Pertgen v. Baca et al
Filing
22
ORDER that ECF No. 18 Motion to Extend Time is granted; First Amended Complaint due by 11/30/2020; if Plaintiff fails to timely file his first amended complaint, this action will be dismissed with prejudice for failure to state a cla im; ECF No. 19 Motion for leave to amend is granted; ECF No. 20 Motion for a copy of § 1983 form is granted; Clerk directed to send Plaintiff an approved form § 1983 form with instructions (Attached hereto for distribution to p). Signed by Magistrate Judge William G. Cobb on 10/16/2020. (Attachments: # 1 Inmate 1983 Complaint form w instructions)(Copies have been distributed pursuant to the NEF - LW)
UNITED STATES DISTRICT COURT
DISTRICT OF NEVADA
INSTRUCTIONS FOR FILING A CIVIL RIGHTS COMPLAINT
BY AN INCARCERATED INDIVIDUAL UNDER 42 U.S.C. § 1983
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 42 U.S.C. § 1983 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
conviction. If you want to challenge a state conviction or sentence, you should file a
under 28 U.S.C. § 2254 for writ of habeas corpus by a person in state custody. If you
challenge a federal conviction or sentence, you should file a motion under 28 U.S.C. §
vacate sentence in the federal court that entered judgment.
of your
petition
want to
2255 to
Filing a § 1983 Civil Rights Action
To initiate a § 1983 civil rights action, you must submit:
1) a completed complaint form
and
2) a check or money order for $400 (which includes the $350 filing fee and the
$50 administrative fee), or an inmate application to proceed in forma pauperis.
If you can pay the full $400 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.
Revised 7/8/19
Page 1 of 3
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 9 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.
• A civil cover sheet is not required in prisoner civil rights cases.
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.
• Jury Demand: If you want a jury trial, you must write “JURY TRIAL DEMANDED” in the
space below “CIVIL RIGHTS COMPLAINT PURSUANT TO 42 U.S.C. § 1983.”
• Bivens Action: If you are filing a complaint in which you are naming a federal officer as a
defendant instead of a state, county, or city official, you should cross out “42 U.S.C. §
1983” and below it write “BIVENS ACTION.”
Part A: Jurisdiction
• Page 1: Fill in all of the requested information about you on page 1 in the spaces
provided.
• Page 2: Fill in all of the requested information about each of the defendants in the
spaces provided. If you are naming more than five defendants, then make a copy of
page 2 of the form and provide the necessary information for the additional defendants.
Label the page(s) “2-A”, “2-B”, etc. at the bottom of the page and insert the additional
page(s) immediately behind page 2.
• Page 3: If you wish to assert jurisdiction under a different or additional statute(s), list
them on page 3.
Part B: 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 C).
Revised 7/8/19
Page 2 of 3
Part C: Cause 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 “6-A,” “6-B,” etc. and insert the
pages immediately behind page 6.
• You must identify which civil rights you claim have been violated.
• 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. 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). “Each allegation must be simple,
concise, and direct.” Fed. R. Civ. P. 8(d)(1). “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 count. Id. You may add multiple claims to a lawsuit when those
claims are against the same defendant. Fed. R. Civ. P. 18(a). 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). Unrelated claims that
involve different defendants must be brought in separate lawsuits.
Part D: Previous Lawsuits
• You must identify any other lawsuit you have filed in either state or federal court that
relates to the same or similar claims that you have alleged in this civil rights complaint.
Part E: Request for Relief
• Print the relief you are seeking in the space provided.
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 in itself 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.
Revised 7/8/19
Page 3 of 3
______________________________
Name
______________________________
______________________________
______________________________
Prison Number
UNITED STATES DISTRICT COURT
DISTRICT OF NEVADA
***
___________________________________ ,
Plaintiff
Case No. ___________________
(Supplied by Clerk of Court)
vs.
CIVIL RIGHTS COMPLAINT
PURSUANT TO
42 U.S.C. § 1983
___________________________________ ,
___________________________________ ,
___________________________________ ,
___________________________________ ,
___________________________________ ,
Defendant(s).
