Molina v. Westchester County Dept. of Correction et al
OPINION AND ORDER: Defendants' motion to dismiss GRANTED. Plaintiff is granted leave to amend only as to his Section 1983 failure to protect claim against the individual defendants Saraireh and Santora. Plaintiff shall file his amended compl aint by no later than June 1, 2017. Plaintiff is directed to utilize the Amended Complaint form attached hereto. If plaintiff fails to comply with this order, his complaint may be dismissed for failure to prosecute or failure to comply with a cou rt order. Fed. R. Civ. P. 4 1(b). The Court certifies pursuant to 28 U.S.C. § l915(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. See Co ppedge v. United States, 369 U.S. 438, 44445 (1962). The Clerk is instructed to terminate the County of Westchester as a defendant. The Clerk is further instructed to terminate the motion. (Doc. #17). (Signed by Judge Vincent L. Briccetti on 4/28/2017) (Copies Mailed to Plaintiff on 4/28/2017 By Chambers of Vincent L. Briccetti) (lnl)
ELECTRONICALLY Fit t I)
N1 FED S F \TES DIS FRICT COF RT
SOUTHERN DISTRIC I OF NEW YORK
AR FIR R R. MOLINA,
OPINION AND ORDER
I lIE (Of NIY OF \kESTCHI SFER;
(ORRLC FION OFFICER SARAIRET 1.
ST TILED NO. 1580: and CO. SANTORA,
SHIELD NO. 1598.
Plaintiff Arthur R. Molina, proceeding pse and in forma pauperis, brings this action
under 42 U.S.C.
§ 1983, alleging defendants violated his constitutional rights while he was
incarcerated at Westchester County Jail, by failing to protect him from assault by another inmate.
Now pending is defendants’ motion to dismiss the complaint pursuant to Rule I
For the reasons set forth below, the motion is GRANTED. I lowever, plaintiff is granted
leave to file an amended complaint, with the limitations explained belov.
This Court has subject matterjurisdiction pursuant to 28 U.S.C.
§ 133 1.
For purposes of ruling on a motion to dismiss, the Court accepts all factual allegations of
thL complaint as true, and dras&s all reasonable inferences in plaintiff s faor
I)efendants filed their motion to dismiss on Septembei 22, 2016. Plaintiff filed his
opposition, after the Court sua
evtended his time to do so (Doc. #24). on No ember 1 4.
2016. (I)oc. #25). Defendants never submitted a reply or a request for an extension of time. and
their deadline to do so has long passed. The Court therefore deems the motion to be fulls
On March 8.2016. while plaintiff was an inmate at Westchester County Jail. he was
attacked by another inmate. “Mr. Tucker,” who had recently been mo ed 1i’om the Special
Housing [nit (“SH[”) to the cell next to plaintiffs. Specifically, plaintiff alleges \hile he was
“walkin the yard.’’ Tucker “ran up from behind
and attacked jhim.] hitting I himi. with
closedfj fists.” and that fuckers “intention jwas] to cause plaintiff serious bodily harm.”
(Compl. at 8). Plaintil’f alleges Tucker carried out this assault because, five minutes earlier,
another inmate told Tucker that if he attacked someone, he would be moved to another cell
Plaintiff alleges correction officers Saraireh and Santora were “not walking the rec/yard
and sitting in the doorway that enters the rec/yard therefor[e] could not see or hear what was
going on in the rec/yard.” (Compl. at 11). In addition, he alleges Saraireh and Santora “knew of
the risk to [plaintiff js safety and [werej negligent for not trvin[gj to prevent the assault before it
happen[edj.” (Compi. at 9). lIe alleges they “had reasonable knowledge to know that an
incident was tak[ingj place.” but “waited to the last minute to defuse the incident.”
Plaintiff suffered several injuries and was taken to the emergency
received medical care. When he returned to Westchester County Jail, he was told he “would not
face any disciplinary action,” and that the inmate who attacked him would be put back in SHU.
