wend ed

V. VERIFICATION AND SIGNATURE

Initial Each Statement and Sign at the Bottom

a

\- I have included two properly completed summons forms (available from the

clerk) for each defendant I am suing, including full name, job title and work
address.

\ 5 I have included one properly completed process receipt and return form
(USM-285) (available from the U.S. Marshal) for each defendant I am suing.

ain ») In addition to this complaint with an original signature, I have included one
copy of this complaint for each defendant and one extra for the court.

G. 6
\ I have included full payment of the filing fee OR attached a properly
completed petition to proceed in forma pauperis (available from the clerk).

va
( >) I agree to promptly notify the clerk of any change of address.

é ( 5 I have read all of the statements in this complaint. /Do not forget to keep a copy

for your records.]

\ ‘ 5 I declare under penalty of perjury that the foregoing is true and correct.

Signed this Yth day of mM wi , 20. LL.



Hote of andiang

Cause(s) of Action with Supporting Facts (continued)

TQ__Clus_wha the L.€er-
qook and Who is the pfhicer wh» Tnhrviewpgy 2
pl (Son f Plas Zn mate S .

wilt ws.

Allen cdnaty jar[ Check glen s flys -
Coplindmend Cer” ris Preston Tati? leek Laer Durs none
tmbiaamtnt officer me Flug hes Z

7 ot hospital ont 4Audtid
Gna ofeiter wor Ling
Ill. PREVIOUS LAWSUITS

Have vou fer sued anyone for the same things you wrote about in this complaint?
O_O YES - /Print or type the following information about the case. Attach additional
sheets if there is more than one prior case.]

Court:
Judge: Docket Number:
Date filed: Date closed:

ih Men od IV. RELIEF

Write exactly what you want the court to do for you. This court cannot order that

a defendant be fired, investigated, or criminafly Cc
or criminal Por Fra State FP

Ho we G9
rc brea ting +he “7,

pate od aIndan a te Pay 20,600, 607) boausy
co them tp do a humane | bei ne Uke tiwniS and
Ast hnve a Care in the world why Shane

Aot__h \

“Lo « .
Allen County .\y! { oo 600
Gackview teaver Nosertal * 1,600, 300

vit ville Soe (GSon_ [,000, 600
Soca | Security adimiastraton u Hoe, 000

RS. Sedo as You Can See his Tar
Patter n



FILED

UNITED STATES DISTRICT COUR).
NORTHERN DISTRICT OF INDIANA
“Ty ua n. Qhewact ra

Biesfaore PLAINTIFF cast »%)
[Type or print your name on the line ene )

4 Py 3 24

DEFENDANT
[Type or print only the name of the first
person you are suing. List everyone you

supply the cause number when
your case is received.]

)
) .
g Stat @ of L Ind ara) cause no, it bev sb clerk will
)
)
)

are suing on page 2.] )
AmerDe
LAL ng Ad
42 U.S.C. § 1983
I. PARTIES
A. PLAINTIFF [You are the plaintiff in this lawsuit. Neatly print or type your information below.]

1. Tuan Tare\\ Cte wor 4

Namb: First Middle Last

2. What is your address: 45 (2) A ashi ni D Y.

Phone number bo) 45 lp _ 3 q ( cS

B. DEFENDANT(S) How many defendants are you suing: 5

[The defendants are the people you are suing. Print or type the defendant’s name, job title, the
state or local government agency the defendant works for, and the address of that government
agency. Remember to include the defendant you named in the caption on page one. If you are
suing more than one defendant, number them.]

(Revised May 2, 2006)


LL manckeA

# Defendant’s Name __Job Title/Government Agency Work Address

1. Vote of Tndiang OCG ok toe Shei 0 w
Wes} ville State prison 5501 $ 1100 W, wes ville, TH
Allen County yad aT § Cabrianst, oF,
Dorkview behaasr hosprtel rae fcr
Social Secur ty Omi arstraorn zie Lincalowsy ty,

fort waynes
Il. CAUSE(S) OF ACTION WITH SUPPORTING FACTS YR

Write why you are suing each defendant. Write who, what , when , where, and how you believe
your rights were violated. It is VERY IMPORTANT that you use each defendant’s name in
describing what happened to you. If you do not write what each defendant did, the court will not
know why you are suing and that defendant will be dismissed.

Explain what constitutional or federal law right, privilege or immunity each defendant violated. Do
not cite or quote cases or statutes. If you want to make legal arguments or citations, you must file
a separate memorandum of law. Do not attach it to this complaint.

Write a new paragraph for each violation. Name each defendant involved in that violation.

Sem er your paragraphs. ~
4 1.
Ss ase? o ©
: : ft laa r
e in en, and while thprt a fas (Caan ng Am
ever” n ZT 1S Vidlta oF
Atuclio flaliag £ (ry Simply cao YE nevec

fat wes" there J Ng Thi S$ Strd mt fo Jact Recauy
bncicelly thee rinat they shserved me ard trey
Bale AL na) Poth tole, ane al

’ rr C ues
A 2, AN_a_che iia Thee se ay iad
Qa Ls Punish and _fhat iS! agé.ast thy

aad Ldonnt Liar) Cruel, Tadafes are .
tle fo 3S meals adage, tyhd Qa GUmphking
ken? un heard , 7 7



Allen Coun ty sar | CRuel andl usuel

Punishment They placel meina cel

where they Was able to lock (esd room door.
hen Pushed hazzered prey refused fo resperd whves
Loreed mt t relieve Wm Self on the floor. Then
The facta MI ia the! hele wrth ont . Shower

Pye dle: gun i have hy tneSeS Some which are
Confirbene ref ot Ce rs and Some wham we Inmates.

ack ven
ewe

Pockview behavior hesprta| mal peaches ge m0

L THed to Check in" around (ec. 14 anol aut
Was (efustd when nas having & psyche fee

Cio, LF (ar ma Vecl into a buleliag yng

te KAl myself. Someone could of Oied encluchng

my Self) Which LT wanted to do At the time
eZ ISCHI Mona F189

Social Security Adminstation L filet for
AiSab (th (1 2409 Ad that time my kas entleding
myself where el ible Loc full @nfets. LD Arve
SuUZ0 cthect ve Aiserder ; PTS p 2 Ma\

3 / or C& eS ian -
Zheye been 19 ard oud o¢ mental hop ita¥. ZL heave
redessiana| Destors tnclading one whem works —
Bt thy Stade. Dr. Weilana Or. Surataat , and
Or, Rose macy or @rtirin my kigs had % Ge Withoud
Lecansy their Pether me's not abile to” manage bis

Life Which deems me Oisable because ad Mental il (eess-
qv hacd black suts 4h wach & hard a Ge and Broke
hiS Jon, IM Tried to Comm Ff So&de mult pl Fim eS
And thore 1s a Mee can thet L tnow Yinad olees no}

tale meds and -he Rueye hés Social Security when "nen me ielrt