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ASH 

IN THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF ARIZONA 

Cary VanDerMeulen, 

Plaintiff, 

v. 

Charles L. Ryan, et al., 

Defendants. 

No. CV 17-03828-PHX-JAT (DMF) 

ORDER 

Plaintiff Cary VanDerMeulen, who is not in custody, 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). The Court will dismiss the Complaint with leave to amend. 

I. Application to Proceed In Forma Pauperis and Filing Fee

 Plaintiff’s Application to Proceed In Forma Pauperis indicates that he is unable to 

pay the costs of these proceedings. Accordingly, Plaintiff’s Application to Proceed will 

be granted, and Plaintiff will not be required to pay the filing fees associated with this 

action. 

II. Statutory Screening of Prisoner Complaints

 Pursuant to 28 U.S.C. § 1915(e)(2), in a case in which a plaintiff has been granted 

in forma pauperis status, the Court 

shall dismiss the case at any time if the court determines that–(A) the 

allegation of poverty is untrue; or (B) the action or appeal–(i) is frivolous or 

malicious; (ii) fails to state a claim on which relief may be granted; or 

(iii) seeks monetary relief against a defendant who is immune from such 

relief. 
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28 U.S.C. § 1915(e)(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 (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. 

. . . . 
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III. Complaint 

 In his Complaint, Plaintiff names as Defendants: Arizona Department of 

Corrections (ADC) Director Charles L. Ryan; Facility Health Administrator Deborah 

Kinder; Arizona State Prison Complex (ASPC)-Douglas Head Chaplain Herman; ADC 

Captain Paul Martell; ADC Coordinator of Food Services Alex Ruiz; ASPC-Douglas 

Warden Meegan Muse; and Corizon Health Services (Corizon). Plaintiff names all 

Defendants in both their individual and official capacities.1

 Plaintiff seeks monetary 

relief and punitive damages. 

 It is not clear to the Court what particular claims Plaintiff is attempting to assert. 

In the “Case against DOC” section of his Complaint, Plaintiff refers to “denial of basic 

necessities,” a “health issue,” “exercise of religious freedom,” “retaliation,” “improper 

medical treatment,” “dietary needs ... [and] prima facie evidence of improper care,” 

“denial of access to the courts,” and “denied published property (book) of a religious 

nature.” Plaintiff also appears to assert claims based on the recent settlement in Parsons 

v. Ryan, 2:12-CV-12-00601-PHX-DKD (D.Ariz. 2012). However, none of these bases 

contain any factual information, nor are they directed at any particular Defendant. 

Rather, Plaintiff provides a separate 22-page “Narrative” that describes, seemingly, his 

entire period of incarceration and that, while occasionally referencing the named 

 

1

 A suit against a defendant in his or her individual capacity seeks to impose personal liability upon the official. Kentucky v. Graham, 473 U.S. 159, 165-66 (1985). 

For a person to be liable in his or her individual capacity, “[a] plaintiff must allege facts, not simply conclusions, that show that the individual was personally involved in the deprivation of his civil rights.” Barren v. Harrington, 152 F.3d 1193, 1194 (9th 

Cir. 1998). By comparison, a suit against a defendant in his or her official capacity represents only another way of pleading an action against the entity that employs the defendant. Kentucky, 473 U.S. at 165. That is, the real party in interest is not the named defendant, but the entity that employs the defendant. Id. To bring a claim against an individual in his official capacity, a plaintiff must show that the constitutional deprivation resulted from the entity’s policy, custom, or practice. Id.; Monell v. Dep’t of Soc. Servs. of New York, 436 U.S. 658, 694 (1978). 

Although Plaintiff has named the defendants in both their individual and official 

capacities, Plaintiff’s allegations fail to plausibly show that any policy, practice, or custom of any entity has resulted in his alleged injuries. Accordingly, the Court will construe Plaintiff’s claims as directed against the Defendants in their individual

capacities only, and evaluate them accordingly. 
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Defendants (as well as numerous other unnamed individuals and entities), does not direct 

any particular claims at any particular Defendants. 

IV. Failure to Comply With Federal Pleading Requirements 

 As an initial matter, Plaintiff may not enforce the settlement or decrees entered in 

Parsons in a separate civil rights action. See Cagle v. Sutherland, 334 F.3d 980, 986 

(11th Cir. 2003); Klein v. Zavaras, 80 F.3d 432, 435 (10th Cir. 1996); DeGidio v. Pung, 

920 F.2d 525, 534 (8th Cir.1990); Green v. McKaskle, 788 F.2d 1116, 1122-23 (5th Cir. 

1986). Standing alone, remedial orders and settlement terms, such as those entered in 

Parsons, cannot serve as a substantive basis for a § 1983 claim for damages because they 

do not create “rights, privileges, or immunities secured by the Constitution and laws.” 

