Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_08-cv-02289/USCOURTS-azd-2_08-cv-02289-0/pdf.json

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

---

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

1

 “Doc.#” refers to the docket number of filings in this case.

JDDL-K

WO SC

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Ronald Smith, 

Plaintiff, 

vs.

Maricopa County Jail, et al., 

Defendants. 

)

)

)

)

)

)

)

)

)

)

)

No. CV 08-2289-PHX-MHM (DKD)

ORDER

Plaintiff Ronald Smith, who is confined in the Towers Jail in Phoenix, Arizona, filed

a pro se civil rights Complaint pursuant to 42 U.S.C. § 1983 and an Application to Proceed

In Forma Pauperis. (Doc.# 1, 3.)1

 Plaintiff then filed a First Amended Complaint and

another Application to Proceed In Forma Pauperis. (Doc.# 4, 5.) The First Amended

Complaint supercedes the Complaint in its entirety and the Complaint is not considered by

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

(Doc.# 4.) 

I. Application to Proceed In Forma Pauperis and Filing Fee

Plaintiff’s first Application to Proceed In Forma Pauperis will be granted, doc.# 3,

and the second will be denied as moot, doc.# 5. 28 U.S.C. § 1915(a). Plaintiff must pay the

statutory filing fee of $350.00. 28 U.S.C. § 1915(b)(1). The Court will not assess an initial

partial filing fee. 28 U.S.C. § 1915(b)(1). The statutory fee will be collected monthly in

Case 2:08-cv-02289-MHM--DKD Document 6 Filed 01/21/09 Page 1 of 19
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

JDDL-K - 2 -

payments of 20% of the previous month’s income each time the amount in the account

exceeds $10.00. 28 U.S.C. § 1915(b)(2). The Court will enter a separate Order requiring the

appropriate government agency to collect and forward the fees according to the statutory

formula. 

II. 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

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 Complaint

will be dismissed for failure to state a claim with leave to amend because the Complaint may

possibly be saved by amendment.

III. First Amended Complaint

Plaintiff alleges three counts for relief in which he purports to incorporate claims

alleged in the original Complaint without setting forth any facts in the First Amended

Complaint. Plaintiff sues the Maricopa County Jail, Lower Buckeye Jail “Medical”, Fourth

Avenue Jail staff, and “entire medical staff.” Plaintiff does not state the relief sought. 

IV. Failure to Comply with Rules and Instructions in the First Amended Complaint

Plaintiff has failed to comply with the rules and instructions for completing the courtapproved form complaint. Rule 8(a) of the Federal Rules of Civil Procedure requires that a

complaint contain “a short and plain statement of [each] claim showing that the pleader is

Case 2:08-cv-02289-MHM--DKD Document 6 Filed 01/21/09 Page 2 of 19
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

JDDL-K - 3 -

entitled to relief.” Fed.R.Civ.P. Rule 8(e)(1) provides that “[e]ach averment of a pleading

shall be simple, concise, and direct.” Fed.R.Civ.P. To comply with Rule 8, a plaintiff should

set forth “who is being sued, for what relief, and on what theory, with enough detail to guide

discovery.” McHenry v. Renne, 84 F.3d 1172, 1177 (9th Cir. 1996). Under the Local

Rules, a plaintiff may not incorporate by reference claims or allegations contained in a prior

pleading. Instead, he must re-allege all facts and claims for which he seeks relief. LR Civ.

15.1(b) (an “amended pleading is not to incorporate by reference any part of the preceding

pleading[.]”) The Instructions for completing the court-approved form complaint states in

relevant part that:

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.

(Instructions at ¶ 1) (italics added). In addition, the Instructions provide that: 

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.

(Id., part C) (italics added). 

In the First Amended Complaint, Plaintiff fails to set forth the relief he seeks or how,

when, where, or by whom he believes his constitutional rights were violated. Instead, he

merely purports to incorporate by reference the facts alleged in his Complaint. As stated

above, a plaintiff may not incorporate by reference allegations contained in a prior complaint.

Case 2:08-cv-02289-MHM--DKD Document 6 Filed 01/21/09 Page 3 of 19
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

JDDL-K - 4 -

The First Amended Complaint otherwise fails to comply with the instruction that “all

questions must be answered clearly and concisely in the appropriate space on the form.” For

these reasons, the First Amended Complaint will be dismissed. 

Plaintiff will be provided an opportunity to submit a second amended complaint that

complies with the Instructions and rules. Plaintiff should carefully follow the Instructions

in completing a second amended complaint. He should set forth only one claim per count.

