Gilbert vs Washington State Department of Corrections

Filing 10

SECOND ORDER TO SHOW CAUSE OR AMEND and ORDER denying the 9 MOTION to Appoint Counsel. Plaintiff's Show Cause Response or Second Amended Complaint is due by 7/14/2017. Signed by Magistrate Judge J Richard Creatura. (Attachments: # 1 Proposed Second Amended Complaint (blank), # 2 Pro Se Instruction Sheet)**12 PAGE(S), PRINT ALL**(Kevin Gilbert, Prisoner ID: 890221)(CMG)

UNITED STATES DISTRICT COURT
WESTERN DISTRICT OF WASHINGTON

C17-5100RBL/JRC
____________________________________
(Name of Plaintiff)

**SECOND AMENDED**
CIVIL RIGHTS COMPLAINT
BY A PRISONER UNDER 42
U.S.C. § 1983

vs.
____________________________________
____________________________________
____________________________________
____________________________________
(Names of Defendant(s))

I. Previous Lawsuits:
A. Have you brought any other lawsuits in any federal court in the United States while a prisoner?:
Yes

No

B. If your answer to A is yes, how many?:_________________. Describe the lawsuit in the space
below. (If there is more than one lawsuit, describe the additional lawsuits on another piece of
paper using the same outline.)
1. Parties to this previous lawsuit:
Plaintiff:________________________________________________________________
_______________________________________________________________________
Defendants:______________________________________________________________
________________________________________________________________________
2. Court (give name of District):_________________________________________________
3. Docket Number: ______________________________________________________________

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4. Name of judge to whom case was assigned: _____________________________________
5. Disposition (For example: Was the case dismissed as frivolous or for failure to state a claim?
Was it appealed? Is it still pending?):
______________________________________________________________________________
6. Approximate date of filing lawsuit: _______________________________________________
7. Approximate date of disposition: _________________________________________________
II. Place of Present Confinement:________________________________________________________
A. Is there a prisoner grievance procedure available at this institution?

Yes

No

B. Have you filed any grievances concerning the facts relating to this complaint?
Yes

No

If your answer is NO, explain why not:
______________________________________________________________________________
______________________________________________________________________________
C. Is the grievance process completed?

Yes

No

If your answer is YES, ATTACH A COPY OF THE FINAL GRIEVANCE
RESOLUTION for any grievance concerning facts relating to this case.

III. Parties to this Complaint
A. Name of Plaintiff: __________________________________ Inmate No.: ________________
Address: ______________________________________________________________________
(In Item B below, place the full name of the defendant, his/her official position, and his/her place
of employment. Use item C for the names, positions and places of employment of any additional
defendants. Attach additional sheets if necessary.)
B. Defendant: ___________________________________ Official Position: ________________
Place of employment: ____________________________________________________________
C. Additional defendants__________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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______________________________________________________________________________

IV. Statement of Claim
(State here as briefly as possible the facts of your case. Describe how each defendant is involved,
including dates, places, and other persons involved. Do not give any legal arguments or cite any
cases or statutes. If you allege a number of related claims, number and set forth each claim in a
separate paragraph. Attach additional sheets if necessary.)
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V. Relief
(State briefly exactly what you want the court to do for you. Make no legal arguments. Cite no
cases or statutes.)

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I declare under penalty of perjury that the foregoing is true and correct.
Signed this ________ day of ___________________ 20 ______.

_____________________________________________
(Signature of Plaintiff)

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