nh EXHAUSTION OF ADMINISTRATIVE REMEDIES

Exhaustion of administrative remedies is required prior to pursuing a civil rights action
regarding conditions or events in any prison, jail, or detention center. 42 U.S.C. § 1997¢e(a).
Plaintiff is warned that any claims for which the administrative grievance process was not
completed prior to filing this lawsuit may be subject to dismissal.

WV. PREVIOUS LAWSUITS

NOTE: FAILURE TO DISCLOSE ALL PRIOR CIVIL CASES MAY RESULT IN THE DISMISSAL OF THIS
CASE. IF YOU ARE UNSURE OF ANY PRIOR CASES YOU HAVE FILED, THAT FACT MUST BE
DISCLOSED AS WELL.

A. Have you initiated other actions in state court dealing with the same or similar
facts/issues involved in this action?
Yes( ) No(

1. Parties to previous action:
(a) Plaintiff(s): wh
(b) Defendant(s): Nv, 7} V4 .

Name of judge: Case #:_ AV
County and judicial circuit: N ] La

T
Approximate filing date: N | fv,

t
If not still pending, date of dismissal: N A
Reason for dismissal: NI Ay

Facts and claims of case: N t A

NOP en

(Attach additional pages as necessary to list state court cases.)

B. Have you initiated other actions in federal court dealing with the same or similar
facts/issues involved in this action?

veh No( )
1. Parties to previous action:
a. Plaintiff(s): CHUstotHEe iM, < Rey

b. Defendant(s): Defur?_@ on) U CALEY

Name of judge: eLi2e@ tty A, OvVECHAVICY Case #:

Approximate filing date: 00, ZoLy

If not still pending, date of dismissal:

Reason for dismissal: SETTLEMENT REACHED BETWEEN OatniEs

Oar ON

3

District and judicial division: MIDDLE DISTRICT o¢ FLOUDA, TAMPA DIvisiDN.


esa

Vi. STATEMENT OF CLAIMS:

State what rights under the Constitution, laws, or treaties of the United States you claim have been violated.
Be specific. Number each separate claim and relate it to the facts alleged in Section V. If claims are not
related to the same basic incident or issue, they must be addressed in a separate civil rights
complaint.

mY 3 AMENDMENT, Cue AND WNUSWAt PUNISHMENT; menicee
LN, ME, Men ID -
CONSPIRACY, BRTTELY RIC ACT, SUPERVISOLY LnBliTY. AS WELL He
Aal/ end te CLAS ZL pwt enced) TD I “Dis Seer.
ASoAUILT  INFLICTion) of EMoTIONAL DISTRESS, PEE ANT
ister REMmENT,

Vil. ~ RELIEF REQUESTED: ~
State briefly what relief you seek from the Court. Do not make legal arguments or cite to cases/ statutes.

Dus 0 ComPleniy OF LéGee [SUES, Cue T RALPOUNTED KewhestiTenes:

| DECLARE UNDER PENALTY OF PERJURY THAT THE FOREGOING STATEMENTS OF FACT,
INCLUDING ALL CONTINUATION PAGES, ARE TRUE AND CORRECT.

Pgutt [82020 bnatple 1 a hana
i“ (Date) (Signature of Plainti

IF MAILED BY PRISONER:

| declare (or certify, verify, or affirm) under penaity of perjury that this complaint was (check one):
‘delivered to prison officials for mailing or 0 Gepestted it in the prison's internal mail system on:

the__/f day of_ August 20.
Df po K ,
hustler U Temes

(Signature of Plaintiffy

Revised 0307

i
i
i



6. Facts and claims of case: Nie

(Attach additional pages as necessary to list cases.)

Vv. STATEMENT OF FACTS: .

State briefly the FACTS of this case. Describe how each Defendant was involved and what each person did
or did not do which gives rise to your claim. In describing what happened, state the names of persons
involved, dates, and places. not make any legal arguments or cite to any cases or statutes. You must set
forth separate factual allegations in separately numbered paragraphs. You may make copies of this page if
necessary to supply all the facts. Barring extraordinary circumstances, no more than five (5) additional pages
should be attached. (If there are facts which are not related to this same basic incident or issue, they
must be addressed in a separate civil rights complaint.)

