Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_06-cv-02563/USCOURTS-azd-2_06-cv-02563-0/pdf.json

Nature of Suit Code: 555
Nature of Suit: Prisoner - Prison Condition
Cause of Action: 42:1983 Prisoner Civil Rights

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JDDL-K

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IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Christian Carson, 

Plaintiff, 

vs.

Joseph M. Arpaio, 

Defendant. 

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No. CV 06-2563-PHX-DGC (MEA)

ORDER

Plaintiff Christian Carson, who is confined in the Maricopa County Lower Buckeye

Jail, filed a pro se civil rights Complaint pursuant to 42 U.S.C. § 1983. The Court dismissed

the Complaint with leave to amend (Doc. #3). On December 8, 2006, Plaintiff filed a First

Amended Complaint. The Court will dismiss the First Amended Complaint with leave to

amend.

I. Statutory Screening of Prisoner Complaints

The Court is required to screen complaints brought by prisoners seeking relief against

a governmental entity or an officer or an employee of a governmental entity. 28 U.S.C.

§ 1915A(a). The Court must dismiss a complaint or portion thereof if a plaintiff has raised

claims that are legally frivolous or malicious, that fail to state a claim upon which relief may

be granted, or that seek monetary relief from a defendant who is immune from such relief.

28 U.S.C. § 1915A(b)(1), (2). If the Court determines that a pleading could be cured by the

allegation of other facts, a pro se litigant is entitled to an opportunity to amend a complaint

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before dismissal of the action. See Lopez v. Smith, 203 F.3d 1122, 1127-29 (9th Cir. 2000)

(en banc). 

The Court should not, however, advise the litigant how to cure the defects. This type

of advice “would undermine district judges’ role as impartial decisionmakers.” Pliler v.

Ford, 542 U.S. 225, 231 (2004); see also Lopez, 203 F.3d at 1131 n.13 (declining to decide

whether the court was required to inform a litigant of deficiencies). Plaintiff’s First

Amended Complaint will be dismissed for failure to state a claim, with leave to amend

because the First Amended Complaint may possibly be saved by amendment.

II. First Amended Complaint

Plaintiff names Sheriff Joseph M. Arpaio as Defendant. The First Amended

Complaint contains three counts, which challenge the conditions of confinement in the Jail.

In Count I, Plaintiff alleges a threat to his safety arising from a violation of the privileges and

immunities clause; the right to life, liberty, and the pursuit of happiness; and equal protection.

In Count II, Plaintiff alleges a denial of medical care arising from a violation of his right to

be free from cruel and unusual punishment. In Count III, Plaintiff alleges a threat to safety

arising from a violation of the right to be free from slavery and involuntary servitude. For

relief, Plaintiff requests damages.

III. Failure to State a Claim

A. Failure to Allege a Proper Constitutional Violation

As the Court previously advised Plaintiff (Doc. #3), a pretrial detainee’s claim for

unconstitutional conditions of confinement arises from the Due Process Clause rather than

from the Eighth Amendment prohibition against cruel and unusual punishment. Bell v.

Wolfish, 441 U.S. 520 (1979). Nevertheless, the Eighth Amendment provides a minimum

standard of care for determining a plaintiff’s rights as a pretrial detainee. Anderson v. Kern,

45 F.3d 1310, 1312-13 (9th Cir. 1995) (citing Redman v. County of San Diego, 942 F.2d

1435, 1442 (9th Cir. 1991)). To prevail on an unconstitutional conditions claim under an

Eighth Amendment standard of care, a plaintiff, whether a pretrial detainee or a convict, must

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show that defendants were “deliberately indifferent” to the alleged constitutional violations.

Redman, 942 F.2d at 1443; Wilson v. Seiter, 501 U.S. 294, 302-03 (1991). 

