Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_23-cv-02525/USCOURTS-azd-2_23-cv-02525-3/pdf.json

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

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JL

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IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Dayshaun Darion Conner,

Plaintiff, 

v. 

K. Taylor, et al.,

Defendants.

No. CV-23-02525-PHX-JAT (JZB)

ORDER

On December 5, 2023, pro se Plaintiff Dayshaun Darion Conner, who is confined 

in the Arizona State Prison Complex-Lewis (ASPC-Lewis), filed a civil rights Complaint 

pursuant to 42 U.S.C. § 1983 and an Application to Proceed In Forma Pauperis. In a 

January 10, 2024 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 January 12, 2024, Plaintiff filed his First Amended Complaint. In a March 26, 

2024 Order, the Court dismissed the First Amended Complaint because Plaintiff had failed 

to state a claim. The Court gave Plaintiff 30 days to file a second amended complaint that 

cured the deficiencies identified in the Order. The Court warned Plaintiff that the Clerk of 

Court would enter a judgment of dismissal with prejudice if he failed to timely file a second 

amended complaint.

Not having received a second amended complaint or a motion for extension of time, 

on May 10, 2024, the Clerk of Court entered a Judgment of dismissal with prejudice. The 

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Clerk of Court sent the May 10, 2024 Judgment to Plaintiff at his address of record. On 

May 13, 2024, the mail was returned as undeliverable because Plaintiff was out to court in 

Maricopa County.

On August 21, 2024, Plaintiff filed a “Motion for Excusable Neglect Pursuant to 

FRCP 60(b)(1) and (6), Prayer to Reopen Case and for Leave to File a Second Amended 

Complaint” and lodged a proposed Second Amended Complaint. In an October 11, 2024 

Order, the Court construed the Motion as a Motion for Relief from Judgment pursuant to 

Rule 60(b) of the Federal Rules of Civil Procedure, granted the Motion, and directed the 

Clerk of Court to vacate the May 10, 2024 Judgment, and reopen this case. Because 

Plaintiff stated in his Motion that he never received the March 26, 2024 Order and did not 

have the benefit of that Order when he filed the lodged proposed Second Amended 

Complaint, the Court directed the Clerk of Court not to file the lodged proposed Second 

Amended Complaint and gave Plaintiff 30 days to file a Second Amended Complaint that 

cured the deficiencies identified in the March 26 Order.

On October 29, 2024, Plaintiff filed a Second Amended Complaint (Doc. 15). The 

Court will dismiss the Second Amended Complaint with leave to amend.

I. Statutory Screening of Prisoner Complaints

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

against a governmental entity or an officer or an employee of a governmental entity. 28 

U.S.C. § 1915A(a). The Court must dismiss a complaint or portion thereof if a plaintiff 

has raised claims that are legally frivolous or malicious, that fail to state a claim upon which 

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

such relief. 28 U.S.C. § 1915A(b)(1)–(2). 

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 

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(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 will dismiss Plaintiff’s Second Amended Complaint 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. Second Amended Complaint 

In his three-count Second Amended Complaint, Plaintiff sues Sergeant Kimo 

Taylor, Corporal Christopher Carter, and Correctional Officer Doe #1. Plaintiff asserts 

excessive force claims. He seeks monetary relief.

Plaintiff alleges the following:

On October 12, 2023, Plaintiff was secured in handcuffs, leg irons, and shackles, 

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and was strapped down and secured in a mobile restraint chair. Plaintiff was incapable of 

moving and posed no physical threat to anyone. While Plaintiff was restrained, Defendants

Taylor, Carter, and Doe #1 all lunged at and slammed into Plaintiff. Defendant Taylor

placed Plaintiff in a “choke hold” and “aggressively chok[ed]” Plaintiff for “what seemed 

like long minutes,” causing him extreme anxiety, apprehension, and panic. Plaintiff 

“legitimately feared for his life and thought he was going to be killed, choked to death.” 

“Then later,” Defendant Taylor “aggressively grabbed” Plaintiff’s neck and lower face area 

and twisted his head and neck at an angle in a manner that again cut off his air supply and 

made it difficult for him to breathe. 

Defendant Carter pushed Plaintiff’s head and neck between his legs and Carter 

“aggressively str[uck]” Plaintiff with a closed fist on the side of his head, causing Plaintiff 

to lose vision and nearly lose consciousness. Defendant Carter “appl[ied] his full body 

weight” on Plaintiff’s head and neck, causing unbearable pain. 

Defendant Doe #1 “aggressively” restrained Plaintiff’s legs and then let go, drew 

his handheld taser, and asked, “Should I tase him?” Defendant Doe #1 tased Plaintiff in 

his lower body, causing him anxiety, apprehension, and panic, as Plaintiff “legitimat[ely] 

feared for [his] life and thought [he] was going to be killed, tased to death.” Defendants 

Taylor, Carter, and Doe #1 “swapp[ed] with new officers” and left the holding cell. 

As a result of the “altercation,” Plaintiff suffered multiple cuts, bruises, and 

lacerations to his neck, shoulders, back, legs, and wrist. Plaintiff felt humiliated and 

degraded and suffered extreme anxiety, stress, and emotional turmoil while he thought he 

was going to be killed and could not breathe. “To this day,” Plaintiff continues to suffer 

extreme anxiety, difficulty sleeping, and often awakes from night sweats and terror, feeling 

like he is suffocating. Plaintiff also has difficulty “dealing with[] and being around staff 

where any sudden movement or loud noises cause[] [him] severe anxiety and paranoia.” 

