Berg v. The State of New York et al

Filing 3

PARTIAL TRANSFER ORDER AND ORDER TO AMEND: Plaintiff is granted leave to file an amended complaint to detail his claims that arise from events at Green Haven. Plaintiff must submit the amended complaint to this Court's Pro Se Intake Unit within sixty days of the date of this order, caption the document as an "Amended Complaint," and label the document with docket number 21-CV-3293 (LTS). An Amended Civil Rights Complaint form is attached to this order. No summons will issue at this time. If Plaintiff fails to comply within the time allowed, and he cannot show good cause to excuse such failure, the complaint will be dismissed for failure state a claim upon which relief may be granted. The Clerk of Court is further directed to sever the claims arising in Great Meadow Correctional Facility, Coxsackie Correctional Facility, and in Clinton County, and transfer them, under 28 U.S.C. 1404(a), to the United States District Court for the Northern District of New York. The Clerk of Court is directed to mail a copy of this order to Plaintiff, and note service on the docket. The Court certifies under 28 U.S.C. 1915(a)(3) that any appeal from this order would not be taken in good faith, and therefore in forma pauperis status is denied for the purpose of an appeal. Cf. Coppedge v. United States, 369 U.S. 438, 444-45 (1962) (holding that an appellant demonstrates good faith when he seeks review of a nonfrivolous issue). SO ORDERED (Signed by Judge Laura Taylor Swain on 6/14/21) (rdz) Transmission to Docket Assistant Clerk for processing. [Transferred from New York Southern on 6/16/2021.]

UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF NEW YORK
MICHAEL ROBERT BERG,
Plaintiff,
-against-

21-CV-3293 (LTS)

THE STATE OF NEW YORK; GOVERNOR
CUOMO; SECRETARY OF STATE
ROSSANA ROSADO; NEW YORK STATE
ATTORNEY GENERAL LETITIA JAMES,

PARTIAL TRANSFER ORDER AND
ORDER TO AMEND

Defendants.
LAURA TAYLOR SWAIN, Chief United States District Judge:
Plaintiff, who is currently incarcerated in Green Haven Correctional Facility, paid the
relevant fees to bring this pro se action under 42 U.S.C. §1983, alleging that Defendants violated
his constitutional rights. For the reasons set forth below, the Court grants Plaintiff leave to file an
amended complaint within sixty days of the date of this order.
STANDARD OF REVIEW
The Court has the authority to dismiss a complaint, even when the plaintiff has paid the
filing fee, if it determines that the action is frivolous, Fitzgerald v. First E. Seventh Tenants
Corp., 221 F.3d 362, 363-64 (2d Cir. 2000) (per curiam) (citing Pillay v. INS, 45 F.3d 14, 16-17
(2d Cir. 1995) (per curiam) (holding that Court of Appeals has inherent authority to dismiss
frivolous appeal)), that it fails to state a claim, Wachtler v. County of Herkimer, 35 F.3d 77, 82
(2d Cir. 1994), or that the Court lacks subject matter jurisdiction, Ruhrgas AG v. Marathon Oil
Co., 526 U.S. 574, 583 (1999). The Court is obliged, however, to construe pro se pleadings
liberally, Harris v. Mills, 572 F.3d 66, 72 (2d Cir. 2009), and interpret them to raise the “strongest
[claims] that they suggest,” Triestman v. Fed. Bureau of Prisons, 470 F.3d 471, 474-75 (2d Cir.
2006) (internal quotation marks and citations omitted) (emphasis in original).