With regard to providing pretrial detainees with such basic necessities as food, living

space, and medical care, the minimum standard allowed by the Due Process Clause is the

same as that allowed by the Eighth Amendment for convicted persons. Hamm v. Dekalb

County, 774 F.2d 1567, 1574 (11th Cir. 1985). To comply with the Eighth Amendment’s

prohibition against cruel and unusual punishment, a prison must provide prisoners with

“adequate food, clothing, shelter, sanitation, medical care, and personal safety.” Hoptowit

v. Ray, 682 F.2d 1237, 1246 (9th Cir. 1982). However, this does not mean that federal courts

can or should interfere whenever prisoners are inconvenienced or suffer de minimis injuries.

See Bell, 441 U.S. at 539 n.21 (noting that a de minimis level of imposition does not rise to

a constitutional violation).

Count I alleges a threat to Plaintiff’s safety arising from a violation of the privileges

and immunities clause; the right to life, liberty, and the pursuit of happiness; and equal

protection. Count III alleges a threat to safety arising from a violation of the right to be free

from slavery and involuntary servitude. Equal protection requires that “all persons similarly

situated shall be treated alike.” Plyler v. Doe, 457 U.S. 202, 216 (1982). “The term

‘involuntary servitude’ was intended to cover those forms of compulsory labor akin to

African slavery. . . .” Butler v. Perry, 240 U.S. 328, 332 (1916). The First Amended

Complaint does not allege the unequal treatment of persons similarly situated or allege any

facts constituting compulsory labor. As Plaintiff was previously advised, claims challenging

the conditions of confinement would be appropriately brought under the Fourteenth

Amendment. 

B. Violation of Rule 8

The First Amended Complaint fails to comply with Rule 8 of the Federal Rules of

Civil Procedure and Rule 3.4 of the Local Rules of Civil Procedure. Rule 8(a) requires a

“short and plain statement of the claim.” Fed. R. Civ. P. 8(a). The Local Rules require that

complaints by inmates must be written “on forms approved by the Court and in accordance

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with the instructions provided with the forms.” LRCiv 3.4. The court-approved form and

instructions, which were provided to Plaintiff, specifically require that a plaintiff raise only

one claim per count. 

Moreover, although pro se pleadings are liberally construed, Haines v. Kerner, 404

U.S. 519 (1972), conclusory and vague allegations will not support a cause of action. Ivey

v. Board of Regents of the University of Alaska, 673 F.2d 266, 268 (9th Cir. 1982); Rhodes

v. Robinson, 612 F.2d 766, 772 (3d Cir. 1979). Further, a liberal interpretation of a civil

rights complaint may not supply essential elements of the claim that were not initially pled.

Ivey, 673 F.2d at 268. 

Plaintiff has raised numerous claims in each count. For example, Count I, which is

seven pages long, purports to be a claim regarding threat to safety, but Plaintiff alleges

everything from overcrowding to failure to provide “small games such as checkers,

dominoes, and chess in each day room sufficient to permit Plaintiff access to reasonable and

meaningful recreational activities designed to stimulate and satisfy the physical and

psychological needs of Plaintiff.” The Amended Complaint is also filled with rhetoric, which

makes it difficult to review.

The allegations are not a short, plain statement of the claim; contain several

allegations of fact alleging merely de minimis harm – e.g. denial of television and small

games; appear to be an effort to enforce the Amended Judgment in Hart v. Hill, CV 77-0479-

PHX-EHC (D. Ariz.), which Plaintiff was previously advised that he may not do (Doc. #3);

and are often vague and conclusory because they do not clearly allege what happened to

Plaintiff himself. 

Likewise, Count II , which is three pages long, purports to be about denial of medical

care, but Plaintiff never states precisely what medical care he sought, for what condition, and

how Defendant’s conduct resulted in denial of specific care. Instead, Plaintiff alleges a

failure to provide reasonable screening of each detainee “sufficient to identify and begin

segregation and treatment of those with mental or physical illness. . . .,” failure to provide

access to “medical services and facilities which meet the standards designated as essential

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by the National Commission on Correctional Health Care (NCCHC) Standards for Health

Services in Jails,” and failure to “provide a reasonable, meaningful monitoring system by

which Plaintiff and other pretrial detainees may be assured that sick call requests are

delivered to the responsible health care authority. . . .” 

