Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_20-cv-00872/USCOURTS-azd-2_20-cv-00872-0/pdf.json

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

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WO SC

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Daniel Alan Kleinfelt,

Plaintiff, 

v. 

Correctional Officer III Gilbert, et al.,

Defendants.

No. CV 20-00872-PHX-JAT (JFM)

ORDER

Plaintiff Daniel Alan Kleinfelt, who is confined in the Arizona State Prison 

Complex-Lewis, in Buckeye, Arizona, has filed a pro se civil rights Complaint pursuant to 

42 U.S.C. § 1983 (Doc. 1) and an Application to Proceed In Forma Pauperis (Doc. 2).1 The 

Court will dismiss the Complaint with leave to amend.2

I. Application to Proceed In Forma Pauperis and Filing Fee

The Court will grant Plaintiff’s Application to Proceed In Forma Pauperis. 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 assess an initial partial filing fee of $38.72. The remainder 

1

 Plaintiff filed a previous case, Kleinfelt v. Gilbert, No. 2:20cv00793-PHX-JAT 

(JFM), in which he filed a notice of change of address indicating that he is now incarcerated 

in the Arizona State Prison Complex-Tucson. Plaintiff has not, to date, filed a notice of 

change of address in this case and must do so if his address has changed.

2

 If Plaintiff is granted in forma pauperis status in his previously filed case, CV 20-

00793, he will be responsible for paying the filing fee for both this case and that case. In 

that event, the Court would be required to collect 20% of Plaintiff’s previous month’s 

income, for each case, each month. Bruce v. Samuels, ___ U.S. ___, ___, 136 S. Ct. 627, 

631 (2016) (“[Section] 1915(b)(2) calls for simultaneous, not sequential recoupment of 

multiple filing fees.”).

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of the fee will be collected monthly in payments of 20% of the previous month’s income 

credited to Plaintiff’s trust account 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). 

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

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

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

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

conclusory statements, do not suffice.” Id.

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

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

550 U.S. 544, 570 (2007)). A claim is plausible “when the plaintiff pleads factual content 

that allows the court to draw the reasonable inference that the defendant is liable for the 

misconduct alleged.” Id. “Determining whether a complaint states a plausible claim for 

relief [is] . . . a context-specific task that requires the reviewing court to draw on its judicial 

experience and common sense.” Id. at 679. Thus, although a plaintiff’s specific factual 

allegations may be consistent with a constitutional claim, a court must assess whether there 

are other “more likely explanations” for a defendant’s conduct. Id. at 681.

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

must “continue to construe pro se filings liberally.” Hebbe v. Pliler, 627 F.3d 338, 342 

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(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). 

Plaintiff’s Complaint will be dismissed for failure to state a claim, but because it may 

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

III. Complaint

In his two-count Complaint, Plaintiff alleges claims for denial of due process in 

disciplinary proceedings and wrongful or excessive confinement. Plaintiff sues the 

following employees of the Arizona Department of Corrections (ADC) at the Lewis 

Complex: Correctional Officers (COs) III Gilbert and T. Wade; CO IV Trapanier; and 

Captain Hileman. Plaintiff seeks injunctive, compensatory, and punitive relief.

Plaintiff alleges the following facts in Count I:

On April 28, 2020, Plaintiff had a disciplinary hearing on three incidents. Prior to 

the hearing, Plaintiff requested staff assistance because he had been placed in segregation, 

which prevented Plaintiff from preparing a defense to the charges. The Disciplinary 

Hearing Officer (DHO) said “too bad.” Prior to the hearing, Plaintiff also asked whether 

he had to convince DHO that he was not guilty, and the DHO responded, “yes.” Plaintiff 

claims the DHO was not impartial and denied him due process. Plaintiff claims that he 

was charged with the disciplinary infractions in retaliation for submitting grievances and 

complaints. Plaintiff claims that “prison officials” refused to interview or call witnesses, 

which prevented Plaintiff from effectively presenting a defense. Plaintiff claims that the 

denial of staff assistance and the right to be heard significantly hindered Plaintiff’s ability 

to defend himself against the charges. Plaintiff contends that he reasonably relied on ADC 

regulations, and the failure to produce witnesses and comply with its own regulations 

violated his right to due process.

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As his injury, Plaintiff alleges that he was classified from a minimum custody to a 

level 4 custody, lost early release credit (ERC), and experienced physical and mental pain 

and suffering.