BACKGROUND
The complaint names as Defendants the State of New York, Governor Andrew Cuomo,
Secretary of State Rossana Rosado, and Attorney General Letitia James. The complaint is 117
pages long, quite disorganized, and consists largely of legal jargon. It sets forth the following
facts. In 2010, Plaintiff was charged with predatory sexual assault against a child. After months
of being in custody and suffering “mental, emotional and physical torment,” Plaintiff pleaded
guilty. According to Plaintiff, his “rights as an accused man” were violated, and he seeks the
restoration of the “rights and privileges of citizenship,” dismissal of the indictment, and other
unspecified relief. (ECF 1 at 4-5.) According to the New York State Department of Corrections
and Community Supervision (DOCCS) database, Plaintiff was convicted in Clinton County, and
he entered DOCCS custody in 2011.
Plaintiff was incarcerated at Great Meadow Correctional Facility from at least 2013
through 2017. During that time, Correction Officer (CO) Daniel Mulligan conspired with other
unnamed correction officers and prisoners to brutalize Plaintiff and other sex offenders. Although
DOCCS officials knew about Mulligan’s behavior, they not only failed to punish him, but
promoted him. Mulligan also kept Plaintiff in keeplock for no reason. (Id. at 54-55.) From
January 24, 2014, through January 30, 2014, correction officers conspired with another prisoner
to sexually assault plaintiff in the shower on two occasions. COs Mulligan and Ashline verbally
harassed plaintiff and told him that they were not going to do anything about the assaults against
him. CO Ashline also searched Plaintiff’s cell and destroyed his books because of animus
towards Plaintiff’s religion. In 2017, CO MacNally and a John Doe correction officer conspired
to physically assault Plaintiff. (Id. at 57.) When Plaintiff was transferred to Coxsackie
Correctional Facility in November 2017, he was forced to carry his property, which weighed 200
pounds, and his typewriter was damaged.
2

It is not clear when Plaintiff was transferred to Green Haven, but on March 26, 2019, CO
Stenvensen and other corrections officers and prisoners assaulted plaintiff because of his sexoffender status. Plaintiff sustained injuries, and he now suffers from tinnitus. (Id. at 58.) Plaintiff
has been regularly subjected to physical and verbal abuse and property loss at Green Haven, and
he has not pursued his “administrative remedies” because of “threats duress and coercion.” (Id. at
59.)
DISCUSSION
To state a claim under section 1983, Plaintiff must allege both that: (1) a right secured by
the Constitution or laws of the United States was violated, and (2) the right was violated by a
person acting under the color of state law, or a “state actor.” West v. Atkins, 487 U.S. 42, 48-49
(1988).
A plaintiff proceeding under section 1983 must also allege facts showing the individual
defendants’ direct and personal involvement in the alleged constitutional deprivation. See
Spavone v. N.Y. State Dep’ t of Corr. Serv., 719 F.3d 127, 135 (2d Cir. 2013) (“It is well settled in
this Circuit that personal involvement of defendants in the alleged constitutional deprivations is a
prerequisite to an award of damages under § 1983.”) (internal quotation marks and citation
omitted). A defendant may not be held liable under § 1983 solely because that defendant employs
or supervises a person who violated the plaintiff’s rights. See Iqbal, 556 U.S. at 676 (2009)
(“Government officials may not be held liable for the unconstitutional conduct of their
subordinates under a theory of respondeat superior.”). Rather, “[t]o hold a state official liable
under § 1983, a plaintiff must plead and prove the elements of the underlying constitutional
violation directly against the official.” Tangreti v. Bachmann, 983 F.3d 609, 620 (2d Cir. 2020).

3

A.

Claims arising at Green Haven Correctional Facility
Assaults
Plaintiff asserts that he has been subjected to physical and sexual assaults at Green Haven

Correctional Facility. In the body of the complaint, Plaintiff mentions corrections officers who
were involved in those events, but he does not name them as defendants, and he provides few
specific facts about what occurred and who was involved. The Court grants Plaintiff leave to
amend his complaint to detail his claims of assaults and excessive force arising at Green Haven
and to name defendants who were personally involved in those events.
Loss of Property
A claim for deprivation of property is not recognized by law in federal court if the state
courts provide a remedy for the deprivation of that property. See Hudson v. Palmer, 468 U.S.
517, 533 (1984); Marino v. Ameruso, 837 F.2d 45, 47 (2d Cir. 1988) (citations omitted). New
York provides such a remedy in § 9 of the New York Court of Claims Act. See Jenkins v.
McMickens, 618 F. Supp. 1472, 1474 (S.D.N.Y. 1985) (state tort action available to compensate
detainee for alleged loss of property by city prison officials); Cook v. City of New York, 607 F.
Supp. 702, 704 (S.D.N.Y. 1985) (detainee had meaningful post-deprivation remedy for loss of
book through state action for negligence, replevin or conversion); Boyle v. Kelley, 42 N.Y.2d 88,
90-91, 396 N.Y.S.2d 834, 835-36 (1977) (property wrongfully seized by officials during a search
recoverable by replevin action or Article 78 proceeding); Moreno v. New York, 69 N.Y.2d 432,
515 N.Y.S.2d 733 (1987) (alternative state remedies to recover seized property discussed).
Plaintiff has not alleged facts that would demonstrate that his state remedies are in any
way inadequate or inappropriate. See Butler v. Castro, 896 F.2d 698, 700-04 (2d Cir. 1990).