Plaintiff was previously advised of the requirements for stating a claim of denial of

medical care (Doc. #3). Like the allegations in his original Complaint, these allegations do

not state a claim for denial of medical care. Plaintiff fails to specify any medication or

treatment that he needs, what treatment he sought, and what he did not receive. Moreover,

the allegations appear to be an effort to enforce the Amended Judgment in Hart, which

Plaintiff cannot do.

 Finally, Count III, which is five pages long, also alleges a threat to safety. Plaintiff

makes allegations such as “ Defendant failed to provide reasonable, nutritional substitutions

for pretrial detainees who are prohibited for medical or established religious beliefs from

eating certain foods.” It is unclear how this relates to a threat to safety, and nowhere in the

Count does Plaintiff state that he had any religious or medical needs that required food

substitution, or that he told anyone at the Jail about the needs, or how Defendant’s conduct

resulted in a denial. Count III also contains a claim regarding the failure to formulate an

inmate grievance policy (see below). The allegations in Count III are not a short, plain

statement of the claim; contain allegations of fact alleging different claims – e.g.

overcrowding and special needs diets; appear to be an effort to enforce the Amended

Judgment in Hart; and are often vague and conclusory because they do not clearly allege

what happened to Plaintiff himself. 

In its present form, the First Amended Complaint cannot be reviewed in any

meaningful way by this Court as required by 28 U.S.C. § 1915A(a). Accordingly, Counts

I, II, and III fail to state claims under § 1983 and will be dismissed.

C. Grievance Process

Plaintiff is advised that with regard to his claim for failure to formulate a meaningful

grievance process, an inmate has no independent constitutional right to a grievance process.

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In Mann v. Adams, 855 F.2d 639, 640 (9th Cir. 1988), the Ninth Circuit held that a prisoner

does not have a protected liberty interest in prison grievance procedures. Without a liberty

interest, Plaintiff has no procedural due process rights at stake. Accordingly, Plaintiff’s

allegations regarding the alleged refusal of Defendant to establish a grievance procedure do

not state a claim under § 1983.

D. No Relief Available Under Hart v. Hill

It appears to the Court that many of the alleged conditions and violations about which

Plaintiff complains are taken from the Amended Judgment of the class action Hart v. Hill.

As Plaintiff was previously advised (Doc. #3), injunctive relief sought in connection with the

rights enumerated in the Amended Judgment of Hart may only be sought or enforced within

the original case. The Amended Judgment in the class action precludes Plaintiff from

seeking separate and individual injunctive relief. 

Likewise, Hart provides no independent cause of action for monetary relief because

remedial orders alone cannot serve as a substantive basis for a § 1983 claim for damages;

such orders do not create “rights, privileges, or immunities secured by the Constitution and

laws.” See Green v. McKaskle, 788 F.2d 1116, 1122-23 (5th Cir. 1986). 

IV. Leave to Amend

For the foregoing reasons, Plaintiff’s First Amended Complaint will be dismissed for

failure to state a claim upon which relief may be granted. Within 30 days, Plaintiff may

submit a second amended complaint to cure the deficiencies outlined above and in the

Court’s Order filed November 14, 2006 (Doc. #3). The Clerk of Court will mail Plaintiff a

court-approved form to use for filing a second amended complaint. If Plaintiff fails to use

the court-approved form, the Court may strike the amended complaint and dismiss this action

without further notice to Plaintiff.

Plaintiff must clearly designate on the face of the document that it is the “Second

Amended Complaint.” The second amended complaint must be retyped or rewritten in its

entirety on the court-approved form and may not incorporate any part of the original or First

Amended Complaints by reference. 

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A second amended complaint supersedes the original and first amended complaints.

