Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_13-cv-01876/USCOURTS-azd-2_13-cv-01876-1/pdf.json

Nature of Suit Code: 550
Nature of Suit: Prisoner - Civil Rights (U.S. defendant)
Cause of Action: 42:1983 Prisoner Civil Rights

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JDDL-K 

MD 

WO 

IN THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF ARIZONA 

Delano Danny Quiroz, Jr., 

Plaintiff, 

vs. 

Phoenix Police Department, et al., 

Defendants. 

No. CV 13-1876-PHX-DGC (LOA) 

ORDER 

On September 11, 2013, Plaintiff Delano Danny Quiroz, Jr., who is confined in the 

Maricopa County Fourth Avenue Jail, filed a pro se civil rights Complaint pursuant to 42 

U.S.C. § 1983 and an Application to Proceed In Forma Pauperis. In a November 4, 2013 

Order, the Court granted the Application to Proceed and dismissed the Complaint 

because Plaintiff had failed to state a claim. The Court gave Plaintiff 30 days to file an 

amended complaint that cured the deficiencies identified in the Order. On December 4, 

2013, Plaintiff filed his First Amended Complaint (Doc. 7). 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 

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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). 

 A pleading must contain a “short and plain statement of the claim showing that the 

pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2) (emphasis added). While Rule 8 

does not demand detailed factual allegations, “it demands more than an unadorned, thedefendant-unlawfully-harmed-me accusation.” Ashcroft v. Iqbal, 556 U.S. 662, 678 

(2009). “Threadbare recitals of the elements of a cause of action, supported by mere 

conclusory statements, do not suffice.” Id. 

 “[A] complaint must contain sufficient factual matter, accepted as true, to ‘state a 

claim to relief that is plausible on its face.’” Id. (quoting Bell Atlantic Corp. v. Twombly, 

550 U.S. 544, 570 (2007)). A claim is 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.” Id. “Determining whether a complaint states a plausible 

claim for relief [is] . . . a context-specific task that requires the reviewing court to draw 

on its judicial experience and common sense.” Id. at 679. Thus, although a plaintiff’s 

specific factual allegations may be consistent with a constitutional claim, a court must 

assess whether there are other “more likely explanations” for a defendant’s conduct. Id.

at 681. 

 But as the United States Court of Appeals for the Ninth Circuit has instructed, 

courts must “continue to construe pro se filings liberally.” Hebbe v. Pliler, 627 F.3d 338, 

342 (9th Cir. 2010). A “complaint [filed by a pro se prisoner] ‘must be held to less 

stringent standards than formal pleadings drafted by lawyers.’” Id. (quoting Erickson v. 

Pardus, 551 U.S. 89, 94 (2007) (per curiam)). 

 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 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. 

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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, but because it 

may possibly be amended to state a claim, the Court will dismiss it with leave to amend. 

II. First Amended Complaint 

 In his three-count First Amended Complaint, Plaintiff asserts claims of excessive 

force by an officer, denial of due process, and failure to train. He names as Defendants 

the Phoenix Police Department and Lieutenant Russel Frederiksen #5344 of the Phoenix 

Police Department. Plaintiff seeks compensatory and punitive damages. 

 Plaintiff designates Count I as a claim of excessive force by an officer. He alleges 

the following facts: On October 18, 2011, Plaintiff was the passenger in a vehicle that 

was pulled over by two Phoenix police officers (Campbell and Burke) who believed the 

vehicle “matched the description of alleged theft vehicle at the time.” Plaintiff exited the 

vehicle and fled from the officers “due to a parole hold.” Defendant Frederiksen was 

driving a Chevy Tahoe and swerved into Plaintiff’s path, striking Plaintiff. Plaintiff 

continued to flee toward an eight-foot brick wall. Plaintiff attempted to climb over the 

wall and had both hands on the top of the wall and was hanging from the wall with his 

back toward Frederiksen when Frederiksen removed his gun, a Glock 30 .45 caliber, from 

his holster and yelled to Plaintiff, “Get down from there. Get down.” Without waiting 

for a response from Plaintiff, Frederiksen fired his gun six times in rapid succession and 

struck Plaintiff four times in his lower extremities. Plaintiff asserts that all four bullets 

struck him from behind. Plaintiff was shot once in the left leg and three times in his right 

leg, which shattered his knee cap and required extensive surgery. Plaintiff now has pins, 

rods, and a plate in his right leg, has trouble walking, and is in constant chronic pain. 