UPON BEING TANSFERED TO DkFLDNSA COLLECTIONAL INETITUTION WHILE ON)
a

‘2. « oN Because Of CEN TUE! Tew ae
INSTITUTION Exe tenner ROCs Lortd THe institutions water surPLy,
TL was GETING WY Picguré Taven ey L:T MekiTT Any Sle mnpe A FEW
COMMENTS TD ME THIS was 5-l0-2020  APPROKUMATELY \I'30 FM IN tHe Picture
Roo E BulupiWe ENTE Re OE 0, me
Lit. Metitr_abvep me, "Do You HAVE A NuMBed THTTOOED ON You AnywHeree ?,”
=X Repiey “NO, Mum! SHE (UT MERIT) sHATED " BECAUSE You. Look Uke You JUST
CAME FEM Oo COnceNTRATION cAMP! AnD SHHtTeED UWUGHNGr Lot Two OTHE
CraeeemonS oFAcets. cE ReAied "THATS HILARIOUS VE BEEN IN CoN FINETVENT
For Mmost & eases." ste sraveD “war sme BEING Mt Pussy!" or Hen
STATED “aVe BEEN ON CM for GATIERY on AN OFficeR.” Site THen smaTeD
 TDMATD , ToMATo,” AT one PONT TE Tord UT Meuitt a Used to Ge
DT _OYALOOSA CoLECTION At NSTTUTI TION, ~aeree GETTING MY PHT TkeN
x= ws AND IN, Te ie PHOTD
Roo. =r eA) LT. Mere tet oad vrheent THAT HAD ‘A Suey
“ or ER CEN ue a ReHED

EACH ME OUPEETY > WORE To TD STRAIN wl & Le un ale duenl

ons Wa oe (OM ons snap ME ae cas ante henGled W. oFrited Bhi wea haat IN. OFFICEX bby WENT De wa) THE
=

LANE ACPI: "LERItUFES” He PUT MINE ONL THE LePT CUE WR Sp
Tee 10 oS CUTTING DAE CAROLUATION IW oty HAND. HAD ¢tY OeepercrY

IN Pow Case in oly HANDS BHD MY Back, OFFiceEk —THYUK APP PRoAtHeD

5


7. Facts and claims of case:_14 AME WOMENT VIOLATION FoR.

Excéssive USE SF HecE Or A PLETRIAL DETAINEE ASSAULTED BY DFC.

(Attach additional pages as necessary to list other federal court cases.)

Cc. Have you initiated other actions (besides those listed above in Questions (A) and
(B)) in either state or federal court that relate to the fact or manner of your
incarceration (including habeas corpus petitions) or the conditions of your
confinement (including civil rights complaints about any aspect of prison life,
whether it be general circumstances or a particular episode, and whether it involved
excessive force or some other wrong)?

Yes(_ ) No(

If YES, describe each action in the space provided below. If more than one action, describe
all additional cases on a separate piece of paper, using the same format as below.

1. Parties to previous action:

a. Plaintiff(s): Nee

b. Defendant(s): __v i A .
District and judicial division: N. |

Name of judge: AIA Case #: nlp

Approximate filing date: N fos

If not still pending, date of dismissal: 771/ e
Reason for dismissal: ff

Facts and claims of case: Nl fe

NOP YN

(Attach additional pages as necessary to list cases.)

D. Have you ever had any actions in federal court dismissed as frivolous, malicious,
failing to state a claim, or prior to service? If so, identify each and every case so
dismissed:

Yes(_ ) No( A

1. Parties to previous action:
a. Plaintiff(s): ula

b. Defendant(s): N/A

District and judicial division: __N. {a

Name of judge: MA Case Docket #__N Ih
Approximate filing date: N/A Dismissal date: Nie

