White v. Ewert

Filing 14

ORDER GRANTING MOTION FOR EXENSION OF TIME TO AMEND OR VOLUNTARILY DISMISS AND REJECTING REPORT AND RECOMMENDATION; rejecting ECF No. 11 Report and Recommendation; granting ECF No. 13 Construed Motion for Extension of Time to Amend. Amen d or File Voluntary Dismissal due within 30 days of the date of this order. Signed by Judge Salvador Mendoza, Jr. (Attachments: # 1 ECF No. 7 Order Directing Plaintiff to Amend or File a Motion for Voluntary Dismissal, # 2 Civil Rights Complaint Form) (TR, Case Administrator)**24 PAGE(S), PRINT ALL**(Donald White, Prisoner ID: 308364)

United States District Court
Eastern District of Washington

(In the space above enter the full name(s) of the plaintiff(s).)
Case No. _______________
4:16-CV-05122-MKD
(To be filled out by Clerk’s Office only)

-against-

FIRST AMENDED

COMPLAINT
(Pro Se Prisoner)

(In the space above enter the full name(s) of the defendant(s).
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 in the above caption must be
identical to those contained in Section IV. Do not include
addresses here.)

Jury Demand?
☐Yes
☐ No

NOTICE
Federal Rule of Civil Procedure 5.2 addresses the privacy and security concerns resulting from
public access to electronic court files. Under this rule, papers filed with the court should 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.
Plaintiff need not send exhibits, affidavits, grievance or witness statements, or any other
materials to the Clerk’s Office with this complaint.

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I.

COMPLAINT

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

42 U.S.C. § 1983 (state, county, or municipal defendants)

☐

Action under Bivens v. Six Unknown Federal Narcotics Agents, 403 U.S. 388 (1971)
(federal defendants)

II.

PLAINTIFF INFORMATION

Name (Last, First, MI)

Aliases

Prisoner ID #
Place of Detention

Institutional Address

County, City
III.

State

Zip Code

PRISONER STATUS

Indicate whether you are a prisoner or other confined person as follows:
☐
☐
☐
☐
☐

Pretrial detainee
Civilly committed detainee
Immigration detainee
Convicted and sentenced state prisoner
Convicted and sentenced federal prisoner

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IV.

DEFENDANT(S) INFORMATION

Please list the following information for each defendant. If the correct information is not
provided, it could result in the delay or prevention of service. Make sure that the defendant(s)
listed below are identical to those contained in the above caption. Attach additional sheets of
paper as necessary.
Defendant 1:
Name (Last, First)

Current Job Title

Current Work Address

County, City

State

Zip Code

State

Zip Code

Defendant 2:
Name (Last, First)

Current Job Title

Current Work Address

County, City

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Defendant(s) Continued
Defendant 3:
Name (Last, First)

Current Job Title

Current Work Address

County, City

State

Zip Code

State

Zip Code

Defendant 4:
Name (Last, First)

Current Job Title

Current Work Address

County, City

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V.

STATEMENT OF CLAIM

Place(s) of
occurrence:

Date(s) of occurrence:
State which of your federal constitutional or federal statutory rights have been violated:

State here briefly the FACTS that support your case. Describe how each defendant was
personally involved in the alleged wrongful actions, state whether you were physically injured as
a result of those actions, and if so, state your injury and what medical attention was provided to
you.
FACTS:

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Page 6 of 10

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VI.

ADMINISTRATIVE PROCEDURES

WARNING: Prisoners must exhaust administrative procedures before filing an action in federal
court about prison conditions. 42 U.S.C. § 1997e(a). Your case may be dismissed if you have not
exhausted your administrative remedies.
Have you filed a grievance concerning the facts relating to this complaint? ☐ Yes
If no, explain why not:

☐ No

☐ Yes

☐ No

Is the grievance process completed?
If no, explain why not:

VII.

RELIEF

State briefly what you want the court to do for you. Make no legal arguments. Cite no cases or
statutes.

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VIII. PRISONER’S LITIGATION HISTORY
The “three strikes rule” bars a prisoner from bringing a civil action or an appeal in forma
pauperis in federal court if that prisoner has “on three or more occasions, while incarcerated or
detained in any facility, brought an action or appeal in a court of the United States that was
dismissed on the grounds that it is frivolous, malicious, or fails to state a claim upon which relief
may be granted, unless the prisoner is under imminent danger of serious physical injury.” 28
U.S.C. §1915(g).
Have you brought any other lawsuits in state or federal court while a
prisoner?

☐ Yes

☐ No

If yes, how many?
Number each different lawsuit below and include the following:
•
•
•

Name of case (including defendants’ names), court, and docket number
Nature of claim made
How did it end? (For example, if it was dismissed, appealed, or is still pending, explain
below.)

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IX.

PLAINTIFF’S DECLARATION AND WARNING

Under Federal Rule of Civil Procedure 11, by signing below, I certify to the best of my
knowledge, information, and belief that this complaint: (1) is not being presented for an improper
purpose, such as to harass, cause unnecessary delay, or needlessly increase the cost of litigation;
(2) is supported by existing law or by a nonfrivolous argument for extending or modifying
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 Rule 11.
I agree to provide the Clerk's Office with any changes to my address where case-related papers
may be served. 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.
Plaintiff must sign and date the complaint and provide prison identification number and prison
address.

Dated

Plaintiff’s Signature

Printed Name (Last, First, MI)

Prison Identification #

Prison Address

City

State

Zip Code

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