In Count II, Plaintiff alleges the following:

On December 17, 2020, Plaintiff brought a concern under the Prison Rape 

Elimination Act (PREA) to an unidentified sergeant and asked for assistance in addressing 

the issue. The same day, Plaintiff was placed in segregation in a detention unit, where 

Plaintiff was held through the filing of his Complaint in this case, awaiting transfer to a 

permanent facility. Plaintiff claims that he has not received a periodic review to determine 

whether his placement in segregation was necessary. He claims that prison officials 

arbitrarily have housed him in segregation, which was clearly excessive. He claims that his 

continued housing in segregation violated a state liberty interest and violated due process. 

He contends that his continued confinement in segregation was retaliatory. 

As his injury, Plaintiff alleges lost wages and physical and mental suffering.

IV. 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 

(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).

A. Defendants

Plaintiff sues four correctional officers employed in the Lewis Complex, Bachman 

Detention Unit. While each of the Defendants may be sued under § 1983, Plaintiff fails to 

state a claim against any of them.

To state a claim against a defendant, “[a] plaintiff must allege facts, not simply 

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conclusions [to] show that an individual was personally involved in the deprivation of his 

civil rights.” Barren v. Harrington, 152 F.3d 1193, 1194 (9th Cir. 1998). For an individual 

to be liable in his or her official capacity, a plaintiff must allege injuries resulting from a 

policy, practice, or custom of the agency over which that individual has final policy-making 

authority. See Cortez v. County of Los Angeles, 294 F.3d 1186, 1188 (9th Cir. 2002). In 

addition, there is no respondeat superior liability under § 1983, so a defendant’s position 

as the supervisor of someone who allegedly violated a plaintiff’s constitutional rights, 

absent more, does not make him liable. Monell v. Dep’t of Soc. Servs., 436 U.S. 658, 691 

(1978); Taylor v. List, 880 F.2d 1040, 1045 (9th Cir. 1989). A supervisor in his personal 

capacity “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, 880 F.2d at 1045. Further, under Ninth Circuit law, a defendant 

can be liable for failure to act. Id. 

Plaintiff fails to allege any facts against any of the named Defendants. For that 

reason, he fails to state a claim for relief against any named Defendant, and they will be 

dismissed.

B. Count I

1. Heck v. Humphrey

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 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). See also Wilkinson v. Dotson, 544 U.S. 74, 81-82 (2005) (“[A] 

state prisoner’s § 1983 action is barred (absent prior invalidation) – no matter the relief 

sought (damages or equitable relief), no matter the target of the prisoner’s suit (state 

conduct leading to conviction or internal prison proceedings)–if success in that action 

would necessarily demonstrate the invalidity of confinement or its duration.”).

Plaintiff alleges that he lost ERC as a result of the disciplinary proceeding he is 

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challenging in Count I. In other words, the finding of guilt affects the duration of Plaintiff’s 

confinement. If Plaintiff succeeded on the merits of his due process claim, that success 

would necessarily demonstrate the invalidity of the duration of his confinement as to the 

loss of good time credit. Plaintiff has not alleged that the disciplinary finding has been 

invalidated, therefore, Plaintiff’s due process claim is barred as not yet having accrued 

under Heck. If Plaintiff files an amended complaint asserting a due process claim, he must 

allege when and how his disciplinary was invalidated.

2. Due Process

Even if Plaintiff’s due process claim is not barred as not having yet accrued, Plaintiff 

fails to state a claim for violation of due process. Liberty interests that entitle an inmate to 

due process are “generally limited to freedom from restraint which, while not exceeding 

the sentence in such an unexpected manner as to give rise to protection by the Due Process 

Clause of its own force, nonetheless imposes atypical and significant hardship on the 

inmate in relation to the ordinary incidents of prison life.” Sandin v. Conner, 515 U.S. 472, 

484 (1995) (internal citations omitted). Thus, “[a]s long as the conditions or degree of 

confinement to which the prisoner is subjected is within the sentence imposed upon him 

and [does] not otherwise violat[]e . . . the Constitution, the Due Process Clause does not in 

itself subject an inmate’ s treatment by prison authorities to judicial oversight.” Montanye 

v. Haymes, 427 U.S. 236, 242 (1976). But a prisoner may challenge a disciplinary action 

that deprives or restrains a state-created liberty interest in some “unexpected manner.” 

Ramirez v. Galaza, 334 F.3d 850, 860 (9th Cir. 2003) (citing Sandin, 515 U.S. at 483-84)). 

However, a claim that prison officials “added things” to an appeal to mask procedural 

errors, for example, is not significant and atypical, because inmates lack a separate 

constitutional entitlement to a specific prison grievance procedure. Id. (citing Mann v. 