Reason for dismissal: ul lee

t

a Fen



WY LEFT weisr was W SO_oyld PHN, HAD FELT A POP Dutin & THE

STRUGGLE by tHe Mowat STALL AND my THUMA DN my LEFT HAND WENT

Nhe jaca a a vpteteoaepnlG Taree

fétvl GetTIne wy CeoCs AnD PO ACTY LT HeAtS AND SAW OFFICER
HurteHleson Cong “inD THE HALL AnD SAY, “THE TRAINS LEAVIN tHe TRANS
Levin!” HE(HurcHeN on Ane UP TD Me AND HT ME ON TP OF THE
Head AniD SAID "You AINT QoNNA TELL NOBODY, You HiT Gorin TELL
Bier? "I SAID NO Sie! WAS THEN RD By OF CER py HSH To WALK
Wy L KE, (ALD BALE
nat BY THe (How HAW, Aoud PAST MEDICAL yo E-bokm.T CouLd See
NE MATE t= OAS ESCORTED
jim ehoeas LATER THAN THe OTHE WMATES « THE COLONEL (3.) WAS
“rene Te A AL THE INMATES: AS Son AS HE CoweneL GET Cipsé —
€ B {" We SM
Uke Tyne PENS, SO WHAT’ AD WALKED PAST ME, WE bid N SOARES Hen
peaceR J HetrWay LEANED InN WY EAC AND SAtD,"THAT ONES CDNA CST
You | Was “THEN THEN YO MY CELL Aetet ‘Cetus’ wee Cur BFE,

(ecweTaey FOL aC ) Diy NET PLOPEELY TRA, SUARLUBE, DR DISCLOUNE
SYUPFEVISOE. 4 zx
HiME Ati D AP As ol AL LE iD Ee DA A_MesseD UP wkeron My LEFT “tb Arlb Me ree ae

ATONE AT ES TTT TTT



UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF FLORIDA

PENSACOLA

DIVISION

CIVIL RIGHTS COMPLAINT FORM

TO BE USED BY PRISONERS IN ACTIONS UNI 42 U.S.C.

EHeTOMER MICHAEL Teen ey

Inmate # RSessY
(Enter full name of Plaintiff)

vs.

LT MeQ\tT

offices J. HaTTAWAY

ofFICER DUNHAM

aricek_P. WALSH

officed THY Lo

(Enter name and title of each Defendant.

if additional space is required, use the

blank area below and directly to the right.)

ANSWER ALL QUESTIONS ON THE FOLI

FILED USDC FLND PN
AUG 21 '20 PMi2:13

CASE NO: Z wo) ‘i IS, -Icl
(To be assigned by Clerk) Ue

OF Fice RRDAY
COLONEL. SCHWEINBERGER,

Nueseé CARPENTER

orficee Hutcdensow

MARK INCH IN HIS ore
Feeion Decne IMENT SF CERKECTIONS

WARDEN BOOKER
CXALCOSA C:T.

ING PAGES:



TE REQUEST Team Number:

Institution:

XCATIN: NAKDEN STATE OF FLORIDA
2 DEPARTMENT OF CORRECTIONS Mail Number:

TO: Wy Warden Classification O Medical 0 Dental
i C1 Other

(Check One) Asst. Warden ibe ity (1 Mental Health

FROM: Inmate Name DC Number Quarters Job Assignment | Date
Cyecoer Thani RIS |E-3IIOL ule 51-20

REQUEST Check here if this is an informal grievance [~

Xo was “wrtensoneped” aap resauctey By Srficees( J HAT AWAY DUNHAM: P. WALSH
TRYloR; HuTCHenisenl) WHEN or ARWED AT OvALSSA COE: Duane Lecewinle goe nid
Lawfhur REASON LL WANT To PeEess CHAeGrES [MMERDIATELY ALSO _LoANT To speak
WITH THE INSPECTOR GENERAL AS O.0.. DHS IS # VioLATION OK MY x amenaMente
COuEL p> UN USua PLINISHMENT, TS ASSAULT Took PLACE fT APPROXIMATELY 12:00//
12:30 AM. IN A SHowek Str, AND HAuWAY in) THe BUILDING WHEN You Rest Come
IN o€¢ he GVS. Diese péficeds WWE piteven A Bone IN My weIsT/HAND ON MY
Leer ACM the LT on hilt told Hm to do ttX wes alto choked really bad.
PLEASE PRESeOvE fu MUBDO/VIDED Rom ZECEWING BUILDING AND! COMeoUAID
CAMEZAS AND E-Doit WING 3 Cameeas Flom (5-10 -20)+(S-1|-20) por.
LITIGATION PURPOSES 5 You CAA Coe Tc Heke LATE 1D E-DoRM Soekiner

