UNITED STATES DISTRICT COURT 

DISTRICT OF OREGON 

J!JUGENE DIVISION 

\""\-~Q,.,_L\. 

--=~ - 2.e~c~\~:)l;o:cvW: ~~c.1.:·.-~-3C-C~ -tl--_ 

I S)f.3\lo}-

(Enter full name of plaintiff(s)) 

Plaintiff(s), 

v. 

(Enter full name of ALL defendant(s)) 

Defendant(s). 

I. 

--------CivilCase.No. C:;./_'9-J.~ .~~~ ~0>!S (to be ossigned by Clerk of the Court} 

PRISONER CIVIL RIGHTS 

COlYIPLAINT 

A. Have you brought any other action or appeal in a court of the United States while a 

prisoner? 

Yes~ NoO 

B. If your answer to A is yes, how many? 1.. . Describe the lawsuit(s) in the 

space below. (If there is more than one lawsuit, describe the additional lawsuits on 

another piece of paper, using the same outline.) 

1. Parties to the previous lawsuit: 

Plaintiff(s): \:>e\ec A\exo.ncl"<C $--,c,1i,, 

CIVIL RIGHTS COMPLAINT 

Revised: April 24, 2008 

Page 1 

Case 6:16-cv-00205-BR Document 2 Filed 02/03/16 Page 1 of 5
Defendant(s): ?:i\o.-te oR C>~n, 

Court: \ ),'~ o\\~\61~-± c cur\-

Docket Number: LP·. IS -c1 t- 0\025 -Tc, 

Name of judge to whom case was assigned: 1A~C1 

2. 

3. 

4. 

5. Disposition ry./as the case dismissed? Was it appealed? Is it still pending?) 

01~1~'.'gcJ. ~c\,\ \!> ~\<?... 0.. C\a.1('{) 

~ '-e&J?':'J ~ re:'"'*;\eiY\R'\1 cl Ctt$ dn -lo re\a.\-\"" ------ --- -- l\N\ -\o lO\\;'.Oo\~ee,,., Mt;\. o\.e,\),f,\c>\o.M;;, - - --- ---- - --

6. 

7. 

Approximate date of filing: -:Jl'-l-'-'''"'('-"i~2..,1"'-:>""l s,_..e&=-· -------

Approximate date of disposition: Oc\o'otr 2ol5 -e';\= I 

II. 

A. Place of confinement: _,,O"'O"'-"c""c,'---_,o"""::.""c""I.=------------

B. Is there a prisoner grievance procedure in this institution? 

Yes¢ NoO 

C. Have you filed a grievance concerning the facts relating to this complaint? 

YesO 

If your answer is no, explain why not: 

'.t: Wl\& ~\eJ. 'T05.\ c\,t.rn l'\o\.i.cf~., 

D. Is the grievance process completed? 

Yes]Zf 

CIVIL RIGHTS COMPLAINT 

Revised: April 24, 2008 

NoO 

Page 2 

Case 6:16-cv-00205-BR Document 2 Filed 02/03/16 Page 2 of 5
III. PARTIES 

(In item A below, place your name in the first blank and place your present address in the 

second blank Do the same for additional plaintijft, if any.) 

A. Name of plaintiff: \=>e:\--e.< A\e:J<arv'J..-(5 '2o1\o.. 

Security Identification No.: ~ffi~· ~3~-~3~\~-~l~q~q~l=~-------­

Address: bSCI - 2f{oS Qe.e.< Qo<lt. Dc\ve, "OC. 

'Sct\-crn ~ l'.17<5\b 

(In item B, place the full name of each defendant, his/her official position, and his/her place 

.. . :~fgmpi!lYJJL~m.~: .: ::. :._ _ _:_: :..-.:.-::..:::·.:..·_:~ __ -: __ _: ____ . ____ : ____ _:~_:: ___ . __ 

B. Defendant \\A,/ \=on13 $lnoel& Tnc.. is employed as \Anltniiwo 

at <!.tt\;.~\o.. 

Defendant ---------is employed as------~ 

at ________________________ _ 

Defendant _________ is employed as ______ _ 

at ________________________ _ 

Defendant _________ is employed as----'-----

at ________________________ _ 

Defendant---------is employed as-------

at -------------------------

Additional defendants: ------------------

CIVIL RIGHTS COMPLAINT 

Revised: April 24, 2008 

Page 3 

Case 6:16-cv-00205-BR Document 2 Filed 02/03/16 Page 3 of 5
IV. STATEMENT OF CLAIM 

Claim! 

State what right under the Constitution, laws, or treaties of the United States has been 

violated . 

•. .. _:_ __ _:_ ili:tPJJClrting_I". act.s.:_ (St.. ate_ here .E~ _b~iefly as fJ.G_ssi}J[;ihe_{jl.Efs. ef JJl!.U~ cq._se. __ Qes_c!ibefi()}j) __ .. 

each defendant is involved and when the conduct occurred. It is not necessary to give any legal 

arguments or cite any cases or statutes.) 

~~~.fum.~~~~~hi.~&:,_,;;~~lb~~~~X=~~m..m~ru;;,::oo\!Ll,lQ.J. ~-n:.~''" lo.x\\'""°e c!l,, 

TIJE,_Q~im~l.!ll'~~\1tl!Uhl@1/n::ID,.Qil:',fj.'.l'.Ll&l'..!Si'l:..Ll"-"'~&\S'.:.e..i23:<~~ll>.c!:=&J&;!!;OO de~"'-.\c.t\.\S "" 1J> 

Claim II 

State what right under the Constitution, laws, or treaties of the United States has been 

violated. 

CIVIL RIGHTS COMPLAINT 

Revised: April 24, 2008 

Page 4 

Case 6:16-cv-00205-BR Document 2 Filed 02/03/16 Page 4 of 5
(I/you have additional claims, describe them on another piece of paper, using the same outline.) 

V. RELIBF 

____ -~Stat(!_ b_~iefl~ exa~tly_re!UJl"fo_u~res~e_ki_ng.__1vfa_~eno_!eX_a_l_ar[;U_111_(3_nt~it(3_no_ c_a_ses_o! _ _ _ 

statutes. 

Signed this '2. S day of_Jl_,....,n~Ul\.~~c'-""'-----' 20 I LP-. 

r 

CIVIL RIGHTS C()MPLAINT 

Revised: April 24, 2008 

(Signature of Plaintiff(s)) 

Page 6 

Case 6:16-cv-00205-BR Document 2 Filed 02/03/16 Page 5 of 5