A.
1)
JURISDICTION
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 that were directed against Plaintiff at
_______________________________________
(institution/city where violation occurred)
on
the
following
____________________, ____________________, and ____________________.
(Claim 2)
(Claim 3)
(Claim 1)
Revised 7/8/19
dates:
Make a copy of this page to provide the below
information if you are naming more than five (5) defendants
2)
Defendant ________________________ resides at ______________________________, and is
(full name of first defendant)
(address of first defendant)
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: ______________________________________________________________
______________________________________________________________________________
3)
Defendant ________________________ resides at ______________________________, and is
employed as _______________________________. This defendant is sued in his/her
___ individual ___ official capacity. (Check one or both.) Explain how this defendant was acting
under color of law: ______________________________________________________________
______________________________________________________________________________
4)
Defendant ________________________ resides at ______________________________, and is
employed as _______________________________. This defendant is sued in his/her
___ individual ___ official capacity. (Check one or both.) Explain how this defendant was acting
under color of law: ______________________________________________________________
______________________________________________________________________________
2
5)
Defendant ________________________ resides at ______________________________, and is
employed as _______________________________. This defendant is sued in his/her
___ individual ___ official capacity. (Check one or both.) Explain how this defendant was acting
under color of law: ______________________________________________________________
______________________________________________________________________________
6)
Defendant ________________________ resides at ______________________________, and is
employed as _______________________________. This defendant is sued in his/her
___ 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.
8)
NATURE OF THE CASE
Briefly state the background of your case.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
3
C.
CAUSE(S) OF ACTION
CLAIM 1
The following civil rights have been violated: _________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Supporting Facts: [Include all facts 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].
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
4
CLAIM 2
The following civil rights have been violated: _________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Supporting Facts: [Include all facts 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].
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
5
CLAIM 3
The following civil rights have been violated: _________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Supporting Facts: [Include all facts 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].
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
6
9)
Have you filed other actions in state or federal courts involving the same or similar facts as
involved in this action? Circle one: Yes or No. If your answer is “Yes,” describe each lawsuit.
(If more than one, describe the others on an additional page answering the following questions.)
a)
Defendants: ________________________________________________________
b)
Name of court and docket number: ______________________________________
c)
Disposition (for example, was the case dismissed, appealed or is it still pending?):
___________________________________________________________________
d)
Issues raised: ________________________________________________________
___________________________________________________________________
___________________________________________________________________
e)
f)
10)
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? Circle one: Yes
or 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 answering the following
questions.)
Lawsuit #1 dismissed as frivolous, malicious, or failed to state a claim:
a)
Defendants:
b)
Name of court and case number:
c)
The case was dismissed because it was found to be (circle one): (1) frivolous;
(2) malicious; or (3) failed to state a claim upon which relief could be granted.
d)
Issues raised: ________________________________________________________
___________________________________________________________________
___________________________________________________________________
e)
Approximate date it was filed:
f)
Approximate date of disposition:
7
Lawsuit #2 dismissed as frivolous, malicious, or failed to state a claim:
a)
Defendants:
b)
Name of court and case number:
c)
The case was dismissed because it was found to be (circle one): (1) frivolous;
(2) malicious; or (3) failed to state a claim upon which relief could be granted.
d)
Issues raised: ________________________________________________________
___________________________________________________________________
___________________________________________________________________
e)
Approximate date it was filed:
f)
Approximate date of disposition:
Lawsuit #3 dismissed as frivolous, malicious, or failed to state a claim:
a)
Defendants:
b)
Name of court and case number:
c)
The case was dismissed because it was found to be (circle one): (1) frivolous;
(2) malicious; or (3) failed to state a claim upon which relief could be granted.
d)
Issues raised: ________________________________________________________
___________________________________________________________________
___________________________________________________________________
e)
Approximate date it was filed:
f)
Approximate date of disposition:
8
D.
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)
9
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