See Ferdik v. Bonzelet, 963 F.2d 1258, 1262 (9th Cir. 1992); Hal Roach Studios v. Richard

Feiner & Co., 896 F.2d 1542, 1546 (9th Cir. 1990). After amendment, the Court will treat

an original and first amended complaints as nonexistent. See Ferdik, 963 F.2d at 1262. Any

cause of action that was raised in the original or first amended complaint is waived if it is not

raised in a second amended complaint. King v. Atiyeh, 814 F.2d 565, 567 (9th Cir. 1987).

Plaintiff may include only one claim per count. Any counts raising multiple claims

will be dismissed. Plaintiff must make short, plain statements of his claims.

V. Warnings

A. Release

Plaintiff must pay the unpaid balance of the filing fee within 120 days of his release.

Also, within 30 days of his release, he must either (1) notify the Court that he intends to pay

the balance or (2) show good cause, in writing, why he cannot. Failure to comply may result

in dismissal of this action.

B. Address Changes

Plaintiff must file and serve a notice of a change of address in accordance with Rule

83.3(d) of the Local Rules of Civil Procedure. Plaintiff must not include a motion for other

relief with a notice of change of address. Failure to comply may result in dismissal of this

action.

C. Copies

Plaintiff must submit an additional copy of every filing for use by the Court. See

LRCiv 5.4. Failure to comply may result in the filing being stricken without further notice

to Plaintiff.

D. Possible “Strike”

Because the First Amended Complaint has been dismissed for failure to state a claim,

if Plaintiff fails to file a second amended complaint correcting the deficiencies identified in

this Order and the Order filed November 14, 2006, the dismissal will count as a “strike”

under the “3-strikes” provision of 28 U.S.C. § 1915(g). Under the 3-strikes provision, a

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prisoner may not bring a civil action or appeal a civil judgment in forma pauperis under 28

U.S.C. § 1915 “if the prisoner has, on 3 or more prior 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). 

E. Possible Dismissal

If Plaintiff fails to timely comply with every provision of this Order, including these

warnings, the Court may dismiss this action without further notice. See Ferdik, 963 F.2d at

1260-61 (a district court may dismiss an action for failure to comply with any order of the

Court).

IT IS ORDERED: 

(1) The First Amended Complaint (Doc. #5) is dismissed for failure to state a

claim. Plaintiff has 30 days from the date this Order is filed to file a second amended

complaint in compliance with this Order.

(2) If Plaintiff fails to file a second amended complaint within 30 days, the Clerk

of Court must, without further notice, enter a judgment of dismissal of this action with

prejudice that states that the dismissal counts as a “strike” under 28 U.S.C. § 1915(g).

(5) The Clerk of Court must mail Plaintiff a court-approved form for filing a civil

rights complaint by a prisoner.

DATED this 20th day of December, 2006.

Case 2:06-cv-02563-DGC-MEA Document 6 Filed 12/22/06 Page 8 of 19
Revised 4/9/06 1

INFORMATION AND INSTRUCTIONS FOR A

PRISONER FILING CIVIL RIGHTS COMPLAINT

 IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

I. General Information About the Civil Rights Complaint Form:

A. The Form. The civil rights complaint form is designed to help prisoners prepare a complaint

seeking relief for a violation of their federal civil rights. Local Rule of Civil Procedure 3.4(a)

requires that prisoner civil rights complaints be filed on the court-approved form. Your

complaint must be typewritten or legibly handwritten. All information must be clearly and

concisely written, only in the space provided on the form. If needed, you may attach no more

than fifteen additional pages of standard letter size paper to continue any part of the complaint.

You must identify which part of the complaint is being continued and number all pages.

B. Your Signature. You must sign the complaint. Your signature constitutes a certificate that:

1) you have read the complaint; 2) to the best of your knowledge, information and belief formed

after reasonable inquiry it is well grounded in fact and law; and 3) it is not being filed for any

improper purpose. Please review Rule 11 of the Federal Rules of Civil Procedure. Rule 11

provides for the imposition of sanctions if the complaint is signed in violation of the Rule. 