 Plaintiff asserts that at no time did he pose any harm or threat to Frederiksen or the 

other officers. After Plaintiff was shot, he was lying on the ground and asked the officers 

to please call an ambulance because he had been shot in his legs. “They” rolled Plaintiff 

onto his stomach and said, “you aren’t shot,” and then repeatedly picked up Plaintiff’s 

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legs “slamming them onto the ground causing [Plaintiff] crucial pain.” Plaintiff yelled 

for them to stop, “but they repeatedly did so.” Plaintiff asserts that after his arrest, 

detectives tried to “link up” the vehicle Plaintiff was in with two robberies. Plaintiff 

states that he is currently awaiting trial “in an ongoing case.” Plaintiff also alleges that 

Defendant Frederiksen and Officer Campbell “fabricated reports to cover up the 

unjustifiable and unconstitutional shooting.” 

 In Count II, Plaintiff alleges that his due process rights were violated when 

Defendant Frederiksen shot him. He alleges that Frederiksen chose to deprive him of 

“life and liberty, oversee me equal protection of the law, which as a United States citizen 

as a resident of Arizona [he] is entitled to, bypass the courts and deny [Plaintiff his] right 

to due process.” Plaintiff further alleges that Defendant Frederiksen and Officers 

Campbell and Burke “fabricated reports to cover up the unjustified and unconstitutional 

malicious act.” 

 Plaintiff designates Count III as a Fifth Amendment violation and the issue 

involved as “inadequately train/[illegible]/discipline officers on excessive use of force.” 

Plaintiff alleges that the “Phoenix Police Department is liable to ensure the safety of each 

and every citizen in Maricopa County, concerning the actions and conduct of their 

officers. Excessive use of force occurs very often toward citizens of Maricopa County 

and it occurred directly to [Plaintiff] on Oct. 18, 2011[.]” Plaintiff alleges that the 

Phoenix Police Department failed to perform a “professional and thorough investigation 

upon the use of excessive force” to discover that he was “shot from the back unlawfully,” 

that the officers’ reports were fabricated, and that it was “physically impossible for their 

story to be true.” Plaintiff alleges that “the obvious improper training, the lack of 

discipline, and the failure to properly and thoroughly investigate use of excess force by 

the Phoenix Police Department is liable to [Plaintiff’s] injuries, and disability, and 

violated [his] 5th Amendment of the Constitution by depriving [Plaintiff] of life, liberty, 

or property, without due process of law.” 

/ / / 

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 According to records available online, Plaintiff is in custody and awaiting trial in 

Maricopa County Superior Court, case CR2011-154084, on charges of armed robbery, 

first-degree burglary, theft-means of transportation, aggravated assault, endangerment, 

and misconduct involving weapons, all stemming from events on October 18, 2011.1

 

Trial on these charges is currently scheduled to begin on February 6, 2014. 

III. Failure to State a Claim

 To state a claim under § 1983, a plaintiff must allege facts supporting that (1) the 

conduct about which he complains was committed by a person acting under the color of 

state law and (2) the conduct deprived him of a federal constitutional or statutory right. 

Wood v. Ostrander, 879 F.2d 583, 587 (9th Cir. 1989). A plaintiff must also allege that 

he suffered a specific injury as a result of the conduct of a particular defendant and he 

must allege an affirmative link between the injury and the conduct of that defendant. 

Rizzo v. Goode, 423 U.S. 362, 371-72, 377 (1976). 

 A. Phoenix Police Department and Count III 

 Plaintiff sues the Phoenix Police Department. As the Court informed Plaintiff in 

its November 4, 2013 Order, a municipal police department is not a “person” within the 

meaning of § 1983 and cannot be sued. See e.g., Petaway v. City of New Haven Police 

Dep’t, 541 F. Supp. 2d 504 (D. Conn. 2008); Pahle v. Colebrookdale Tp., 227 F. Supp. 

2d 361 (E.D. Pa. 2002). Accordingly, the Phoenix Police Department and Count III will 

be dismissed. 

 B. Count I 

 The use of excessive force by police officers in the course of an arrest can violate 

the arrestee’s Fourth Amendment right to be free from unreasonable seizures. See White 

by White v. Pierce County, 797 F.2d 812, 816 (9th Cir. 1986). The Fourth Amendment 

does not prohibit the use of reasonable force. Tatum v. City & County of San Francisco, 

441 F.3d 1090, 1095 (9th Cir. 2006). Whether the force was excessive depends on 

 

1

See http://www.superiorcourt.maricopa.gov/docket/CriminalCourtCases/caseInfo

.asp (last visited Feb. 6, 2014). 

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“whether the officers’ actions [were] ‘objectively reasonable’ in light of the facts and 

circumstances confronting them, without regard to their underlying intent or motivation.” 