4

Because New York provides an adequate post-deprivation remedy, Plaintiff cannot state a claim
that he has been deprived of property without due process of law. Love v. Coughlin, 714 F.2d
207, 208-09 (2d Cir. 1983). This claim is therefore dismissed. See 28 U.S.C. § 1915(e)(2)(B)(ii).
B.

Claims against the named defendants
New York State
The Court must dismiss Plaintiff’s section 1983 claims against the State of New York.

“[A]s a general rule, state governments may not be sued in federal court unless they have waived
their Eleventh Amendment immunity, or unless Congress has abrogated the states’ Eleventh
Amendment immunity . . . .” Gollomp v. Spitzer, 568 F.3d 355, 366 (2d Cir. 2009). New York has
not waived its Eleventh Amendment immunity to suit in federal court, and Congress did not
abrogate the states’ immunity in enacting 42 U.S.C. § 1983. See Trotman v. Palisades Interstate
Park Comm’n, 557 F.2d 35, 40 (2d Cir. 1977).
Plaintiff’s section 1983 claims against the State of New York are therefore barred by the
Eleventh Amendment and are dismissed.
Cuomo, Rosado, and James
Plaintiff names Governor Cuomo, Secretary of State Rosado, and Attorney General
James as defendants, but he fails to explain how they were personally involved in the events
underlying Plaintiff’s claims arising at Green Haven. Plaintiff cannot assert viable claims against
individuals in supervisory positions simply because they are in positions of authority. In fact,
Plaintiff names these individuals in the caption of the complaint but asserts no specific facts
against any of them in the body of the complaint. See Iwachiw v. New York State Dep’t of Motor
Vehicles, 299 F. Supp.2d 117, 121 (E.D.N.Y. 2004) (quoting Dove v. Fordham Univ., 56 F. Supp.
2d 330, 335 (S.D.N.Y. 1999) (“[W]here the complaint names a defendant in the caption but
contains no allegations indicating exactly how the defendant violated the law or injured the
5

plaintiff, a motion to dismiss the complaint in regard to that defendant should be granted”), aff’d,
396 F.3d 525 (2d Cir. 2005).
Because Plaintiff fails to allege any facts suggesting that Cuomo, Rosado, or James were
personally involved in violating his constitutional rights during his custody at Green Haven, his
claims against those Defendants are dismissed.
C.

Severance of claims arising outside this District
Rules 18 and 20 of the Federal Rules of Civil Procedure govern joinder of claims and