C. The Filing Fee. You must pay the $350.00 filing fee. If you are unable to pay the filing fee

when the complaint is filed, you may request leave to proceed in forma pauperis. Please review

the "Information for Prisoners Seeking Leave to Proceed with a (Non-Habeas) Civil Action in

Federal Court In Forma Pauperis Pursuant to 28 U.S.C. § 1915" for more information.

D. Court Divisions. If you resided in Maricopa, Pinal, Yuma, La Paz, or Gila county when

your rights were allegedly violated, you should file your complaint in the Phoenix Division of

the court. If you resided in Apache, Navajo, Coconino, Mohave, or Yavapai county when your

rights were allegedly violated, you should file your complaint in the Prescott Division of the

court. If you resided in Pima, Cochise, Santa Cruz, Graham, or Greenlee county when your

rights were allegedly violated, you should file your complaint in the Tucson Division of the

court. See LRCiv 5.1(a) and 77.1(a). 

You should mail THE ORIGINAL AND ONE COPY of your complaint with the

$350.00 filing fee or the application to proceed in forma pauperis to:

Phoenix & Prescott Divisions: OR Tucson Division:

U.S. District Court Clerk U.S. District Court Clerk

U.S. Courthouse, Suite 321 U.S. Courthouse, Suite 1500

401 West Washington Street, SPC 10 405 West Congress Street

Phoenix, Arizona 85003-2119 Tucson, Arizona 85701-5010

Case 2:06-cv-02563-DGC-MEA Document 6 Filed 12/22/06 Page 9 of 19
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E. Certificate of Service on Defendants. You must furnish the opposing party or their attorney

with a copy of any document you submit to the court (except the initial complaint and

application to proceed in forma pauperis). Pursuant to Rules 5(a) and (d) of the Federal Rules

of Civil Procedure, each original document (except the initial complaint and application for

leave to proceed in forma pauperis) must include a certificate of service on the last page of the

document stating the date a copy of the document was mailed to the opposing party or their

attorney and the address to which it was mailed. Any document received by the court which

does not include a certificate of service may be stricken. A certificate of service should be in

the following form:

I hereby certify that a copy of the foregoing document was mailed

this day of (month) , (year) , to:

Name: 

Address: 

 Attorney for Defendant(s)/Respondent(s)

 

(Signature)

F. Original and Judge's Copy. You must furnish an original and one copy of any document

submitted to the court. You must furnish one additional copy to the clerk if you wish to have

a file-stamped copy of the document returned to you. All copies must be identical to the

original.

G. Exhibits. You should not submit exhibits with the complaint. Instead, the relevant

information should be paraphrased in the complaint. You should keep the exhibits to use to

support or oppose a motion for summary judgment or at trial.

H. Change of Address. You must immediately notify the clerk and the opposing party or their

attorney in writing of any change in your mailing address. Failure to notify the court of any

change in your mailing address may result in the dismissal of your case.

I. Amended Complaint. If you need to change any of the information in the initial complaint,

you must file an amended complaint. The amended complaint must be written on the courtapproved civil rights complaint form. Rule 15(a) of the Federal Rules of Civil Procedure allows

you to file one amended complaint prior to any defendant filing an answer. After any defendant

has filed an answer, you must file a motion for leave to amend and lodge a proposed amended

complaint. Local Rule of Civil Procedure 15.1(a)(2) prohibits any amended pleading from

referencing any prior pleading. Further, any allegations or defendants not included in the

amended complaint are considered dismissed.

J. Letters and Motions. It is generally inappropriate to write a letter to any of the District

Judges, Magistrates Judges, or the staff of any of the judicial officers. The appropriate way to

communicate with these persons is by filing a written pleading or motion. 