III. Failure to State a Claim

To prevail in a § 1983 claim, a plaintiff must show that (1) acts by the defendants 

(2) under color of state law (3) deprived him of federal rights, privileges or immunities and 

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(4) caused him damage. Thornton v. City of St. Helens, 425 F.3d 1158, 1163-64 (9th Cir. 

2005) (quoting Shoshone-Bannock Tribes v. Idaho Fish & Game Comm’n, 42 F.3d 1278, 

1284 (9th Cir. 1994)). In addition, 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).

When an inmate claims that prison officials violated his Eighth Amendment rights 

by using excessive physical force, the relevant inquiry is “whether force was applied in a 

good-faith effort to maintain or restore discipline, or maliciously and sadistically to cause 

harm.” Hudson v. McMillian, 503 U.S. 1, 7 (1992). However, the Supreme Court has 

made it clear that not every use of physical force violates the Eighth Amendment:

That is not to say that every malevolent touch by a prison guard 

gives rise to a federal cause of action. See Johnson v. Glick, 

481 F.2d [1028, 1033 (2nd Cir. 1973)] (“Not every push or 

shove, even if it may later seem unnecessary in the peace of a 

judge’s chambers, violates a prisoner’s constitutional rights”). 

Id. at 9.

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, 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.

Plaintiff’s allegations are too vague to state an excessive force claim. Plaintiff does 

not state why he had been handcuffed, shackled, and placed in a restraint chair, and he does 

not state what happened just before Defendants allegedly lunged at and slammed into him. 

Without additional information, the Court cannot reasonably infer that the force used was 

applied maliciously and sadistically to cause harm.1 Plaintiff has primarily recited the 

1 The Court notes that Plaintiff was convicted in Maricopa County Superior Court, 

case #CR-2024101574, of aggravated assault, with an offense date of October 12, 2023. 

See https://www.superiorcourt.maricopa.gov/docket/CriminalCourtCases/caseInfo.asp?

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elements of an excessive force claim, but that is insufficient to state a claim. See Iqbal, 

556 U.S. at 678. As presented, Plaintiff fails to state a claim in the Second Amended 

Complaint, and it will be dismissed. 

IV. Leave to Amend

For the foregoing reasons, the Court will dismiss Plaintiff’s Second Amended 

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

Plaintiff may submit a third amended complaint to cure the deficiencies outlined above. 

The Clerk of Court will mail Plaintiff a court-approved form to use for filing a third

amended complaint. If Plaintiff fails to use the court-approved form, the Court may strike 

the third 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 “Third

Amended Complaint.” The third 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 or prior Amended Complaints by reference. Plaintiff may include only one 

claim per count.

A third amended complaint supersedes the original Complaint and prior Amended 

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 the original Complaint and prior Amended Complaints as nonexistent. Ferdik, 

963 F.2d at 1262. Any cause of action that was raised in the original Complaint or prior 

Amended Complaints and that was voluntarily dismissed or was dismissed without 

prejudice is waived if it is not alleged in a third amended complaint. Lacey v. Maricopa 

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

Plaintiff should note that a prisoner’s claim for damages cannot be brought under 

42 U.S.C. § 1983 if “a judgment in favor of the plaintiff would necessarily imply the 

caseNumber=CR2024-101574 (last accessed Dec. 17, 2024). In addition, according to 

Plaintiff’s online inmate record, on October 12, 2023, he was charged with disorderly 

conduct and assault on staff that did not involve serious injury and was found guilty of both 

charges. See https://corrections.az.gov/inmate-data-search (search by Inmate Number 

304527) (last accessed Dec. 17, 2024).

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invalidity of his conviction or sentence,” unless the prisoner demonstrates that the 

conviction or sentence has previously been reversed, expunged, or otherwise invalidated. 

Heck v. Humphrey, 512 U.S. 477, 486-87 (1994).

V. Warnings

A. Release

If Plaintiff is released while this case remains pending, and the filing fee has not 

been paid in full, Plaintiff must, within 30 days of his release, either (1) notify the Court 

that he intends to pay the unpaid balance of his filing fee within 120 days of his release or 

(2) file a non-prisoner application to proceed in forma pauperis. 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. Possible “Strike”

Because the Second Amended Complaint has been dismissed for failure to state a 

claim, if Plaintiff fails to file a third amended complaint correcting the deficiencies 

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). 

D. Possible Dismissal

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

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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 Second Amended Complaint (Doc. 15) is dismissed for failure to state 

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

complaint in compliance with this Order.

(2) If Plaintiff fails to file a third 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) 

and deny any pending unrelated motions as moot.

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

rights complaint by a prisoner.

Dated this 20th day of December, 2024.

Case 2:23-cv-02525-JAT--JZB Document 17 Filed 12/23/24 Page 8 of 18
Revised 11/6/24 

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 $405.00 ($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 

$405 filing and administrative fees or the application to proceed in forma pauperis to:

Case 2:23-cv-02525-JAT--JZB Document 17 Filed 12/23/24 Page 9 of 18
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. 

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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 2:23-cv-02525-JAT--JZB Document 17 Filed 12/23/24 Page 11 of 18
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 2:23-cv-02525-JAT--JZB Document 17 Filed 12/23/24 Page 12 of 18
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 2:23-cv-02525-JAT--JZB Document 17 Filed 12/23/24 Page 13 of 18
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: 

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 2:23-cv-02525-JAT--JZB Document 17 Filed 12/23/24 Page 16 of 18
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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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