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Case 3:06-cv-00740-MHT-SRW Document 1 Filed 02/13/2006 Page 4 of 7 Case 1:06-cv-00088-CB-M Document 1 Filed 02/13/2006 Page 4 of 7

His/her present address is 1 SQL ,cv V)(~~(Q .~`r~i~~C'\tX C~~ y 1C~ ',5i~-

(a) Claim against this defendant : O. G(~~;tit(~Q( a ~C\ ~C) \ C~1 ~r -

(b) Supporting facts (Include date/location of incident):

2. _O Ll X ~u ~~o- y COuo~u 3c, ► ~ .a .2 rx ~~u ~Pri~x; )o .

a ~c~s ~Vt ~1\C\h b tCk ., O(C.Q Jt a~~ I ~ is ~o~in +

C. Additional Defendants : (If there are additional defendants, you may list them on separate pages

using the same outline above).

IV. A. You must answer the following questions:

1 . State the conviction(s) for which you are presently incarcerated : L-14QCC~ A( 1

J . coQ c (Cn\ Ott c ICoCCo c\\

2. When were you convicted? UGC

3 . What is the term of your sentence? I O NQC, c

4. When did you start serving this sentence? 46 \ VT O (o

5 . Do you have,,, any other convictions which form the basis of a future sentence? Ye s

No (V)

If so, complete the following :

(a) Date of conviction:

(b) Term of sentence :

6. What is your expected end of sentence (E .O.S .) date? U3`kcL 60 Cc-( (1( yo

B. If this present lawsuit concerns your c riminal conviction or sentence,

state whether your conviction has been:

Conviction Sentence

Reversed yes() no() yes() no( )

Expunged yes() no() yes() no( )

Invalidated yes( ) no() yes() no( )

( )

6

Case 3:06-cv-00740-MHT-SRW Document 1 Filed 02/13/2006 Page 5 of 7 Case 1:06-cv-00088-CB-M Document 1 Filed 02/13/2006 Page 5 of 7

Writ of habeas yes() no() yes() no( )

corpus granted

C. If you answered yes to any of the questions, state the Court or entity that relieved you from your

conviction or sentence and the date :

V. State briefly exactly what you want the Court to do for you if you win (make no legal argument, cite

no cases or statutes) :

`OO .c cc oo vcv dc~,ccc oo caeca ~Q(YOJ z card Qc~~,p~c Q yc'c c v~~ vc Ct r.

VI. AFFIRMATION. By my signature below, I swear or affirm under penalty of perjury that the facts

set out in this complaint are true and correct.

'tiff nder Penalty of Perjury)

P.a . 2.®x ,Lj o

Current Mailing Address

ItA\\Y C6 Q\G O

Telephone Number

PLAINTIFF SHALL IMMEDIATELY ADVISE THE COURT IN WRITING OF ANY CHANGE IN

HIS ADDRESS E.G. RELEASED, TRANSFERRED MOVED ETC . FAILURE TO NOTIFY THE

COURT OF A NEW ADDRESS WILL RESULT IN THE DISMISSAL OF THIS ACTION FOR

FAILURE TO PROSECUTE AND TO OBEY THE COURT'S ORDER.

7

Case 3:06-cv-00740-MHT-SRW Document 1 Filed 02/13/2006 Page 6 of 7 Case 1:06-cv-00088-CB-M Document 1 Filed 02/13/2006 Page 6 of 7

1 h1~ (c3t~t1 dWO.rC ') d'' o

lit Cray Crta~\S), }?,o~ ; c~

Case 3:06-cv-00740-MHT-SRW Document 1 Filed 02/13/2006 Page 7 of 7