parties, respectively. Rule 18 permits a plaintiff to join as many claims as he has against a
particular defendant. See Fed. R. Civ. P. 18(a). By contrast, under Rule 20, a plaintiff may not
pursue unrelated claims against multiple defendants. Deskovic v. City of Peekskill, 673 F. Supp.
2d 154, 167 (S.D.N.Y. 2009).
Rule 20(a)(2) permits a plaintiff to join multiple defendants in one action if: (A) any right
to relief is asserted against them jointly, severally, or in the alternative arising out of the same
transaction, occurrence, or series of transactions . . . ; and (B) any question of law or fact
common to all defendants will arise in the action. Although courts have interpreted Rule 20(a)
liberally to allow related claims to be tried within a single proceeding, Barr Rubber Products Co.
v. Sun Rubber Co., 425 F.2d 1114, 1126-27 (2d Cir. 1970), “the mere allegation that Plaintiff was
injured by all Defendants is not sufficient to join unrelated parties as defendants in the same
lawsuit pursuant to Rule 20(a),” Deskovic, 673 F. Supp. 2d at 167.
Rule 21 of the Federal Rules of Civil Procedure provides that “[o]n motion or on its own,
the court may at any time, on just terms, add or drop a party. The court may also sever any claim
against a party.” Fed. R. Civ. P. 21. In determining whether to sever a claim, the court considers
“the two requirements of Rule 20 and additional factors, including (1) whether severance will
serve judicial economy; (2) whether prejudice to the parties would be caused by severance; and
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(3) whether the claims involve different witnesses and evidence.” Kehr v. Yamaha Motor Corp.,
596 F. Supp. 2d 821, 826 (S.D.N.Y. 2008) (relying on Laureano v. Goord, No. 06-CV-7845
(SHS) (RLE), 2007 WL 2826649, at *8 (S.D.N.Y. Aug. 31, 2007)). Put another way, courts “look
to the logical relationship between the claims and determine ‘whether the essential facts of the
various claims are so logically connected that considerations of judicial economy and fairness
dictate that all the issues be resolved in one lawsuit.’” Kalie v. Bank of Am. Corp., No. 12-CV9192 (PAE), 2013 WL 4044951, at *3 (S.D.N.Y. Aug. 9, 2013) (quoting United States v.
Aquavella, 615 F.2d 12, 22 (2d Cir. 1979)).
Plaintiff sets forth claims arising from events that occurred in Great Meadow, Coxsackie
Facility, and in connection with his Clinton county criminal proceedings. Joinder of those claims
with those arising at Green Haven does not comport with Rule 20(a). Plaintiff asserts claims
against Mulligan, Ashline, and other unnamed correction officers at Great Meadow regarding
events occurring from 2013 through 2017, and he asserts claims against MacNally and other
unnamed officers at Coxsackie about at least one assault in 2017. In addition, Plaintiff asserts
violations of his constitutional rights arising out of his Clinton County conviction. These claims
are not logically connected to his claims that he has been subjected to sexual and physical
assaults at Green Haven since 2019. See, e.g., Smith v. Goord, No. 04-CV-6432, 2006 WL
2850597, at *3 (W.D.N.Y. Sep. 22, 2006) (disallowing joinder of claims against defendants at
different correctional facilities where there was no suggestion that original defendants were
involved in the actions taken against plaintiff in a different facility more than one year later);
Webb v. Maldanado, No. 13-CV-144 (RNC), 2013 WL 3243135, at *3 (D. Conn. June 26, 2013)
(“Unrelated claims against different defendants belong in different suits . . . to prevent the sort of

7

morass” created by a complaint with more than twenty defendants and countless unrelated
claims.”) (quotation and citation omitted).
For these reasons, the Court concludes that it is appropriate to sever Plaintiff’s claims
arising in Great Meadow and Coxsackie and in Clinton County from his Green Haven claims.
The Court therefore severs those claims.
D.

Transfer of Claims Arising outside this District
When a court orders the severance of claims, it creates two or more separate “actions,”

and the court may transfer one separate action while retaining jurisdiction of another. Wyndham
Assoc. v. Bintliff, 398 F.2d 614, 618 (2d Cir. 1968).
Under 28 U.S.C. § 1391(b), a civil action may be brought in
a judicial district in which any defendant resides, if all defendants are residents of
the State in which the district is located; a judicial district in which a substantial
part of the events or omissions giving rise to the claim occurred, or a substantial
part of property that is the subject of the action is situated; or if there is no district
in which an action may otherwise be brought as provided in this section, any
judicial district in which any defendant is subject to the court’s personal
jurisdiction with respect to such action.
28 U.S.C. § 1391(b)
Under § 1391(c), a “natural person” resides in the district where the person is domiciled,
and an “entity with the capacity to sue and be sued” resides in any judicial district where it is
subject to personal jurisdiction with respect to the civil action in question. See 28 U.S.C.
§ 1391(c)(1), (2).
The events giving rise to Plaintiff’s claims arising in Great Meadow and Coxsackie
occurred in Washington County and Greene County, respectively, both of which fall within the
Northern District of New York. Clinton County is also located in the Northern District. See 28
U.S.C. § 112(a). Plaintiff does not allege that any defendant named in connection with the events