(Compl. at 9). I-fe was also told that “the facility [was going to} press[J charges.” (Id. at 10).
Citations to the complaint
the top of the aee.
to the page numbers stamped by the ECF tiling system at
Standard of Review
In deciding a Rule 12(b)(6) motion, the Court ea1uates the sufficiency of the operati\e
complaint under the “two-pronged approach” articulated by the Supreme Court in Ashcroft
yjql. 556 LS. 662, 679 (2009). First, plaintiffs legal conclusions and “[t)hreadbare recitals
of the elements of a cause of action. supported by mere conclusorv statements,” are not entitled
to the assumption of truth and are thus not sufficient to withstand a motion to dismiss, Id. at 678:
Hayden. Paterson, 594 F.3d 150. 161 (2d Cir. 2010). Second, “[wjhen there are well-pleaded
factual allegations, a court should assume their veracity and then determine whether they
plausibly give rise to an entitlement to relief.” Ashcroft v. Igbal, 556 U.S. at 679.
To survive a Rule I 2(b)(6) motion, the allegations in the complaint must meet a standard
of “plausibility.” Id. at 678; Bell At!. Corp. v. Twombly, 550 U.S. 544, 564 (2007). A claim is
facially plausible “when the plaintiff pleads factual content that allows the court to draw the
reasonable inference that the defendant is liable for the misconduct alleged.” Ashcroft v. lqbal,
556 U.S. at 678. ‘The plausibility standard is not akin to a ‘probability requirement,’ but it asks
for more than a sheer possibility that a defendant has acted unlawfully.” j.
The Court must liberally construe submissions oCpy litigants, and interpret them “to
raise the strongest arguments that they suggest.” Triestman v. Fed. Bureau of Prisons. 470 F.3d
471, 474 (2d Cir. 2006) (per curiam) (internal quotation marks and citation omitted). Apply ing
the pleading rules permissieIy is particularly appropriate when. as here, a p yç plaintiff alleges
civil rights violations g Sealed PlaintiffScaled_Defenp,. 537 F.3d I 85. 191 (2d Cir.
2008). “Even in a
se case, hoveer.
threadbare recitals of the elements of a cause of
action, supported by mere conclusory statements, do not suffice.”
ius, 618 F.3d
162, 170 (2d Cir, 2010) (internal quotation marks and citation omitted). Nor may the Court
“inent factual allegations” plaintiff has not pleaded. j4.
Failure to Protect Claim
Defendants argue plaintiff has failed to state a constitutional violation for failure to
protect him against assault by another inmate.
The Court agrees.
A claim for deliberate indifference brought by a convicted prisoner “is analyzed under
the Eighth Amendment,” Caiozzo v. Koreman, 581 F.3d 63, 69 (2d Cir. 2009) (overruled on
other grounds b Darnell
Pineiro, 849 F.3d 17 (2d Cir. 2017)). whereas “[a] pretrial detainee’s
are governed by the Due Process Clause of the Fourteenth Amendment.” Darnell v.
Pineiro, 849 F.3d at 29.
To to state a claim for deliberate indifference, whether under the Eighth or Fourteenth
Amendment, plaintiff’s allegations must satisfy a two-prong test. First, the plaintiff must
plausibly allege he suffered a sufficiently serious constitutional deprivation. Second, the plaintiff
must plausibly allege that the defendant acted with deliberate indifference. ]yiyoid,
548 Fed. Appx. 696. 698 (2d Cir. 2013) (summary order) (convicted prisoner); Darnell v.
Pineiro. 849 F.3d at 29 (pretrial detainee).
With respect to the first prong. the standard is the same whether the claim is brought by a
con’icted prisoner or a pretrial detainee. “Under both the Eighth and Fourteenth Amendments,
to establish an objecti e deprivation. ‘the inmate must show that the conditions, either alone or in
combination, pose an unreasonable risk of serious damage to his health.”’ Darnell v. Pineiro.