Green, 788 F.3d at 1123-24. Rather, settlements and remedial decrees are the means by 

which unconstitutional conditions are corrected. Id. at 1123. For these reasons, Plaintiff 

may not properly seek § 1983 relief to enforce Parsons in this action and he fails to state 

a claim to the extent that he seeks relief pursuant to Parsons. 

Additionally, Rule 8(a) of the Federal Rules of Civil Procedure requires a “short 

and plain statement of the claim.” Fed. R. Civ. P. 8(a)(2). Rule 8(d)(1) states that 

“[e]ach allegation must be simple, concise, and direct.” A complaint having the factual 

elements of a cause of action scattered throughout the complaint and not organized into a 

“short and plain statement of the claim” may be dismissed for failure to satisfy Rule 8(a). 

See Sparling v. Hoffman Constr. Co., 864 F.2d 635, 640 (9th Cir. 1988); see also 

McHenry v. Renne, 84 F.3d 1172 (9th Cir. 1996). It is not the responsibility of the Court 

to review a rambling narrative in an attempt to determine the number and nature of 

Plaintiff’s claims. 

 Here, Plaintiff’s allegations fail to comply with Rule 8. As noted, Plaintiff’s 22-

page “Narrative” Plaintiff describes numerous events occurring on different dates and 

involving different Defendants (and numerous other individuals and entities not named as 

Defendants), and appears to allege different causes of action against different Defendants. 

In many instances, Plaintiff refers to “they,” “officials,” or “higher-ups” without 
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identifying who these individuals are, or whether he is attempting to assert claims against 

them. As such, Plaintiff’s allegations make it impossible for the Court to determine what 

exactly Plaintiff’s claims are, and at whom they are directed. Put simply, Plaintiff’s 

allegations are neither short nor plain, and it would be impossible for any Defendant to 

meaningfully respond to the Complaint. Accordingly, the Court will dismiss the 

Complaint because it fails to comply with Rule 8 of the Federal Rules of Civil Procedure. 

V. Leave to Amend 

 Within 30 days, Plaintiff may submit a first amended complaint to cure the 

deficiencies outlined above. The Clerk of Court will mail Plaintiff a court-approved form 

to assist him with filing a first amended complaint. 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 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). 

 Plaintiff should be aware that to state a claim for unconstitutional conditions of 

confinement, a plaintiff must allege an objectively “sufficiently serious” deprivation that 

results in the denial of “the minimal civilized measure of life’s necessities.” Farmer v. 

Brennan, 511 U.S. 825, 834 (1994); Allen v. Sakai, 48 F.3d 1082, 1087 (9th Cir. 1994); 

see Estate of Ford v. Ramirez-Palmer, 301 F.3d 1043, 1049-50 (9th Cir. 2002). That is, a 

plaintiff must allege facts supporting that he is incarcerated under conditions posing a 

substantial risk of harm. Farmer, 511 U.S. at 834. “The circumstances, nature, and 

duration of a deprivation of [ ] necessities must be considered in determining whether a 
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constitutional violation has occurred.” Hearns v. Terhune, 413 F.3d 1036, 1042 (9th Cir. 

2005) (quoting Johnson v. Lewis, 217 F.3d 726, 731 (9th Cir. 2000)). Further, whether a 

condition of confinement rises to the level of a constitutional violation may depend, in 

part, on the duration of an inmate’s exposure to that condition. Keenan v. Hall, 83 F.3d 

1083, 1089 (9th Cir. 1996) (citing Hutto v. Finney, 437 U.S. 678, 686-87 (1978)). In 

addition, allegations of overcrowding, alone, are insufficient to state a claim. See Rhodes 

v. Chapman, 452 U.S. 337, 348 (1981). When, however, overcrowding causes an 

increase in violence or reduces the provision of other constitutionally required services, 

or reaches a level where the institution is no longer fit for human habitation, the inmate’s 

right against cruel and unusual punishment may be violated. See Balla v. Idaho State Bd. 

of Corr., 869 F.2d 461, 471 (9th Cir. 1989); Toussaint v. Yockey, 722 F.2d 1490, 1492 

(9th Cir. 1984). 

 A plaintiff must also allege facts to support that a defendant acted with deliberate 

indifference. Deliberate indifference is a higher standard than negligence or lack of 

ordinary due care for the prisoner’s safety. Farmer, 511 U.S. at 835. To state a claim of 

deliberate indifference, a plaintiff must meet a two-part test. First, the alleged 

constitutional deprivation must be, objectively, “sufficiently serious”; the official’s act or 

omission must result in the denial of “the minimal civilized measure of life’s necessities.” 

Id. at 834 (citations omitted). Second, the prison official must have a “sufficiently 

culpable state of mind,” i.e., he must act with deliberate indifference to inmate health or 

safety. Id. (citations omitted). In defining “deliberate indifference” in this context, the 

Supreme Court has imposed a subjective test: “the official must both be aware of facts 

from which the inference could be drawn that a substantial risk of serious harm exists, 

and he must also draw the inference.” Id. at 837 (emphasis added). 