Graham v. Connor, 490 U.S. 386, 397 (1989); Tatum, 441 F.3d at 1095; Lolli v. County 

of Orange, 351 F.3d 410, 415 (9th Cir. 2003). The Court must balance the nature and 

quality of the intrusion against the countervailing governmental interests at stake. 

Graham, 490 U.S. at 396; Lolli, 351 F.3d at 415. Moreover, 

[t]he “reasonableness” of a particular use of force must be judged from the 

perspective of a reasonable officer on the scene, rather than with the 20/20 

vision of hindsight. . . . . “Not every push or shove, even if it may later 

seem unnecessary in the peace of a judge’s chambers,” violates the Fourth 

Amendment. 

Graham, 490 U.S. at 396 (citations omitted). “Whether a particular use of force was 

‘objectively reasonable’ depends on several factors, including the severity of the crime 

that prompted the use of force, the threat posed by a suspect to the police or to others, and 

whether the suspect was resisting arrest.” Tatum, 441 F.3d at 1095. 

 In this case, Plaintiff provides little information about the circumstances of his 

arrest that would allow the Court to evaluate the reasonableness of the force used against 

him. For instance, Plaintiff fails to provide information about why he was on a parole 

hold, the severity of the crime at issue, whether he was shot during daylight hours or after 

dark, whether he was carrying a weapon, and whether the officers were aware of any 

weapon on Plaintiff. Also, other than Frederiksen’s command to get down from the wall, 

Plaintiff fails to state whether Frederiksen or the other officers said anything else to him 

before he was shot. Plaintiff asserts that he was fleeing from officers, which indicates he 

may have been evading or resisting arrest. Finally, Plaintiff fails to state if he was 

arrested at the time he was shot and what charges if any resulted from his arrest. 

Plaintiff’s allegations of excessive force in Count II fail to state a claim. 

 C. Count II 

 Plaintiff designates Count II as a Fourteenth Amendment due process violation. 

Plaintiff alleges that when Defendant Frederiksen shot Plaintiff, Frederiksen chose to 

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deprive Plaintiff of “life and liberty, oversee me equal protection of the law, which as a 

United States citizen as a resident of Arizona [he] is entitled to, bypass the courts and 

deny [Plaintiff his] right to due process.” It is unclear from these assertions what process 

Plaintiff has been denied. As noted, Plaintiff is scheduled for trial on multiple charges 

related to events on October 18, 2011. Although pro se pleadings are liberally construed, 

Haines v. Kerner, 404 U.S. 519, 520-21 (1972), conclusory and vague allegations will 

not support a cause of action. Ivey v. Bd. of Regents of the Univ. of Alaska, 673 F.2d 266, 

268 (9th Cir. 1982). Further, a liberal interpretation of a civil rights complaint may not 

supply essential elements of the claim that were not initially pled. Id. Because Plaintiff 

fails to allege any facts supporting that he has been denied due process, Count II will be 

dismissed.2

 

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. 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 second 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 

 

2

 To the extent Plaintiff may be seeking this Court’s intervention in his state court 

proceedings, the abstention doctrine set forth in Younger v. Harris, 401 U.S. 37 (1971), 

prevents a federal court in most circumstances from directly interfering with ongoing criminal proceedings in state court. The Younger abstention doctrine also bars requests for declaratory and monetary relief for constitutional injuries arising out of a plaintiff’s ongoing state criminal prosecution. Mann v. Jett, 781 F.2d 1448, 1449 (9th Cir. 1986). 

In addition, the Younger abstention doctrine applies while a case works its way through the state appellate process, if a prisoner is convicted. New Orleans Pub. Serv., Inc. v. 

Council of City of New Orleans, 491 U.S. 350, 369 (1989). Only in extraordinary circumstances will the Younger doctrine not bar federal interference with ongoing (non- final) state criminal proceedings. 

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Complaint or First Amended Complaint by reference. Plaintiff may include only one 

claim per count. 

 A second amended complaint supersedes the original Complaint and First 

Amended Complaint. 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 the original Complaint and First Amended Complaint as 

nonexistent. Ferdik, 963 F.2d at 1262. Any cause of action that was raised in the 

original complaint or first amended complaint and that was voluntarily dismissed or was 

dismissed without prejudice is waived if it is not alleged in a second amended complaint. 

Lacey v. Maricopa County, 693 F.3d 896, 928 (9th Cir. 2012) (en banc). 

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 

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identified in this Order, the dismissal may count as a “strike” under the “3-strikes” 

provision of 28 U.S.C. § 1915(g). Under the 3-strikes provision, a 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. 7) 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 may count as a “strike” under 28 U.S.C. 

§ 1915(g). 