Plaintiff will be proided with copies of all unpublished opinions cited in this decision.
See Lebron Sanders. 557 F.3d 76.79 (2d Cir. 2009).
849 F.3d at 30 (quoting Walker v. Schult, 717 F.3d 119, 125 (2d Cir, 2013)). “There is no static
test’ to determine whether a deprivation is sufficiently serious; instead, ‘the conditions
themselves must be evaluated in light of contemporary standards of decency.”
Coughlin. 66 F.3d 531. 537 (2d Cir. 1995)).
\\ ith respect to the second prong. however, the legal standards are different fhr convicted
prisoners and pretrial detainees. e Darnell
Pineiro. 849 F.3d at 32—36.
For convicted prisoners, to whom the Eighth Amendment applies, a corrections officer
acts with deliberate indifference when he subiectively “has knowledge that an inmate faces a
substantial risk of serious harm and he disregards that risk by failing to take reasonable measures
to abate the harm.” Hayes v. N.Y.C. Dep’t of Corr.. 84 F.3d 614, 620 (2d Cir. 1996). The
officer “must both be aware of Facts from which the inference could be drawn that a substantial
risk of serious harm exists. and he must also draw the inference.” Cuoco v. Moritsugu. 222 F.3d
99, lO7çdCir. 2000).
However, for pretrial detainees, to whom the Fourteenth Amendment applies, the second
prong “of a deliberate indifference claim is defined objectively.” Darnell v. Pineiro. 849 F.3d at
35 (emphasis added), A “pretrial detainee must prove that the defendant-official acted
... or recklessly failed to act with reasonable care to mitigate the risk ... even
though the defendant-official knew. or should have known.” of the risk of harm. Id. Thus.
unlike the Eiehth Amendment, the Due Process Clause of the Fourteenth Amendment “can be
violated when an ofrci.ai does not have subjective awareness that th.e official’s acts. (or
om.i.ss ions) have subjected the pretrial detainee to a substantial risk of harm.”
1-lere, defendants presume, without explaining, that plaintiff was a convicted prisoner, not
a pretrial detainee, during the relevant period. Because neither party has dearly articulated
whether plaintiff was a cons icted prisoner or a pretrial detainee at the time of the alleged
incident, the Court will ealuate plaintiff’s complaint under both standards.
Appl ing the applicable standards, the Court concludes plaintiff’s allegations are
ufflcient with recpect to the first prong of the deliberate inJitirence claim. hut are insumcient
as to the second prong.
Sufficientl\ Serious Constitutional Depri ation
Plaintiff alleges defendants Saraireh and Santora did not “walk” the area where he was
attacked, and instead sat “in the doorway” and that they “therefor[e] could not see or hear what
was going on in the rec/yard.” (Compl. at Ii). In addition, in his opposition papers. plaintiff
states there was an “absence of any correctional officers
present or within any plain ‘,isible
jew at any time in the recreational ard[.] thus violating the procedures.”
The failure of a correction officer to oversee prisoners. intervene in an attack, or
otherwise fail to abide by prison safety protocols may under certain circumstances create a
condition which poses a substantial risk of serious harm thus constituting a sufficiently serious
constitutional violation. See. çg., Fernandez
N.Y.C. Dep’t oCCorr., 2010 WL 1222017, at *4
(S.D.N.Y. Mar. 29. 2010) (finding complaint sufficiently alleged substantial risk of harm where
it was “possible that had [a corrections officer] been in the dorm area at the time of [plaintiffs]
attack. he could hae presented or interrupted the attack”): Rennalls v. Alfredo. 2015 WL
5’30332. at *4 (S.D \.Y. Sept. 30. 20l 5 (the Court was “w fling to assume. gi en the early
stage in th[e Action, Plaintiti ba[d] plausibl alleged that [detendant’s] actions mas hase put
Plaintiff at a substantial risk of serious harm,” where plaintiff alleged one of the defendants
failed to comply with a safety protocol).