Case 2:06-cv-02563-DGC-MEA Document 6 Filed 12/22/06 Page 10 of 19
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II. Completing the Civil Rights Complaint Form:

HEADING:

1. Your Name. Print your name, prison or jail inmate number, and mailing address on

the lines provided. 

2. Defendants. Print the names of each of your defendants. If you name more than four

defendants, you should print the name of one defendant and "see additional page for

defendants" in the space provided. On the additional page you must list the names of

all of the defendants. This additional page should be inserted after page 1 and numbered

as page "1-A" at the bottom of the page. The initial complaint must contain the names

of all of the parties (plaintiffs as well as defendants) in the heading (or on the additional

page if more than four defendants). See Rule 10(a) of the Federal Rules of Civil

Procedure.

3. Jury Demand. If you want a jury trial, you must write "JURY TRIAL DEMANDED"

on the line below "CIVIL RIGHTS COMPLAINT BY A PRISONER.” Failure to do

so will result in the loss of the right to a jury trial. A jury trial is not available if you are

seeking only injunctive relief.

Part A. JURISDICTION:

1. Nature of Suit. Mark whether you are filing the complaint pursuant to 42 U.S.C. §

1983 for state, county, or city defendants; "Bivens v. Six Unknown Federal Narcotics

Agents" for federal defendants; or "other." If you mark "other," identify the source of

that authority. 

2. Plaintiff. Print all of the requested information on the spaces provided. Identify the

institution and city where the alleged violation of your rights occurred. 

3. Defendants. Print all of the requested information about each of the defendants in the

spaces provided. If you are naming more than four defendants, you must provide the

necessary information about each additional defendant on a separate page. Label the

page(s) as "2-A," "2-B," etc., at the bottom of the page and insert the additional page(s)

immediately behind page 2.

Part B. PREVIOUS LAWSUITS:

You must identify any other lawsuit you have filed in either state or federal court while

you were a prisoner. Print all of the requested information about each lawsuit in the spaces

provided. If you have filed more than three lawsuits, you must provide the necessary

information about each additional lawsuit on a separate page. Label the page(s) as "2-A," "2-

B," etc., at the bottom of the page and insert the additional page(s) immediately behind page 2.

Part C. CAUSE OF ACTION:

You must identify what rights the defendant(s) violated. The form provides space to

allege three separate counts (one violation per count). If you are alleging more than three

Case 2:06-cv-02563-DGC-MEA Document 6 Filed 12/22/06 Page 11 of 19
4

counts, you must provide the necessary information about each additional count on a separate

page. Number the additional pages "5-A", "5-B", etc., and insert them immediately behind page

5. Remember that you are limited to a total of fifteen additional pages.

 

1. Counts. You must identify which civil right was violated. YOU MAY ALLEGE

THE VIOLATION OF ONLY ONE CIVIL RIGHTS CLAIM PER COUNT.

2. Issue Involved. Check the box that most closely identifies the issue involved in your

claim. YOU MAY CHECK ONLY ONE BOX PER COUNT. If you check the box

marked “Other,” you must identify the specific issue involved in the space provided.

3. Supporting Facts. After you have identified which civil right was violated, you need

to state the supporting facts. Be as specific as possible. You must state what each

individual defendant did to violate your rights. If there is more than one defendant, you

need to identify which defendant did what act. You also need to state the date(s) on

which the act(s) occurred if possible.

4. Injury. State precisely how you were injured by the alleged violation of your rights.

5. Administrative Remedies. Exhaustion of administrative remedies is a prerequisite

to filing a civil rights complaint. 42 U.S.C. § 1997e requires prisoners to exhaust the

available administrative remedies before being allowed to file a civil rights action.

Consequently, you must disclose whether you have exhausted the inmate grievance

procedures or administrative appeals for each count in your complaint. If one of your

counts is exempt from the grievance procedures or administrative appeals, fully explain

the exemption on the lines provided.

Part D. 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. Your signature

must be an original signature, not a photocopy. 