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

civil rights complaint by a prisoner. 

 Dated this 12th day of February, 2014. 

Case 2:13-cv-01876-DLR Document 8 Filed 02/12/14 Page 9 of 19
Revised 5/1/2013 1

Instructions for a Prisoner Filing a Civil Rights Complaint 

in the United States District Court for the District of Arizona

1. Who May Use This Form. The civil rights complaint form is designed to help incarcerated

persons prepare a complaint seeking relief for a violation of their federal civil rights. These

complaints typically concern, but are not limited to, conditions of confinement. This form should

not be used to challenge your conviction or sentence. If you want to challenge a state conviction

or sentence, you should file a petition under 28 U.S.C. § 2254 for a writ of habeas corpus by a

person in state custody. If you want to challenge a federal conviction or sentence, you should file

a motion under 28 U.S.C. § 2255 to vacate sentence in the federal court that entered the judgment.

2. The Form. Local Rule of Civil Procedure (LRCiv) 3.4(a) provides that complaints by

incarcerated persons must be filed on the court-approved form. The form must be typed or

neatly handwritten. The form must be completely filled in to the extent applicable. All questions

must be answered clearly and concisely in the appropriate space on the form. If needed, you may

attach additional pages, but no more than fifteen additional pages, of standard letter-sized paper.

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

not fill out the form properly, you will be asked to submit additional or corrected information, which

may delay the processing of your action. You do not need to cite law. 

3. Your Signature. You must tell the truth and sign the form. If you make a false statement of a

material fact, you may be prosecuted for perjury.

4. The Filing and Administrative Fees. The total fees for this action are $400.00 ($350.00 filing fee

plus $50.00 administrative fee). If you are unable to immediately pay the fees, 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 additional instructions.

5. Original and Judge’s Copy. You must send an original plus one copy of your complaint and of

any other documents submitted to the Court. You must send one additional copy to the Court if you

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

the original. Copies may be legibly handwritten.

6. Where to File. You should file your complaint in the division where you were confined when

your rights were allegedly violated. See LRCiv 5.1(a) and 77.1(a). If you were confined in

Maricopa, Pinal, Yuma, La Paz, or Gila County, file in the Phoenix Division. If you were confined

in Apache, Navajo, Coconino, Mohave, or Yavapai County, file in the Prescott Division. If you

were confined in Pima, Cochise, Santa Cruz, Graham, or Greenlee County, file in the Tucson

Division. Mail the original and one copy of the complaint with the $400 filing and

administrative fees or the application to proceed in forma pauperis to:

Case 2:13-cv-01876-DLR Document 8 Filed 02/12/14 Page 10 of 19
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Phoenix & Prescott Divisions: OR Tucson Division:

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

U.S. Courthouse, Suite 130 U.S. Courthouse, Suite 1500

401 West Washington Street, SPC 10 405 West Congress Street

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

7. Change of Address. You must immediately notify the Court and the defendants 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.

8. Certificate of Service. You must furnish the defendants with a copy of any document you submit

to the Court (except the initial complaint and application to proceed in forma pauperis). Each

original document (except the initial complaint and application 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 defendants and the address to which it was mailed. See Fed. R. Civ.

P. 5(a), (d). Any document received by the Court that 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 (month, day, year) to:

Name: 

Address: 

 Attorney for Defendant(s)

 

(Signature)

9. 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 court-approved

civil rights complaint form. You may file one amended complaint without leave (permission) of

Court before any defendant has answered your original complaint. See Fed. R. Civ. P. 15(a). After

any defendant has filed an answer, you must file a motion for leave to amend and lodge (submit) a

proposed amended complaint. LRCiv 15.1. In addition, an amended complaint may not incorporate

by reference any part of your prior complaint. LRCiv 15.1(a)(2). Any allegations or defendants

not included in the amended complaint are considered dismissed. All amended complaints are

subject to screening under the Prison Litigation Reform Act; screening your amendment will take

additional processing time.

10. Exhibits. You should not submit exhibits with the complaint or amended complaint. Instead,

the relevant information should be paraphrased. You should keep the exhibits to use to support or

oppose a motion to dismiss, a motion for summary judgment, or at trial.

11. Letters and Motions. It is generally inappropriate to write a letter to any judge or the staff of

any judge. The only appropriate way to communicate with the Court is by filing a written pleading

or motion.

Case 2:13-cv-01876-DLR Document 8 Filed 02/12/14 Page 11 of 19
3

12. Completing the Civil Rights Complaint Form.

HEADING:

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

on the lines provided.

