Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_24-cv-00509/USCOURTS-azd-2_24-cv-00509-0/pdf.json

Nature of Suit Code: 555
Nature of Suit: Prisoner - Prison Condition
Cause of Action: 28:1331 Federal Question: Bivens Act

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JL

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IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Derek Bluford,

Plaintiff, 

v. 

United States of America,

Defendant.

No. CV-24-00509-PHX-JAT (ASB)

ORDER

Plaintiff Derek Bluford, who is confined in the United States Penitentiary-Lompoc, 

has filed a pro se Verified Complaint pursuant the Federal Tort Claims Act and the 

Rehabilitation Act (Doc. 1) and paid the filing and administrative fees. The Court will 

dismiss the 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). 

Local Rule of Civil Procedure 3.4 requires in part that “[a]ll complaints . . . by 

incarcerated persons must be signed and legibly written or typewritten on forms approved 

by the Court and in accordance with the instructions provided with the forms.” Plaintiff’s 

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Complaint is not on the court-approved form. The Court may, in its discretion, forgo the 

requirement that a plaintiff use a court-approved form. See LRCiv 3.4. The Court will 

require use of the court-approved form here because Plaintiff’s Complaint does not 

substantially comply with the requirements of the court-approved form. Plaintiff’s 

Complaint will be dismissed without prejudice and with leave to amend.

II. Leave to Amend

Within 30 days, Plaintiff may submit a first amended complaint to cure the 

deficiencies outlined above. The Clerk of Court will mail Plaintiff a court-approved form 

to use for filing a first 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 “First 

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

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

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

A first amended complaint supersedes the original 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 

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

original Complaint and that was voluntarily dismissed or was dismissed without prejudice 

is waived if it is not alleged in a first amended complaint. Lacey v. Maricopa County, 693 

F.3d 896, 928 (9th Cir. 2012) (en banc).

The Court notes that Plaintiff’s Complaint comprises 32 pages and includes legal 

arguments. The court-approved form Complaint is six pages long and both the form 

Complaint and accompanying instructions permit an inmate to attach “no more than 

fifteen additional pages” of standard letter-sized paper. (Instructions at 1 ¶ 2). A 

document that complies with Local Rule of Civil Procedure 3.4, therefore, would be no 

longer than 21 pages. In addition, the court-approved form provides that a plaintiff should 

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state as briefly as possible the facts supporting each claim by describing exactly what each 

Defendant did or did not do that violated the plaintiff’s rights. The form further provides, 

“State the facts clearly in your own words without citing legal authority or arguments.” 

Therefore, if Plaintiff files an amended complaint, he should not cite legal authority or 

make legal arguments to support his claims.

III. Warnings

A. 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.

B. 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 Complaint (Doc. 1) is dismissed for failure to comply with Rule 3.4 of 

the Local Rules of Civil Procedure. Plaintiff has 30 days from the date this Order is filed 

to file a first amended complaint in compliance with this Order.

(2) 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 without

prejudice and deny any pending unrelated motions as moot.

. . . .

. . . .

. . . .

. . . .

. . . .

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

civil rights complaint by a prisoner.

Dated this 10th day of April, 2024.

Case 2:24-cv-00509-JAT--ASB Document 3 Filed 04/10/24 Page 4 of 14
Revised 12/1/23 

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 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 $455.00 ($350.00 filing 

fee plus $55.00 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. This section does not apply to 

inmates housed at an Arizona Department of Corrections facility that participates in 

electronic filing.

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. Unless you are an inmate housed at an Arizona Department of Corrections facility 

that participates in electronic filing, mail the original and one copy of the complaint with the 

$455 filing and administrative fees or the application to proceed in forma pauperis to:

Case 2:24-cv-00509-JAT--ASB Document 3 Filed 04/10/24 Page 5 of 14
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. This section does not apply to inmates housed at an Arizona Department 

of Corrections facility that participates in electronic filing. 

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 within 21 days after serving it or within 21 days after any defendant has 

filed an answer, whichever is earlier. See Fed. R. Civ. P. 15(a). Thereafter, 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 2:24-cv-00509-JAT--ASB Document 3 Filed 04/10/24 Page 6 of 14
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 2:24-cv-00509-JAT--ASB Document 3 Filed 04/10/24 Page 7 of 14
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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 2:24-cv-00509-JAT--ASB Document 3 Filed 04/10/24 Page 8 of 14
Revised 12/1/23 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, 

v. 

(1) _______________________________________ , 

(Full Name of Defendant) 

(2) _______________________________________ , 

(3) _______________________________________ , 

(4) _______________________________________ , 

Defendant(s). 

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

CASE NO. __________________________________ 

 (To be supplied by the Clerk) 

CIVIL RIGHTS COMPLAINT 

BY A PRISONER 

G Original Complaint 

G First Amended Complaint 

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 2:24-cv-00509-JAT--ASB Document 3 Filed 04/10/24 Page 9 of 14
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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: 

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.

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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. 

. 

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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 2:24-cv-00509-JAT--ASB Document 3 Filed 04/10/24 Page 12 of 14
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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.

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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. 

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