FINAL NOTE

You should follow these instructions carefully. Failure to do so may result in your

complaint being stricken or dismissed by the court. All questions must be answered concisely

in the proper space on the form. If needed, you may attach no more than fifteen additional

pages. The form, however, must be completely filled in to the extent applicable. If you attach

additional pages, be sure to identify which section of the complaint is being continued and

number the pages.

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Revised 4/9/06 1 550/555

Name and Prisoner/Booking Number

Place of Confinement

Mailing Address

City, State, Zip Code

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

)

 , )

(Full Name of Plaintiff) Plaintiff, )

)

 vs. ) CASE NO. 

) (To be supplied by the Clerk)

 , )

)

 , )

) CIVIL RIGHTS COMPLAINT

 ,) BY A PRISONER

)

 , ) G Original Complaint

(Full Name of Each Defendant) Defendant(s). ) G First Amended Complaint

) G Second Amended Complaint

A. JURISDICTION

1. This Court has jurisdiction over this action pursuant to:

a. G 28 U.S.C. § 1343(a)(3); 42 U.S.C. § 1983

b. G 28 U.S.C. § 1331; Bivens v. Six Unknown Federal Narcotics Agents, 403 U.S. 388 (1971).

c. G Other: (Please specify.) .

2. Name of Plaintiff: .

Present mailing address: .

(Failure to notify the Court of your change of address may result in dismissal of this action.)

Institution/city where violation occurred: .

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3. Name of first Defendant: . The first Defendant is employed as:

at . (Position and Title) (Institution)

The first Defendant is sued in his/her: G individual capacity G official capacity (check one or both).

Explain how the first Defendant was acting under color of law: 

.

4. Name of second Defendant: . The second Defendant is employed as:

at . (Position and Title) (Institution)

The second Defendant is sued in his/her: G individual capacity G official capacity (check one or both).

Explain how the second Defendant was acting under color of law: 

.

5. Name of third Defendant: . The third Defendant is employed as:

at . (Position and Title) (Institution)

The third Defendant is sued in his/her: G individual capacity G official capacity (check one or both).

Explain how the third Defendant was acting under color of law: 

.

6. Name of fourth Defendant: . The fourth Defendant is employed as:

at . (Position and Title) (Institution)

The fourth Defendant is sued in his/her: G individual capacity G official capacity (check one or both).

Explain how the fourth Defendant was acting under color of law: 

.

(If you name more than four Defendants, answer the questions listed above for each additional Defendant on a separate page.)

B. PREVIOUS LAWSUITS

1. Have you filed any other lawsuits while you were a prisoner? G Yes G No

2. If your answer is "yes," how many lawsuits have you filed? . Describe the previous lawsuits in the

spaces provided below.

3. First prior lawsuit:

a. Parties to previous lawsuit:

Plaintiff: .

Defendants: 

.

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b. Court: (If federal court, identify the district; if state court, identify the county.) 

.

c. Case or docket number: .

d. Claims raised: 

e. Disposition: (For example: Was the case dismissed? Was it appealed? Is it still pending?) 

.

f. Approximate date lawsuit was filed: .

g. Approximate date of disposition: .

4. Second prior lawsuit:

a. Parties to previous lawsuit:

Plaintiff: .

Defendants: 

.

b. Court: (If federal court, identify the district; if state court, identify the county.) 

.

c. Case or docket number: .

d. Claims raised: 

.

e. Disposition: (For example: Was the case dismissed? Was it appealed? Is it still pending?) 

.

f. Approximate date lawsuit was filed: .

g. Approximate date of disposition: .

5. Third prior lawsuit:

a. Parties to previous lawsuit:

Plaintiff: .

Defendants: 

.

b. Court: (If federal court, identify the district; if state court, identify the county.) 

.

c. Case or docket number: .

d. Claims raised: 

.

e. Disposition: (For example: Was the case dismissed? Was it appealed? Is it still pending?) 

.

f. Approximate date lawsuit was filed: .

g. Approximate date of disposition: .