For each count, Plaintiff should summarize facts to support the constitutional right violated,

by whom, when and where, and how each defendant violated the right. 

V. Failure to State a Claim

In addition to non-compliance with the Instructions and rules, the First Amended

Complaint fails 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). In addition, to state

a valid constitutional claim, a plaintiff must 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. Failure to Name Proper Defendants

To state a claim under § 1983, a plaintiff must sue a “person” who, acting under color

of state law, violated the plaintiff’s constitutional rights. None of the Defendants named by

Plaintiff is a “person” within the meaning of § 1983. 

A “person” for purposes of § 1983, includes officials or officers who directly violated

or caused a violation of a plaintiff’s constitutional rights. In addition, a supervisor “is only

liable for constitutional violations of his subordinates if the supervisor participated in or

directed the violations, or knew of the violations and failed to act to prevent them.” Taylor

v. List, 880 F.2d 1040, 1045 (9th Cir. 1989). Further, Rule 10(a) of the Federal Rules of

Civil Procedure requires a plaintiff to include the names of the parties in the action. As a

practical matter, it is impossible in most instances for the United States Marshal or his

Case 2:08-cv-02289-MHM--DKD Document 6 Filed 01/21/09 Page 4 of 19
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

2

 The Ninth Circuit has held that where identity is unknown prior to the filing of a

complaint, the plaintiff should be given an opportunity through discovery to identify the

unknown defendants, unless it is clear that discovery would not uncover the identities, or that

the complaint would be dismissed on other grounds. Wakefield v. Thompson, 177 F.3d

1160, 1163 (9th Cir. 1999) (citing Gillespie v. Civiletti, 629 F.2d 637, 642 (9th Cir. 1980)).

3

 In Arizona, the responsibility for operating jails and caring for prisoners is placed

by law upon the county sheriff, see A.R.S. §§ 11-441(A)(5), 31-101, while the responsibility

for providing medical care for prisoners is placed by law on the county, see A.R.S. §§ 11-

251(8), 11-291(A).

JDDL-K - 5 -

designee to serve a summons and complaint or amended complaint upon an anonymous or

unnamed defendant. That is, a plaintiff must sue the “persons” responsible, not “staff” or

fictitiously-named defendants.2

In addition to individual officers, a municipality is also a “person” for purposes of

§ 1983, i.e., municipality such as a city of county may be sued.3

 See Leatherman v. Tarrant

County Narcotics Intelligence and Coordination Unit, 507 U.S. 163, 166 (1993); Monell v.

Dep’t of Soc. Servs., 436 U.S. 658, 694 (1978). To state a claim against a municipality under

§ 1983, a plaintiff must allege facts to support that his constitutional rights were violated

pursuant to a policy or custom of the municipality. Cortez v. County of Los Angeles, 294

F.3d 1186, 1188 (9th Cir. 2001) (citing Monell, 436 U.S. at 690-91; Thompson v. City of Los

Angeles, 885 F.2d 1439, 1443 (9th Cir. 1989). Therefore, a plaintiff cannot state a § 1983

claim against a municipal defendant unless he alleges that the municipal defendant

maintained a policy or custom pertinent to the plaintiff’s alleged injury and explains how

such policy or custom caused his injury. Sadoski v. Mosley, 435 F.3d 1076, 1080 (9th Cir.

2006) (affirming dismissal of a municipal defendant pursuant to Fed. R. Civ. P. 12(b)(6)).

Plaintiff sues only Jail facilities, or departments thereof, and unidentified “staff.”

None of the Defendants is a “person” within the meaning of § 1983 and they will accordingly

be dismissed. 

B. Medical Claims

It appears that Plaintiff wishes to seek relief for constitutionally deficient medical

care, although as discussed above, he failed to set forth any facts in support any claim. For

Case 2:08-cv-02289-MHM--DKD Document 6 Filed 01/21/09 Page 5 of 19
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

JDDL-K - 6 -

that reason, the Court informs Plaintiff of the following requirements to state a claim for

constitutionally deficient medical care.

To state a claim for denial of constitutionally adequate medical care, a plaintiff must

allege facts to support that he has or had a serious medical need and that a particular

defendant acted with deliberate indifference to that need. See Estelle v. Gamble, 429 U.S.

97, 104-05 (1976); Lolli v. County of Orange, 351 F.3d 410, 418-19 (9th Cir. 2003). To

allege a serious medical need, a plaintiff must set forth facts to support that the “failure to

treat a prisoner’s condition could result in further significant injury or the ‘unnecessary and

wanton infliction of pain.’” Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006) (quoting

McGuckin v. Smith, 974 F.2d 1050, 1059 (9th Cir. 1991), overruled on other grounds by

WMX Techs, Inc. v. Miller, 104 F.3d 1133 (9th Cir. 1997) (en banc)). A plaintiff must also

allege facts to support that a defendant was deliberately indifferent to a serious medical need.