Therefore, construing plaintiffs allegations liberally and drawing all reasonable
inferences in his favor, the Court concludes plaintiff has plausibly alleged facts from which a
sufficiently serious constitutional violation could he inferred.
As mentioned pre iously. the second prong of a deliberate indifference claim differs
depending on whether plaintiff’ is a convicted prisoner or a pretrial detainee. To sur i\ e a motion
to dismiss. a convicted prisoner must plausibl allege the defendant(s) subjectively knew what
they had done—here, their failure to intervene in the inmate-on-inmate attack—was
unreasonable. A pretrial detainee, on the other hand, must plausibly allege the conduct
complained of was objectively unreasonable.
not reasonable under the circumstances.
Here. plaintiff alleges defendants Saraireh and Santora “knew of the risk to [hisi safety
and [werej negligent for not tryin[g] to prevent the assault before it happen[edj.” (Compl. at 9).
He further alleges the corrections officers “had reasonable knowledge to know that an incident
was tak[ingj place,” but ‘waited to the last minute to defuse the incident,” (j4.). However,
plaintiff does not allege or explain how Saraireh or Santora learned of this risk or how plaintiff
knows they became aware of’ this risk. These allegations are insufficient to show either objective
or subjective deliberate indifference for several reasons.
First, such cone lusorv allegations of defendants’ knowledge are insufficient. See
Houston v. \assau Ctv.. 2012 \VL 729352. at *6 (E.D.N.Y. Mar, 7.2012) (“Although plaintiff
alIe.ges that the County was ‘[ajware of plaintiff being at risk of being attacked,’
conclusory allegation is insufficient to maintai.n a Section 1983 deliberate i.ndifference claim.”).
Second. plaintiff alleges defendants were merely “negligent” in their actions. (Compl. at
\egligene is insutflciLnt to state a SLction 1 9 tol ttion undei either the subjectl\ e or
ohective standard, Haves v. N.Y.C. Dep’t of Corr.. 84 F.3d at 620 (“to state a cognizable
1983 claim, the prisoner must allege actions or omissions sufficient to demonstrate
deliberate indifference: mere neclicence will not sulfice”).
I’inall\, and most sinificantlv. the aliecations of the complaint suggest the attack
happened quickly and with very little warning Specifically, plaintiff alleges “at 9:50 AM” the
inmate who attacked him was advised “to attack someone in the yard so he [v ouldj he moved”
to another housing block, (Compl. at 8). Plaintiff alleges the attack then took place five minutes
later, at 9:55 a.m.
(S,,ç,g j. at 2). Plaintiff does not allege any defendant corrections officer heard
this advice or was otherwise aware or should have been aware of this advice. It is implausible
defendants themselves, or reasonable corrections officers in their place, would have learned of
the likelihood ofan attack and been able to do something to prevent it within such a shoil period
of’time. Moreover, plaintiff does not allege he expressed fear for his safety prior to the attack or
provide any other reason why any correction officer should have known there was danger of an
attack. “Absent clear notice of a risk of harm to the prisoner, courts routinely deny’ deliberate
indifference claims based upon surprise attacks.” Fernandez v. N.Y.C. Dep’t of Corr., 2010 WL
1222017, at *4 (internal quotation marks omitted). In addition, plaintiff does not say how long
the alleged attack lasted. He states only that he “t[ook] multiple blows to the head and face
causing a concussion,” and that he “awoke to find the attacker being held on the wall by C.O.