Wet, AND OFFIcecs eStoer ME _ACASS COMPEYNKS BY WYSELE,
Alfrequests will be handled in one of the following ways: 1) Written Information or 2) Personal Interview. All

informal grievances will be to in writin;
Inmate (Signature): (ZAC Xt Torneo a Det: RSGSSY

DO NOT WRITE BELOW THIS LINE RECEIVED

RESPONSE DATE RECEIVED: MAY 12 2028
LS=QO0S- O47 Mba.

erst : ne
ReSNT an Ceneer \ at AS ee Q Soar
0 Loas

[The following pertains to informal grievances only: .
Based on the above information, your grievance is _ {ON {__. (Returned, Denied, jroved)) If your informal grievance is denied,

you have the right to wea formal grievance in accordance with Chapter 33-103.006, FACI) 4

Official (Print Name) ° “ulee— Official (Signaturey: (' LAZO A pate |4+2O)

Original: Inmate (plus one copy)
CC: Retained by official responding or if the response is to an informal grievance then forwart to be placed in inmate’s file

This form is also used to file informal grievances in accordance with Rule 33-103,005, Florida Administrative Code.
Informal Grievances and Inmate Requests will be responded to within 15 days, following receipt by staff.

You may obtain further administrative review of your complaint by obtaining form DC1-303, Request for Administrative Remedy or Appeal, completing the form as
required by Rule 33-103.006, F.A.C., attaching a copy of your informal grievance and response, and forwarding your complaint to the warden or assistant warden no
later than 15 days after the grievance is responded to. If the 15th day falls on a weekend or holiday, the due date shall be the next regular work day.

DC6-236 (Effective 11/18)
Incorporated by” a ‘n Rule 33-103.005, F.A.C.

. 4


Me AND TOK THe PLOW WAKE out oF MWY HAND AND CHABRING MY “Aa cuAe”
WE OTHER 224

OUT OF LINE

 qnis THe Guy? “wDFACER THY LOR when ME DOWN THE HALWwAY TowitkDS
Wiete © Cot off HE BUS , OFF CEX COOK WAS STANDING IN A Dookw4y ,

snip" Him?“ (a Smo " le

Bruny’ t \e ND,

DOWN A HAUWAY wit CELLS wHiGt Wace EMPTY TF ions TD) To Whtk,
i E | AL ONCE
Qeor_ AY A SHeweRr STHU AND WAS TW To ut ALUN) AND SrT on THE

GOUNDTHESE WERE pericens HerrawAy DUNHAM COMING qDWARDS
ME TAYLOL GRABBED ME BY THE BACK oF HE SHIRT Hd HATIAWAY And
yuna Harey eutrt Me BACKWARD INT) Te Slower srLL oKficek.
HOTMUAY Shri “ DONT You event Pur wii Hind a MY STH members
AGA "=E Sh) TAYLOR UNSCREWING A WHITE CAUSTICS BOTTLE AnD
= wrs SHIN "L Dit eur My HANDS DN VeuR STF MeMceErs,
sel Liv!" OFC HerTHWaY Put A RIPPED BUE Towel over
MY FALE AND HAD His Booy PRESSING- DOWN BN ME. THe Towel ws
Aieeady WET = wis TH & BREATHE 45 +t wAsS HAVING Ae

PANIC ATTRAC E]
‘ BAUCM
WAS HuetinG Ato THe ledae/sreP_inty JHE Stfowere PEss iNG—

INTD MY BACK. FELT Like T WAS Gone qo Drown AND WAC

orf of me, EVENMALLY, AFTER STOUGCEUNE, OeCKS CiFTE) ME UF,
Thenl_oefieee petrawey Pur ME ue AGAWSr THE wate BY MY THROAT,
HeATPWAY WAS SQUEEZING MY THAT § HAO) TC Courpn’y Brean IN
oR Bur. OFFAiceR DUNHAM WHS THUKiNe To Me AND CWA TRYING
TOT HM Tt resrecren THe office eS Wer time T wR AT
REMOSA Cr. BUT DUE To hAtrawAYys GUP oN MY tHieear a

COMLONT TRUK ETHEL Im WAS STRUG GUNG AND INVOLUNTARILY KICKED

AT wo MY LEG ANDI BereeLy HiT DUNHAM WIT MY Foot,



Mt,

/).