“Deliberate indifference is a high legal standard.” Toguchi v. Chung, 391 F.3d 1051, 1060

(9th Cir. 2004). Deliberate indifference may occur if “prison officials deny, delay or

intentionally interfere with medical treatment.” Hutchinson v. United States, 838 F.2d 390,

394 (9th Cir.1988). Mere negligence, however, “in diagnosing or treating a medical

condition, without more, does not violate a prisoner’s Eighth Amendment rights.” Lopez,

203 F.3d at 1132 (quoting Hutchinson, 838 F.2d at 394). Further, a delay in receiving

medical care, without more, is insufficient to state a claim against a jailor for deliberate

indifference unless the plaintiff can show that the delay in treatment harmed him. Shapley

v. Nevada Bd. of State Prison Comm’rs, 766 F.2d 404, 407 (9th Cir. 1985). A difference in

medical opinion also does not amount to deliberate indifference. See Toguchi, 391 F.3d at

1058. Rather, to prevail on a claim involving choices between alternative courses of

treatment, a prisoner must show that the chosen course was medically unacceptable under

the circumstances and was chosen in conscious disregard of an excessive risk to the

prisoner’s health. Id. Similarly, differences in judgment between an inmate and prison

medical personnel regarding appropriate medical diagnosis or treatment are not enough to

state a deliberate indifference claim. Sanchez v. Vild, 891 F.2d 240, 242 (9th Cir. 1989).

Case 2:08-cv-02289-MHM--DKD Document 6 Filed 01/21/09 Page 6 of 19
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

JDDL-K - 7 -

VI. 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 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 prior complaints

by reference. Plaintiff may include only one claim per count. 

A second amended complaint supersedes all prior complaints. 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 previous complaints as

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

complaint is waived if it is not raised in a second amended complaint. King v. Atiyeh, 814

F.2d 565, 567 (9th Cir. 1987).

VII. 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.

Case 2:08-cv-02289-MHM--DKD Document 6 Filed 01/21/09 Page 7 of 19
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

JDDL-K - 8 -

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, 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 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) Plaintiff’s Application to Proceed In Forma Pauperis, filed with the Complaint,

is granted. (Doc.# 3.)

(2) As required by the accompanying Order to the appropriate government agency,

Plaintiff must pay the $350.00 filing fee, but is not assessed an initial partial filing fee.

(3) Plaintiff’s second Application to Proceed In Forma Pauperis is denied as

moot. (Doc.# 5.)

(4) The First Amended Complaint is dismissed for failure to state a claim.

Plaintiff has 30 days from the date this Order is filed to file a first amended complaint in

Case 2:08-cv-02289-MHM--DKD Document 6 Filed 01/21/09 Page 8 of 19
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

JDDL-K - 9 -

compliance with this Order. (Doc.# 4.)

(5) If Plaintiff fails to file an 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).

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

rights complaint by a prisoner.

DATED this 15th day of January, 2009.

Case 2:08-cv-02289-MHM--DKD Document 6 Filed 01/21/09 Page 9 of 19
Revised 3/9/07 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 Fee. The filing fee for this action is $350.00. If you are unable to immediately

pay the filing fee, 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 $350 filing

fee or the application to proceed in forma pauperis to:

Case 2:08-cv-02289-MHM--DKD Document 6 Filed 01/21/09 Page 10 of 19
2

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 courtapproved 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 2:08-cv-02289-MHM--DKD Document 6 Filed 01/21/09 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 2:08-cv-02289-MHM--DKD Document 6 Filed 01/21/09 Page 12 of 19
4

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 2:08-cv-02289-MHM--DKD Document 6 Filed 01/21/09 Page 13 of 19
Revised 3/9/07 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 2:08-cv-02289-MHM--DKD Document 6 Filed 01/21/09 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 2:08-cv-02289-MHM--DKD Document 6 Filed 01/21/09 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 2:08-cv-02289-MHM--DKD Document 6 Filed 01/21/09 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 2:08-cv-02289-MHM--DKD Document 6 Filed 01/21/09 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 2:08-cv-02289-MHM--DKD Document 6 Filed 01/21/09 Page 18 of 19
6

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 2:08-cv-02289-MHM--DKD Document 6 Filed 01/21/09 Page 19 of 19