Santora.” (Compi at 9). There are therefore insufficient allegations to suggest dctndants
Saraire.h and Santora waited an unreasonable amount of’ time before the intervened,
As part of his opposition papers. plaintiff also submitted the affidavit of Kevin ,‘\lv arez. a
fello inmate at Westchester County Jail. (Doc. #26). Mr. Alvarez writes in his affidavit that he
itnessed the events and that “[i]t was not until much later that the prison inmate attacker was
attended to.” (Id. “1 6-9). Hoever. “much later” is vague, and
subdued and jplaintiff] v as
h r idd tiora hu Ii ,Ci1tL\ ti o i’ ins JlliLiLn tt stiL,s dctcnjants aLtc,d uni,ason
Under the circumstances alleged, it is not plausible either that defendants subjectively
knew. or that a reasonable corrections officer in their place should have knox’. n. of any
substantial risk to plaintiff, or would have been able to take actions that would have prevented
As a result. plaintill has failed plausibl\ to allege the second prong of the failure to
protect standard under either the Eighth or the Fourteenth Amendment. Accordingly, plaintiff’s
Section 1983 failure to protect claim against defindants Saraireh and Santora is dismissed.
Defendants argue plaintiff has failed to state a claim against Westchester County (“the
County”) under Monell v. Department of Social Services. 436 U.S. 658 (1 978).
The Court agrees.
A municipality like the County is liable under Section 1983 only “when execution of a
government’s policy or custom. whether made by its lawmakers or by those whose edicts or acts
may fairly be said to represent official policy, inflicts the plaintiffsJ injury.” N4onell v. Dep’t of
Soc. Servs., 436 U.S. at 694. To state a Monell claim, a plaintiff need not allege the policy or
custom itself is unconstitutional; rather, liability exists when a municipal policy is valid but the
municipality’s actual practice is not. Amnesty America v. Town of W. Haflford, 361 F.3d 113,
125—26 (2d Cir. 2004) (practice of using excessive force can be basis for municipal liability even
though city’s policy on use of force is itself constitutional),
Defendants also areuc tile \k esichester County Department of Corrections “DOCs”
should he dismissed “because it is not a suable entity.” (Defs.’s Br. at 1. n. I). By Order dated
.iunc 7. 2016, the Court disrnisscd all claims against DOCs for that reason. (Doe. 7). In
addition. defendants argue they are entitled to qualified immunity. (Defs.’s Br. at 9). Fhe Court
need not address qualified immunity at this time. as it dismisses all of plaintiffs’ federal claims
“While 4onell claims are not subject to a ‘heightened’ pleading standard beyond that
defined in Rule 8(a)(2), such claims nevertheless must meet the plausibility requirements ofll
Atlantic CoijpJyomblv. 550 U.S. 544, 572 (2007), and hcrtf1v.Ibal, 556 US. 662, 678.
United States. 2013 \VL 5018553. at *4 (S.D.N.Y. September 13. 2013)
(quotina Leatherman v. Tarrant Cty. Narcotics Intellicence and Coordination Unit, 507 US. 163.
168 19930. In other \\ords. boilerplate allegations will not suffice.” Id. (internal quotation
marks omitted). In sum, without more, “[t]he allegations [a defendant] acted pursuant to a
‘policy,’ without any facts suggesting the policy’s existence, are plainly insufficient,” Missel v.
Cty. of Monroe, 351 F. App’x 543, 54546 (2d Cir. 2009) (summary order) (citing Dwares v.
City of New York. 985 F.2d 94. 100..02 (2d Cir. 1993)).
Here, plaintiff alleges only that the individual defendants’ failure to “walk[j the rec-ard’
and “wait to the last minute to defuse the incident” were “part of a policy[.1 practice. and
custom.” (Compi. at 9).
Applying the legal standards just outlined, plaintiffs boilerplate allegations against the
County are plainly insufficient. Accordingly, plaintiffs claims against the County are dismissed.
State Law Claims
Defendants argue any state law tort claims liberally construed from plaintifis
complaint-—such as causes of action for negligence or negligent infliction of emotional
distress--—--should he dismissed for failure to f1e a notice of claim.
The Court agrees.
a federal court, state noticeofclaim statutes apply to state1aw clai.ms.” Ljar’v.
7 164 F.3d 789, 793 (2d Cir. 1999). “In New York, filing a
condition pieccdent to commencing a tort claim
against an’. employee of that municipality” Chamberlain
Cit’. of White Plains. 986 F. Supp.