2. Defendants. If there are four or fewer defendants, print the name of each. If you name

more than four defendants, print the name of the first defendant on the first line, write the

words “and others” on the second line, and attach an additional page listing the names of all

of the defendants. Insert the additional page after page 1 and number it “1-A” at the bottom.

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

the space below “CIVIL RIGHTS COMPLAINT BY A PRISONER.” Failure to do so may

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. Location. 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 separate pages labeled “2-A,” “2-

B,” etc., at the bottom. 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 each defendant violated. The form provides space to allege

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

Case 2:13-cv-01876-DLR Document 8 Filed 02/12/14 Page 12 of 19
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1. Counts. You must identify which civil right was violated. You may allege the violation

of only one civil right 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.

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

which defendant did what act. You also should 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. You must exhaust any available administrative remedies

before you file a civil rights complaint. See 42 U.S.C. § 1997e. Consequently, you should

disclose whether you have exhausted the inmate grievance procedures or administrative

appeals for each count in your complaint. If the grievance procedures were not available for

any of your counts, fully explain why 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. Failure to sign the

complaint will delay the processing of your action. Unless you are an attorney, you may not bring

an action on behalf of anyone but yourself.

FINAL NOTE

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

being stricken or dismissed. All questions must be answered concisely in the proper space on the

form. If you need more space, you may attach no more than fifteen additional pages. But the form

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.

Case 2:13-cv-01876-DLR Document 8 Filed 02/12/14 Page 13 of 19
Revised 5/1/2013 1 550/555

Name and Prisoner/Booking Number

Place of Confinement

Mailing Address

City, State, Zip Code

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

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)

(1) , )

(Full Name of Defendant) )

(2) , )

) CIVIL RIGHTS COMPLAINT

(3) ,) BY A PRISONER

)

(4) , ) G Original Complaint

Defendant(s). ) G First Amended Complaint

G Check if there are additional Defendants and attach page 1-A listing them. ) G Second Amended Complaint

A. JURISDICTION

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

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

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

G Other: .

2. Institution/city where violation occurred: .

Case 2:13-cv-01876-DLR Document 8 Filed 02/12/14 Page 14 of 19
2

B. DEFENDANTS

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

at .

(Position and Title) (Institution)

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

at .

(Position and Title) (Institution)

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

at .

(Position and Title) (Institution)

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

at .

(Position and Title) (Institution)

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

C. PREVIOUS LAWSUITS

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

2. If yes, how many lawsuits have you filed? . Describe the previous lawsuits:

a. First prior lawsuit:

1. Parties: v. 

2. Court and case number: .

3. Result: (Was the case dismissed? Was it appealed? Is it still pending?)

.

b. Second prior lawsuit:

1. Parties: v. 

2. Court and case number: .

3. Result: (Was the case dismissed? Was it appealed? Is it still pending?)

.

c. Third prior lawsuit:

1. Parties: v. 

2. Court and case number: .

3. Result: (Was the case dismissed? Was it appealed? Is it still pending?)

.

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

Case 2:13-cv-01876-DLR Document 8 Filed 02/12/14 Page 15 of 19
3

D. CAUSE OF ACTION

COUNT I

1. State the constitutional or other federal civil right that was violated: 

.

2. Count I. Identify the issue involved. Check only one. State additional issues in separate counts.

G Basic necessities 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 that violated your rights. State the facts clearly in your own words without citing legal

authority or arguments.

.

4. Injury. State how you were 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 at any level, briefly explain why you

did not. 

.

Case 2:13-cv-01876-DLR Document 8 Filed 02/12/14 Page 16 of 19
4

COUNT II

1. State the constitutional or other federal civil right that was violated: 

.

2. Count II. Identify the issue involved. Check only one. State additional issues in separate counts.

G Basic necessities 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 that violated your rights. State the facts clearly in your own words without citing legal

authority or arguments.

.

4. Injury. State how you were 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 at any level, briefly explain why you

did not. 

.

Case 2:13-cv-01876-DLR Document 8 Filed 02/12/14 Page 17 of 19
5

COUNT III

1. State the constitutional or other federal civil right that was violated: 

.

2. Count III. Identify the issue involved. Check only one. State additional issues in separate counts.

G Basic necessities 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 that violated your rights. State the facts clearly in your own words without citing legal

authority or arguments.

.

4. Injury. State how you were 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 at any 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.

Case 2:13-cv-01876-DLR Document 8 Filed 02/12/14 Page 18 of 19
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E. REQUEST FOR RELIEF

State the relief you are seeking:

.

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 you need more space, you may attach

no more than fifteen additional pages. But the form 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 all pages.

Case 2:13-cv-01876-DLR Document 8 Filed 02/12/14 Page 19 of 19