8

that are alleged to have transpired at those facilities resides in this District. Venue for those
claims therefore does not appear to be proper in this District under § 1391(b)(1) or (2).
Even if venue were proper here, however, the Court may transfer claims “[f]or the
convenience of the parties and witnesses, in the interest of justice.” 28 U.S.C. § 1404(a).
“District courts have broad discretion in making determinations of convenience under Section
1404(a) and notions of convenience and fairness are considered on a case-by-case basis.” D.H.
Blair & Co. v. Gottdiener, 462 F.3d 95, 106 (2d Cir. 2006). Moreover, courts may transfer cases
on their own initiative. See Bank of Am., N.A. v. Wilmington Trust FSB, 943 F. Supp. 2d 417,
426-427 (S.D.N.Y. 2013) (“Courts have an independent institutional concern to see to it that the
burdens of litigation that is unrelated to the forum that a party chooses are not imposed
unreasonably on jurors and judges who have enough to do in determining cases that are
appropriately before them. The power of district courts to transfer cases under Section 1404(a)
sua sponte therefore is well established.” (quoting Cento v. Pearl Arts & Craft Supply Inc., No.
03-CV-2424, 2003 WL 1960595, at *1 (S.D.N.Y. Apr. 24, 2003))); see also Lead Indus. Ass’n.
Inc. v. OSHA., 610 F.2d 70, 79 (2d Cir. 1979) (noting that “broad language of 28 U.S.C.
§ 1404(a) would seem to permit a court to order transfer sua sponte”).
In determining whether transfer under section 1404(a) is appropriate, courts consider the
following factors: (1) the convenience of witnesses; (2) the convenience of the parties; (3) the
locus of operative facts; (4) the availability of process to compel the attendance of the unwilling
witnesses; (5) the location of relevant documents and the relative ease of access to sources of
proof; (6) the relative means of the parties; (7) the forum’s familiarity with the governing law;
(8) the weight accorded to the plaintiff’s choice of forum; (9) trial efficiency; and (10) the
interest of justice, based on the totality of circumstances. Keitt v. N.Y. City, 882 F. Supp. 2d 412,

9

459-60 (S.D.N.Y. 2011); see also N.Y. Marine and Gen. Ins. Co. v. LaFarge No. Am., Inc., 599
F.3d 102, 112 (2d Cir. 2010) (setting forth similar factors). A plaintiff’s choice of forum is
accorded less deference where the plaintiff does not reside in the chosen forum and the operative
events did not occur there. See Iragorri v. United Tech. Corp., 274 F.3d 65, 72 (2d Cir. 2001).
Under section 1404(a), transfer of the severed claims appears to be appropriate in this
case. The events underlying the severed claims occurred in the counties of Washington, Greene,
and Clinton, which fall within the Northern District of New York. See 28 U.S.C. § 112(a). Venue
for the severed claims is therefore proper in the Northern District of New York. See 28 U.S.C.
§ 1391(b). Based on the totality of the circumstances, the Court concludes that it is in the interest
of justice to transfer the severed claims to the United States District Court for the Northern
District of New York. 28 U.S.C. § 1404(a). Plaintiff’s claims arising at Green Haven will remain
in this Court.
LEAVE TO AMEND
Plaintiff proceeds in this matter without the benefit of an attorney. District courts
generally should grant a self-represented plaintiff an opportunity to amend a complaint to cure its
defects, unless amendment would be futile. See Hill v. Curcione, 657 F.3d 116, 123-24 (2d Cir.
2011); Salahuddin v. Cuomo, 861 F.2d 40, 42 (2d Cir. 1988). Indeed, the Second Circuit has
cautioned that district courts “should not dismiss [a pro se complaint] without granting leave to
amend at least once when a liberal reading of the complaint gives any indication that a valid
claim might be stated.” Cuoco v. Moritsugu, 222 F.3d 99, 112 (2d Cir. 2000) (quoting Gomez v.
USAA Fed. Sav. Bank, 171 F.3d 794, 795 (2d Cir. 1999)). Because Plaintiff may be able to allege
additional facts to state a valid claim, the Court grants Plaintiff 60 days’ leave to amend his
complaint to detail his claims that arise from events that occurred at Green Haven.