2d 363. 396 (S.D.N.Y. 2013). “Failure to comply with [this] requirement ordinarth requires a
dismissal for failure to state a cause of action.”
In addition. “General Municipal I ax’.
50—-c makes unauthorized an action against
mdix iduals ‘.x ho ha’.e not been named in a notice of claim.” DC
\VL 3480389. at
\/alIe Cent. Sch. Dist.. 2011
V. June 29, 2011) (internal quotation marks omitted).
Here, plaintiff acknov. ledges he did not file a notice of claim. (See
Opp. Br. ¶
10). In an
effort to oxercome this deficienc, plaintiff requests permission to file a late notice of claim.
This Court does not ha’. e the authority to grant plaintiffs request, however. Ne’.’. York General
Municipal Lax’. Section 50—e(7) “makes clear that [gj[ applications under this section shall be
made to the supreme court or to the county court.” Horvath x. Daniel. 423 F. Supp. 2d 421. 424—
25 (S.D.N.Y. 2006) (internal quotations omitted). “Accordingly. federal district courts are
without jurisdiction to hear these applications.” j4.
Plaintiffs state law claims are therefore dismissed.
Leaxe to Amend
Rule I 5(a)(2) instructs that courts “should freely gix e lea’. e” to amend a complaint “xxhen
justice so requires.” Liberal application of Rule 15(a) is xxarranted xxith respect to p se
litigants v ho “should b affurdcd cx er reasonable opportunin. to demonstrate that [they ha eJ a
iCeD. 228 F,3d 68.81 t2d Cir, 2000) (oLoting Satchel’. Dilworth, 745
F.2d 781. 85 (2d Cir. (98411, District courts “should not dismiss [pse complaints] without
granting leaxe to amend at least once xx hen a liberal reading of the complaint gixes an\
indication that a valid claim might be stated.”
cov.\1ritsgu, 222 F.3d 99. 112 (2d Cir.
200(fl (quotme Gomez v. LSAA Fed. Say, Bank. 1 71 F.3d 7)4. 795 (2d Cir. 1 999)).
Hoever. leave tu amend may “properl be denied har
futilii of amendment”
Ruotokv. City of New York. 514 F3d 184. 191 (2d Cir. 2008) (quotine Foman. Davis. 371
[.S. I 7$ 182 l962. This is true even when plaintiff is proceeding p
Dickson, 100 F. Appx 11. 16 (2d Cir. 2004) (summary order).
Here, as explained above, the Court does not have the authority to grant plaintiff’s
request to file a late notice of claim with respect to his state law claims. In addition, plaintiff’s
Monell claim against the County is plainly insufficient to state a claim, and nothing in the
complaint suggests he might have a valid claim against the County. Thus, granting plaintiff
leave to amend his state law claims or his Monell claim against the County would be futile.
However, a liberal reading of plaintiff’s complaint suggests he may have a valid Section
I 983 claim for failure to protect against defendants Saraireh and Santora. Moreover, plaintiff
has not previously been provided an opportunity to amend his complaint.
Accordingh. plaintiff is granted leave to amend 21th the claim that Saraireh and Santora
violated his constitutional rights by failing to protect him against the inmate attack.
Plaintiff is reminded that any factual allegation in the amended complaint must be true to
the best of his knowledge, information, and belief. See Fed. R. Civ. P. 1 l(b)(3). In the amended
complaint, plaintiff shall clearly set forth the facts that give rise to failure to protect claim,
nciudin.g the dates. times, and places of the aileced underlying acts. See Lee v Grailano, 2013
WL 4426447. at S (\.D.\.Y. Auc. 15. 2u l3. Plaintiff must also state
hether he vas a
pretrial detainee or a con\ icted prisoner at the time of the alleged attack on March 8. 2016.
The amended complaint will completely replace, not supplements the existing
complaint. Therefore. plaintiff must include in the amended complaint all information
necessary for his failure to protect claim.
Defendants motion to dismiss GRANFED.