Adams, 855 F.2d 639, 640 (9th Cir. 1988)). 

In analyzing whether a hardship is atypical and significant, three guideposts to 

consider are: (1) the conditions of confinement; (2) the duration of the condition and the 

degree of restraint imposed; and (3) whether the sanction will affect the duration of the 

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prisoner’s sentence. Ramirez, 334 F.3d at 861; Keenan v. Hall, 83 F.3d 1083, 1088-89 (9th 

Cir. 1996). “Atypicality” requires not merely an empirical comparison but turns on the 

importance of the right taken away from the prisoner. See Carlo v. City of Chino, 105 F.3d 

493, 499 (9th Cir. 1997); see, e.g., Sandin , 515 U.S. at 472 (30 days disciplinary 

segregation is not atypical and significant); Torres v. Fauver, 292 F.3d 141, 151 (3d Cir. 

2002) (4 months in administrative segregation is not atypical and significant); Griffin v. 

Vaughn, 112 F.3d 703, 706-708 (3d Cir. 1997) (15 months administrative segregation is 

not atypical and significant); Beverati v. Smith, 120 F.3d 500, 504 (4th Cir. 1997) (6 months 

of confinement in especially disgusting conditions that were “more burdensome than those 

imposed on the general prison population were not atypical . . . in relation to the ordinary 

incidents of prison life.”); Jones v. Baker, 155 F.3d 810 (6th Cir. 1998) (two years in 

administrative segregation is not atypical and significant); Jacks v. Crabtree, 114 F.3d 983 

(9th Cir. 1997) (denial of year sentence reduction is not an atypical and significant 

hardship). Thus, to determine whether an inmate is entitled to the procedural protections 

afforded by the Due Process Clause, the Court must look to the particular restrictions 

imposed and ask whether they “‘present the type of atypical, significant deprivation in 

which a state might conceivably create a liberty interest.’” Mujahid v. Meyer, 59 F.3d 931, 

932 (9th Cir. 1995) (quoting Sandin, 515 U.S. at 486).

The Supreme Court has held that a liberty interest may be implicated by disciplinary 

placement in a cell with almost no human contact, 24-hour lighting, and exercise for only 

one hour per day, particularly where the placement is of infinite duration and results in 

disqualification of an otherwise eligible inmate for parole. Wilkinson v. Austin, 545 

U.S.209, 223-24 (2005). In such cases, the type of process due before such a placement 

requires consideration of three factors: (1) the private interest that will be affected by the 

official action; (2) the risk of an erroneous deprivation of such interest through the 

procedures used, and the probable value, if any, of additional or substitute procedural 

safeguards; and (3) the government’s interest, including the function involved and the fiscal 

and administrative burden that the additional or substitute procedural requirement would 

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entail. Id. at 224 (quoting Matthews v. Eldridge, 424 U.S. 319, 335 (1976)). On the first 

factor, prisoners have more than a minimal interest at stake, but lawful confinement entails 

curtailment of liberty by definition. Wilkinson, 545 U.S. at 225. On the second factor, 

notice of the factual basis for the placement and a fair opportunity for rebuttal are among 

the most important procedural mechanisms. Id. at 225-26. A short statement of reasons 

for the placement guards against arbitrary decision-making and multiple levels of review 

also reduces the risk of erroneous placement. Id. at 226. The third factor is dominant due 

to a State’s responsibility for managing numerous inmates and obligations to ensure the 

safety of prison personnel, the public, and the prisoners themselves. Id. at 227. Thus, the 

ability to call witnesses or to provide “other attributes of an adversary hearing” are not

required. Id. at 228. Notice and an opportunity to be heard are sufficient. Id. at 229 (citing 

Greenholtz v. Inmates of Neb. Penal and Corr. Complex, 442 U.S. 1 (1979), and Hewitt v. 

Helms, 459 U.S. 460 (1983)). 

In addition to alleging an atypical and significant hardship in relationship to the 

ordinary incidents of incarceration, a plaintiff must also specify the due process safeguard 

he was denied and by whom. “Prison disciplinary proceedings are not part of a criminal 

prosecution, and the full panoply of rights due a defendant in such proceedings does not 

apply.” Wolff v. McDonnell, 418 U.S. 539, 556 (1974). Procedural due process safeguards 

in a prison disciplinary hearing require that the defendant receive: (1) written notice of the 

charges, no less than twenty-four hours prior to the hearing; (2) a written statement by the 

fact-finder as to the evidence relied on and reasons for the disciplinary action and (3) a 

limited right to call witnesses and present documentary evidence when it would not be

unduly hazardous to institutional safety or correctional goals to allow the defendant to do 

so. Id. at 565-66. In addition, due process requires that there be “some evidence” to 

support the official’s decision. Superintendent v. Hill, 472 U.S. 445, 455 (1985). 