(If you filed more than three lawsuits, answer the questions listed above for each additional lawsuit on a separate page.)

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C. CAUSE OF ACTION

COUNT I

1. The following constitutional or other federal civil right has been violated by the Defendant(s): 

.

2. Count I involves: (Check only one; if your claim involves more than one issue, each issue should be stated

in a different count) G Mail G Access to the court G Medical care 

G Disciplinary proceedings G Property G Exercise of religion G Retaliation

G Excessive force by an officer G Threat to safety G Other: .

3. Supporting Facts: (State as briefly as possible the FACTS supporting Count I. Describe exactly what each

Defendant did or did not do to violate your rights. State the facts clearly in your own words without citing legal

authority or arguments).

.

4. Injury: (State how you have been injured by the actions or inactions of the Defendant(s)).

.

5. Administrative Remedies:

a. Are there any administrative remedies (grievance procedures or administrative appeals) available at

your institution? G Yes G No

b. Did you submit a request for administrative relief on Count I? G Yes G No

c. Did you appeal your request for relief on Count I to the highest level? G Yes G No

d. If you did not submit or appeal a request for administrative relief to the highest level, briefly explain

why you did not. 

.

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COUNT II

1. The following constitutional or other federal civil right has been violated by the Defendant(s): 

.

2. Count II involves: (Check only one; if your claim involves more than one issue, each issue should be stated

in a different count) G Mail G Access to the court G Medical care 

G Disciplinary proceedings G Property G Exercise of religion G Retaliation

G Excessive force by an officer G Threat to safety G Other: .

3. Supporting Facts: (State as briefly as possible the FACTS supporting Count II. Describe exactly what each

Defendant did or did not do to violate your rights. State the facts clearly in your own words without citing legal

authority or arguments).

.

4. Injury: (State how you have been injured by the actions or inactions of the Defendant(s)).

.

5. Administrative Remedies:

a. Are there any administrative remedies (grievance procedures or administrative appeals) available at

your institution? G Yes G No

b. Did you submit a request for administrative relief on Count II? G Yes G No

c. Did you appeal your request for relief on Count II to the highest level? G Yes G No

d. If you did not submit or appeal a request for administrative relief to the highest level, briefly explain

why you did not. 

.

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COUNT III

1. The following constitutional or other federal civil right has been violated by the Defendant(s): 

.

2. Count III involves: (Check only one; if your claim involves more than one issue, each issue should be stated

in a different count) G Mail G Access to the court G Medical care 

G Disciplinary proceedings G Property G Exercise of religion G Retaliation

G Excessive force by an officer G Threat to safety G Other: .

3. Supporting Facts: (State as briefly as possible the FACTS supporting Count III. Describe exactly what

each Defendant did or did not do to violate your rights. State the facts clearly in your own words without citing

legal authority or arguments).

.

4. Injury: (State how you have been injured by the actions or inactions of the Defendant(s)).

.

5. Administrative Remedies:

a. Are there any administrative remedies (grievance procedures or administrative appeals) available at

your institution? G Yes G No

b. Did you submit a request for administrative relief on Count III? G Yes G No

c. Did you appeal your request for relief on Count III to the highest level? G Yes G No

d. If you did not submit or appeal a request for administrative relief to the highest level, briefly explain

why you did not. 

.

(If you assert more than three Counts, answer the questions listed above for each additional Count on a separate page.)

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D. REQUEST FOR RELIEF

State briefly exactly what you want the Court to do for you.

.

I declare under penalty of perjury that the foregoing is true and correct.

Executed on 

DATE SIGNATURE OF PLAINTIFF

(Name and title of paralegal, legal assistant, or

other person who helped prepare this complaint)

(Signature of attorney, if any)

(Attorney’s address & telephone number)

ADDITIONAL PAGES

All questions must be answered concisely in the proper space on the form. If needed, you may attach no more

than fifteen additional pages. The form, however, must be completely filled in to the extent applicable.

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