CLAIM 3
1. State the constitutional or other federal civil right that was violated: __________________________
_________________________________________________________________________________
2. Claim 3. Identify the issue involved. Check only one. State additional issues in separate
claims.

□ Basic necessities
□ Disciplinary proceedings
□ Access to the court
□ Threat to safety

□ Medical care
□ Mail
□ Exercise of religion
□ Property
□ Excessive force by officer □ Retaliation
□ Other: ___________________________________________.

3. Date(s) or date range of when the violation occurred: ______________________________.
4. Supporting Facts: State as briefly as possible the FACTS supporting Claim 3. Describe
exactly what each specific defendant (by name) did to violate your rights. State the facts
clearly in your own words without citing legal authority or argument.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
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____________________________________________________________________________________
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____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
If you assert more than three claims, answer the questions listed above for each additional claim on
a separate page.
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E.

PREVIOUS LAWSUITS

1. Have you filed any other lawsuits while incarcerated?

□ Yes

□ No

2. Has this Court or any other court designated you as subject to “three strikes” under 28 U.S.C. §
1915(g)?
□ Yes
□ No
3. If you have “three strikes” under 28 U.S.C. § 1915(g), does this complaint demonstrate that you are
“under imminent danger of serious physical injury?”
□ Yes
□ No

F.

REQUEST FOR RELIEF

I believe 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.
______________________________________ ______________________________________
(signature of plaintiff)
(name of person who prepared or helped
prepare this complaint if not the plaintiff)
______________________________________
(date)

ADDITIONAL PAGES
You must answer all questions concisely in the proper space on the form. Your complaint may
not be more than 30 pages long. It is not necessary to attach exhibits or affidavits to the complaint or any
amended complaint. Rather, the complaint or any amended complaint must sufficiently state the facts and
claims without reference to exhibits or affidavits. If you need to file a complaint that is more than 30 pages
long, you must file a motion seeking permission to exceed the page limit and explain the reasons that
support the need to exceed 30 pages in length.
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