Plaintiff is granted leave to amend onk as to his Section 1983 failure to protect claim
against the indR idual defendants Saraireh and Santora. Plaintiff shall tile his amended
complaint by no later than June 1, 2017. Plaintiff is directed to utilize the Amended Complaint
form attached hereto, If plaintiff fails to comply with this order, his complaint may be dismissed
tbr failure to prosecute or failure to comply with a court order. Fed. R. Civ. P. 4 1(b).
The Court certifies pursuant to 28 U.S.C.
§ l915(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. $g Coppedge v. United States, 369 U.S. 438, 444—45 (1962).
The Clerk is instructed to terminate the County of Westchester as a defendant.
The Clerk is further instructed to terminate the motion. (Doc. #17).
Dated: April 28. 2017
White Plains, NY
Vincent F. Briccetti
(nited States [)strict Judee
Sii Diriic r CooT
Dc Ri OF NE\\ OIR
To oc c o b (;r
W t the fufl nan of eaca piantff
AM F ND ED
ant a ju rv trial?
Write the full name of each defendant. If you cannot fit the
names ot 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
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 oniv the last four digits of a social security number; the year of
rc r’ inita!: aad thc aTt foar digits of a f:nancia account number
I EGAL BASIS FOR CLAIM
State below the federal legal basis for your claim, if known, This form s designed primarily for
prisoners hallenging the conttutionality of their conditions of confinement; those claims are
often brought under 42 U S C § 1983 (against state county, or municipal defendantsi or in a
“Bivens’ action (against federai defendants)
PLAIVI 1FF INFORMATION
Eacn piainriff must provide tn& following nformation Attach additional pages
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
!ndcate below whether you are a prisoner or other confined person:
To the best of your ability, provide the following information for each defendant. lf the correct
information is not providea. it could delay or prevent service of the complaint on the defendant.
Make sure that the defendants listed below are identical to those hsted in the caption. Attach
additional pages as necessary.
Current Job Title (or other identifying information)
Current Work Address
Current Job Title (or other identifying information)
Current Work Address
Current Job Title (or other identifying information)
Current Work Address
Current Job Title (or other identifying information)
Current Work Address
STATE.MENT OF CLAIM
State here briefly the FACTS that support your case. Describe what happened, how you were
harmed. arid 00w each defendant was personally involved n the alleged wrongfui actions. Attach
additional eages as necessary.
If you were injured as a result of these actions, describe your injuries and what medical treatment,
if any, you required and received.
State briefly what money damages or other relief you want the court to order.
PIAIN rIFF’S CERT1FIC \. [ION ANI) VARNINGS
the ht’r nf mx Kn ied. iitinat1nn, and heIit tilut:
C }l pin! N n
na ented Lr m imel pr eurp e ueh a t ha a ca
1k ipnittd L)\
‘t ‘t 1 .!tI)fl1 i2 tnt
factual c !nttnhi
b. N flhI \ ‘1 ‘u are,u m11 t ce lfl$C r\NtIfl4 ia
lt’ s dentiat uppu1 aticI ci
-ape’ I r it
tut)wr n’ —aaati ‘ii t J-.n’r, and 4) th cnmplaint -th-m -u
Rule ul e is ii l’mt cCum
-ci’h th NciLIlrtflk’fl
)l o1 rtifx
I und rstand that
I ri’ lv mali’
ii 1 tile
pi onei that ai u diinisud is
I ma Is dunk ci a eec ‘aunt’? l sttiic
th rtccr mere casu s hdc i am a
P ‘r tail U N fn state a lai
I also understand that prisonel s niw.t exhaust administrative procedurc s before filing an action
in federal court about prison conditions, 42 U.S.C. S 1997e(a), and that m case mciv be
dNrnissed it I has e not exhausted administrative remedics as requiied.
I aglee to pros ide the Clerkk Office with auiv changes to my address. I understand that m
failure to keep a current address on file ss ith the Clerks Office mciv result in the dimisal of my
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.
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