10

Plaintiff is granted leave to amend his complaint to provide more facts about his claims
arising at Green Haven. First, Plaintiff must name as the defendants in the caption 1 and in the
statement of claim those individuals who were allegedly involved in the deprivation of his
federal rights at that facility. If Plaintiff does not know the name of a defendant, he may refer to
that individual as “John Doe” or “Jane Doe” in both the caption and the body of the amended
complaint. 2 The naming of John Doe defendants, however, does not toll the three-year statute of
limitations period governing this action and Plaintiff shall be responsible for ascertaining the true
identity of any “John Doe” defendants and amending his complaint to include the identity of any
“John Doe” defendants before the statute of limitations period expires. Should Plaintiff seek to
add a new claim or party after the statute of limitations period has expired, he must meet the
requirements of Rule 15(c) of the Federal Rules of Civil Procedure.
In the “Statement of Claim” section of the amended complaint form, Plaintiff must
provide a short and plain statement of the relevant facts supporting each claim against each
defendant. If Plaintiff has an address for any named defendant, Plaintiff must provide it. Plaintiff
should include all of the information in the amended complaint that Plaintiff wants the Court to
consider in deciding whether the amended complaint states a claim for relief. That information
should include:
a) the names and titles of all relevant people;

1

The caption is located on the front page of the complaint. Each individual defendant
must be named in the caption. Plaintiff may attach additional pages if there is not enough space
to list all of the defendants in the caption. If Plaintiff needs to attach an additional page to list all
defendants, he should write “see attached list” on the first page of the Amended Complaint. Any
defendants named in the caption must also be discussed in Plaintiff’s statement of claim.
2

For example, a defendant may be identified as: “Correction Officer John Doe #1 on
duty August 31, 2010, at Sullivan Correctional Facility, during the 7-3 p.m. shift.”
11

b) a description of all relevant events, including what each defendant did or failed to do,
the approximate date and time of each event, and the general location where each
event occurred;
c) a description of the injuries Plaintiff suffered; and
d) the relief Plaintiff seeks, such as money damages, injunctive relief, or declaratory
relief.
Essentially, Plaintiff’s amended complaint should tell the Court: who violated his
federally protected rights and how; when and where such violations occurred; and why Plaintiff
is entitled to relief.
Because Plaintiff’s amended complaint will completely replace, not supplement, the
original complaint, any facts or claims that Plaintiff wants to include from the original complaint
must be repeated in the amended complaint.
CONCLUSION
Plaintiff is granted leave to file an amended complaint to detail his claims that arise from
events at Green Haven. Plaintiff must submit the amended complaint to this Court’s Pro Se
Intake Unit within sixty days of the date of this order, caption the document as an “Amended
Complaint,” and label the document with docket number 21-CV-3293 (LTS). An Amended Civil
Rights Complaint form is attached to this order. No summons will issue at this time. If Plaintiff
fails to comply within the time allowed, and he cannot show good cause to excuse such failure,
the complaint will be dismissed for failure to state a claim upon which relief may be granted.
The Clerk of Court is further directed to sever the claims arising in Great Meadow
Correctional Facility, Coxsackie Correctional Facility, and in Clinton County, and transfer them,
under 28 U.S.C. § 1404(a), to the United States District Court for the Northern District of New
York.

12

The Clerk of Court is directed to mail a copy of this order to Plaintiff, and note service on
the docket.
The Court certifies under 28 U.S.C. § 1915(a)(3) that any appeal from this order would
not be taken in good faith, and therefore in forma pauperis status is denied for the purpose of an
appeal. Cf. Coppedge v. United States, 369 U.S. 438, 444-45 (1962) (holding that an appellant
demonstrates good faith when he seeks review of a nonfrivolous issue).
SO ORDERED.
Dated:

July 14, 2021
New York, New York

/s/ Laura Taylor Swain
LAURA TAYLOR SWAIN
Chief United States District Judge

13

U NITED S TATES D ISTRICT C OURT
S OUTHERN D ISTRICT OF N EW Y ORK

_____CV_______________
(Include case number if one has been
assigned)

Write the full name of each plaintiff.