However, this “does not require examination of the entire record, independent assessment 

of the credibility of witnesses, or weighing of the evidence. Instead, the relevant question 

is whether there is any evidence in the record that could support the conclusion.” Hill, 472 

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U.S. at 455-56 (emphasis added). 

Even assuming Plaintiff alleges an atypical and significant hardship in relation to 

the ordinary incidents of incarceration based on the loss of ERC, and that the disciplinary 

charges have been invalidated, Plaintiff fails to allege facts to support that he was denied 

any of the procedural protections required under Wolff. Accordingly, Plaintiff fails to state 

a due process claim. If Plaintiff alleges a due process claim in an amended complaint, he 

must identify the procedural due process he was denied, when, how, and by whom. 

C. Count II

Although unclear, Plaintiff appears to be asserting a claim of retaliation in Count II. 

A viable claim of First Amendment retaliation contains five basic elements: (1) an assertion 

that a state actor took some adverse action against an inmate (2) because of (3) that 

prisoner’s protected conduct, and that such action (4) chilled the inmate’s exercise of his 

First Amendment rights (or that the inmate suffered more than minimal harm) and (5) did 

not reasonably advance a legitimate correctional goal. Rhodes v. Robinson, 408 F.3d 559, 

567-68 (9th Cir. 2005); see also Hines v. Gomez, 108 F.3d 265, 267 (9th Cir. 1997) 

(retaliation claims requires an inmate to show (1) that the prison official acted in retaliation 

for the exercise of a constitutionally protected right, and (2) that the action “advanced no 

legitimate penological interest”). The plaintiff has the burden of demonstrating that his

exercise of his First Amendment rights was a substantial or motivating factor behind the 

defendants’ conduct. Mt. Healthy City Sch. Dist. Bd. of Educ. v. Doyle, 429 U.S. 274, 287 

(1977); Soranno’s Gasco, Inc. v. Morgan, 874 F.2d 1310, 1314 (9th Cir. 1989).

Plaintiff has not alleged facts to support that any Defendant retaliated against him 

for exercising constitutionally protected rights. Accordingly, Plaintiff fails to state a claim 

for retaliation in Count II.

V. Leave to Amend

For the foregoing reasons, Plaintiff’s Complaint will be dismissed for failure to state 

a claim upon which relief may be granted. Within 30 days, Plaintiff may submit a first 

amended complaint to cure the deficiencies outlined above. The Clerk of Court will mail 

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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).

VI. 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 Complaint has been dismissed for failure to state a claim, if Plaintiff 

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fails to file an 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 

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 (Doc. 2) is granted.

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

agency, Plaintiff must pay the $350.00 filing fee and is assessed an initial partial filing fee 

of $38.72.

(3) The Complaint (Doc. 1) 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 compliance 

with this Order.

(4) 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 may count as a “strike” under 28 U.S.C. § 1915(g)

and deny any pending unrelated motions as moot.

. . . .

. . . .

. . . .

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

civil rights complaint by a prisoner.

Dated this 8th day of June, 2020.

Case 2:20-cv-00872-JAT--JFM Document 6 Filed 06/08/20 Page 12 of 22
Revised 3/11/16 1

Instructions for a Prisoner Filing a Civil Rights Complaint 

in the United States District Court for the District of Arizona

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

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

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

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

conviction or sentence, you should file a petition under 28 U.S.C. ' 2254 for a writ of habeas 

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

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

judgment. 

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

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

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

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

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

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

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

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

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

material fact, you may be prosecuted for perjury.

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

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

request leave to proceed in forma pauperis. Please review the “Information for Prisoners Seeking 

Leave to Proceed with a (Non-Habeas) Civil Action in Federal Court In Forma Pauperis Pursuant 

to 28 U.S.C. ' 1915” for additional instructions.

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

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

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

identical to the original. Copies may be legibly handwritten. 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. Mail the original and one copy of the complaint with the $400 filing and 

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

Case 2:20-cv-00872-JAT--JFM Document 6 Filed 06/08/20 Page 13 of 22
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 

court-approved 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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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.

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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 2:20-cv-00872-JAT--JFM Document 6 Filed 06/08/20 Page 16 of 22
Revised 3/11/16 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: .

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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.

Case 2:20-cv-00872-JAT--JFM Document 6 Filed 06/08/20 Page 18 of 22
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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. 

.

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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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