 Similarly, to state a § 1983 medical claim, a plaintiff must show (1) a “serious 

medical need” by demonstrating that failure to treat the condition could result in further 

significant injury or the unnecessary and wanton infliction of pain and (2) the defendant’s 

response was deliberately indifferent. Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 
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2006). 

 “Deliberate indifference is a high legal standard.” Toguchi v. Chung, 391 F.3d 

1051, 1060 (9th Cir. 2004). To act with deliberate indifference, a prison official must 

both know of and disregard an excessive risk to inmate health; “the official must both be 

aware of facts from which the inference could be drawn that a substantial risk of serious 

harm exists, and he must also draw the inference.” Farmer, 511 U.S. at837. Deliberate 

indifference in the medical context may be shown by a purposeful act or failure to 

respond to a prisoner’s pain or possible medical need and harm caused by the 

indifference. Jett, 439 F.3d at 1096. Deliberate indifference may also be shown when a 

prison official intentionally denies, delays, or interferes with medical treatment or by the 

way prison doctors respond to the prisoner’s medical needs. Estelle v. Gamble, 429 U.S. 

97, 104-05 (1976); Jett, 439 F.3d at 1096. 

 Deliberate indifference is a higher standard than negligence or lack of ordinary 

due care for the prisoner’s safety. Farmer, 511 U.S. at 835. “Neither negligence nor 

gross negligence will constitute deliberate indifference.” Clement v. California Dep’t of 

Corr., 220 F. Supp. 2d 1098, 1105 (N.D. Cal. 2002); see also Broughton v. Cutter Labs., 

622 F.2d 458, 460 (9th Cir. 1980) (mere claims of “indifference,” “negligence,” or 

“medical malpractice” do not support a claim under § 1983). “A difference of opinion 

does not amount to deliberate indifference to [a plaintiff’s] serious medical needs.” 

Sanchez v. Vild, 891 F.2d 240, 242 (9th Cir. 1989). A mere delay in medical care, 

without more, is insufficient to state a claim against prison officials for deliberate 

indifference. See Shapley v. Nevada Bd. of State Prison Comm’rs, 766 F.2d 404, 407 

(9th Cir. 1985). The indifference must be substantial. The action must rise to a level of 

“unnecessary and wanton infliction of pain.” Estelle, 429 U.S. at 105. 

 Plaintiff should also be aware that to state a First Amendment, free-exercise-ofreligion claim, a plaintiff must allege that a defendant burdened the practice of plaintiff=s 

religion by preventing him from engaging in a sincerely held religious belief and that the 

defendant did so without any justification reasonably related to legitimate penological 
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interests. Shakur v. Schriro, 514 F.3d 878 (9th Cir. 2008). 

 Additionally, 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 require 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 School 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). 

 Finally, the right of meaningful access to the courts prohibits officials from 

actively interfering with inmates’ attempts to prepare or file legal documents. Lewis v. 

Casey, 518 U.S. 343, 350 (1996). The right of access to the courts is only a right to bring 

petitions or complaints to federal court and not a right to discover such claims or even to 

ligate them effectively once filed with a court. Id. at 354. The right “guarantees no 

particular methodology but rather the conferral of a capability–the capability of bringing 

contemplated challenges to sentences or conditions of confinement before the courts.” 

Id. at 356. 

 As a matter of standing, for an access-to-courts claim, a plaintiff must show that 

he suffered an “actual injury” with respect to contemplated litigation. Id. at 349. To 

show actual injury with respect to contemplated litigation, the plaintiff must demonstrate 

that the defendants’ conduct frustrated or impeded him from bringing to court a 

nonfrivolous claim that he wished to present. Id. at 352-53. 

 “[T]he injury requirement is not satisfied by just any type of frustrated legal 
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claim.” Id. at 354. The right of access to the courts “does not guarantee inmates the 

wherewithal to transform themselves into litigating engines capable of filing everything 

from shareholder derivative actions to slip-and-fall claims.” Id. at 355. The nonfrivolous 

claim must be a direct or collateral attack on the inmate’s sentence or a challenge to the 

conditions of his confinement. Id. “Impairment of any other litigating capacity is simply 

one of the incidental (and perfectly constitutional) consequences of conviction and 

incarceration.” Id. (emphasis in original). 

VI. Warnings

A. Address Changes 

 If Plaintiff’s 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. 

B. 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. 

Plaintiff is not required to pay the filing fees for this action. 

 (2) The Complaint (Doc. 1) is dismissed for failure to comply with Rule 8 of 

the Federal Rules of Civil Procedure. Plaintiff has 30 days from the date this Order is 

filed to file a first amended complaint in compliance with this Order. 

 (3) 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 without 

prejudice, and deny any pending unrelated motions as moot. 

(4) The Clerk of Court must mail Plaintiff a court-approved form for filing a 
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civil rights complaint by a prisoner. 

 Dated this 25th day of January, 2018. 
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:
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.
3

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.
4

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.
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: .
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.
3

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. 

.
4

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. 

.
5

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.
6

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.