AMENDED

-against-

COMPLAINT
(Prisoner)
Do you want a jury trial?
☐ Yes
☐ No

Write the full name of each defendant. If you cannot fit the
names of all of the defendants in the space provided, please
write “see attached” in the space above and attach an
additional sheet of paper with the full list of names. The
names listed above must be identical to those contained in
Section IV.

NOTICE
The public can access electronic court files. For privacy and security reasons, papers filed
with the court should therefore 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.
See Federal Rule of Civil Procedure 5.2.

Rev. 5/20/16

I.

LEGAL BASIS FOR CLAIM

State below the federal legal basis for your claim, if known. This form is designed primarily for
prisoners challenging the constitutionality of their conditions of confinement; those claims are
often brought under 42 U.S.C. § 1983 (against state, county, or municipal defendants) or in a
“Bivens” action (against federal defendants).

☐ Violation of my federal constitutional rights
☐ Other:
II.

PLAINTIFF INFORMATION

Each plaintiff must provide the following information. Attach additional pages if necessary.

First Name

Middle Initial

Last Name

State any other names (or different forms of your name) you have ever used, including any name
you have used in previously filing a lawsuit.
Prisoner ID # (if you have previously been in another agency’s custody, please specify each agency
and the ID number (such as your DIN or NYSID) under which you were held)
Current Place of Detention
Institutional Address

County, City

III.

State

Zip Code

PRISONER STATUS

Indicate below whether you are a prisoner or other confined person:

☐
☐
☐
☐
☐

Pretrial detainee
Civilly committed detainee
Immigration detainee
Convicted and sentenced prisoner
Other:

Page 2

IV.

DEFENDANT INFORMATION

To the best of your ability, provide the following information for each defendant. If the correct
information is not provided, it could delay or prevent service of the complaint on the defendant.
Make sure that the defendants listed below are identical to those listed in the caption. Attach
additional pages as necessary.
Defendant 1:

First Name

Last Name

Shield #

Current Job Title (or other identifying information)
Current Work Address
County, City

State

Zip Code

Defendant 2:

First Name

Last Name

Shield #

Current Job Title (or other identifying information)
Current Work Address
County, City

State

Zip Code

Defendant 3:

First Name

Last Name

Shield #

Current Job Title (or other identifying information)
Current Work Address
County, City

State

Zip Code

Defendant 4:

First Name

Last Name

Shield #

Current Job Title (or other identifying information)
Current Work Address
County, City

State

Zip Code
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V.

STATEMENT OF CLAIM

Place(s) of occurrence:

Date(s) of occurrence:
FACTS:

State here briefly the FACTS that support your case. Describe what happened, how you were
harmed, and how each defendant was personally involved in the alleged wrongful actions. Attach
additional pages as necessary.

Page 4

INJURIES:

If you were injured as a result of these actions, describe your injuries and what medical treatment,
if any, you required and received.

VI.

RELIEF

State briefly what money damages or other relief you want the court to order.

Page 5

VII.

PLAINTIFF’S CERTIFICATION AND WARNINGS

By signing below, I certify to the best of my knowledge, information, and belief that: (1) the
complaint is not being presented for an improper purpose (such as to harass, cause unnecessary
delay, or needlessly increase the cost of litigation); (2) the claims are supported by existing law
or by a nonfrivolous argument to change 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 Federal Rule of Civil Procedure 11.
I understand that if I file three or more cases while I am a prisoner that are dismissed as
frivolous, malicious, or for failure to state a claim, I may be denied in forma pauperis status in
future cases.
I also understand that prisoners must exhaust administrative procedures before filing an action
in federal court about prison conditions, 42 U.S.C. § 1997e(a), and that my case may be
dismissed if I have not exhausted administrative remedies as required.
I agree to provide the Clerk's Office with any changes to my address. 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.

Each Plaintiff must sign and date the complaint. Attach additional pages if necessary. If seeking to
proceed without prepayment of fees, each plaintiff must also submit an IFP application.

Dated
First Name

Plaintiff’s Signature
Middle Initial

Last Name

Prison Address
County, City

State

Zip Code

Date on which I am delivering this complaint to prison authorities for mailing:

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