Qn OF DENA...

DEFENDANTS MAME: OF Fick HuTthensoN

Oca Pasirion . OFFICER.

emPioyeD AT: OKApOSh COkRECTIONAL INSTITUTION
Waitive Abdbieess: 37 Colonel GKEG Slog Kd.
CEESTVEW , Fe »F 239-6 107?

DerevignTS warns < Wark INCH I HIS ofFCAL CAPACITY AS SECRETLY, FD, 6.
FICIAL POSTION ; SEORETHLY OF FLOOR DEPRRTYENT BF COCECTIOMG
Empwoyed 472 FLUICIDR- DEPERTMENT OF CORRECTIONS

Maing Abpeest : SEORETAL IS OFFICE

so! 5: CAtHounl ST

TAILKHESSEE, Ft. 32399

DEFENDANTS: WANE? LJABEN BOOKER

DRFciAL POSITION? WRKDEN OF OKALOOR CE.

employ) AT? OkALOOSA CORRECTIONAL ISTTIVIION

nena AdbLESS: BUF Colowel GkEG s14tloy Kb.

CRETVIA , Fl, 32539-6708

(2 ef 2)


CovrmArinl BF DEFEWDANTS...

Y | perenDants WANE? Of Ace: Pwr sl

beri, Positron 3 OFFICER.

EMPLOYED AT OlRLOOS COKCECTION AL. /WSTITUTION
MAING AOBRES! B/PY COLONEL GREG MALLOY RO.
CRESTVIEW, FL. 325-39-6 10F-

SIDEFENDANTS WANE: OFFICER TAYLOR.

loMaa Position! ¢ EFFICER.

LMMLOYED AT « §=OlrLw0S CORRECTIONAL iniSTITVTION

MaILMlr ADDEES 1 FPF CoconEL GREG MOLLOY RD.
CRESTVIEW, FL. 32537-6700

C\perenbenss wate: office K ORY

rch fOTTION * OFFICER

MHDYD AT t OKALaSYT CL.

Wate ADDRES: 3167 Coronel GKEG MALLOY KO.
CREST WEL! , Fl. 32537 “6 TOP

WARENDAINTE WANE! Cotenél SCHWENBEGER

erricat POSITION: COLONEL

EMUALOYD 472 OFO0SHH CL.

MAIuNG ADRES BIE COLoNnét GEG MALLOY RO.
CREST VIEW , Fe: 32539 -670fF

8 AeA VAME! VASE CRRPINTER

OFFICIAL POSTION! AUR SE

Empuyed #T! CKAIOOSK CL.

Mie Abpeess: 3187 CotoWél GREG WAILOY RO.
CRESTIEW , FL, 3 2539-6 70P

(jer 2 j


1 PLAINTIFF:

State your full name, inmate number (if applicable), and full mailing address in the lines below.

Name of Plaintiff:  c,eistorde MICHAEL Tieeney

Inmate Number R5bS5U :
Prison or Jail: Satna Rosh Cogecctiovar InstTU Ton ANNEX
Mailing address: SANTA ROS C.D. ANNEX

S8SC EAST MILTON ROAD.
MmytToW FL. 32593

M. DEFENDANT(S):

State the name of the Defendant in the first line, official position in the second line, place of
employment in the third line, and mailing address. Do the same for every Defendant:

(1) Defendant'sname: Lil. MERTT
Official position: (ZA
Employed at: DIALOOSA Comet TONAL INSTITUTION
Mailing address: 3199 Coronit Gkay WALLY RD.
LESTVIEW, FL. P25 39- 6 Jog

(2) Defendant's name: = OFficee J. HATTAWAY/
Official position: Ot 1c
Employed at: QLALOOSA COULECTIONAL INSTITUTION
Mailing address; 9 3/57 (Colonel Grea meiley (0.
BST EW) , FL_ 32559 6 18

(3) Defendant'sname: DEFICER DUNHAM _
Official position: OfAcER
Employed at: DKALOOSA CORRECTIONAL INSTITUTION
Mailing address: SY Cocovliel CheG Mptey KO.

CLESTVEW , FL 325 3F-CTLR

ATTACH ADDITIONAL PAGES HERE TO NAME ADDITIONAL DEFENDANTS