1f you need additional space for ANY section, please attach an additional sheet and reference that section.I

l,

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF ILLINOIS

EASTERN DIVISION

(Enter above the full name

of the plaintiff or plaintiffs in

this action)

CHECK

VS.

G,,r\.7.8,?ri+aVea

RECElVED

JUN2s2g2lc/

.IHRUtl,Ef*[Hl8U*'

.",.^". ao cd 3 T(l

(To be supplied by the Clerk of this Court)

*torror"bI e' $ {'sfiqc'seZTef

(Enter above the full name of ALL

defendants in this action. Do not

use "et al.")

ONE ONLY: AMENDED COMPLAINT

COMPLAINT UNDERTHE CIVIL RIGHTS ACT, TITLE 42 SECTION 1983

U.S. Code (state, county, or municipal defendants)

COMPLAINT UNDER THE CONSTITUTION ("BMNS" ACTION), TITLE

28 SECTION 1331 U.S. Code (federal defendants)

OTHER (cite statute, if known)

BEFORE FILLING OUT THIS COMPI-AINT, PLEASE REFER TO "INSTRUCTIONS FOR

FILING." FOLLOW THESE INSTRUCTIONS CAREFULLY.

flf you need additional space for ANY section, please attach an additional sheet and reference that section.l

Case: 1:20-cv-03948 Document #: 12 Filed: 06/28/21 Page 1 of 8 PageID #:42
[lf you need additional space for ANY section, please attach an additional sheet and reference that section.]

I. Plaintiff(s):

A. Name: kt,.enca f*cKSonSF

B. List all aliases:

E.

Prisoner identification number: k'\7 1 OlToo{

Title:

II.

B.

C.

D, Place of present confinement: C( | f C

Address: ]1r:o S. 7r^\,(ornir-

(If there is more than one plaintiff, then each plaintiff must list his or her name, aliases, I.D.

number, place of confinement, and current address according to the above format on a

separate sheet of paper.)

Defendant(s):

(In A below, place the full name of the first defendant in the first blank, his or her official

position in the second blank, and his or her place of employment in the third blank. Space

for two additional defendants is provided in B and C.)

A. Derendant: 6 A,B , ?ri+l Var

Go$et'nef

prace orEmproymen ,, fl(i no ,'S G o W"r, runt

Defendant: ahor't*t Do-f|

Title:

Place of Employment:

(flN n"l 7iV,s; an

Place of Employment: rq{ thi

(If you have more than three defendants,

according to the above format on a separate

then all additional defendants must be listed

sheet of paper.)

Revised 9/2007

[lf you need additional space for ANY section, please attach an additional sheet and reference that section.]

Case: 1:20-cv-03948 Document #: 12 Filed: 06/28/21 Page 2 of 8 PageID #:43
m.

[lf you need additional space for ANY section, please attach an additional sheet and reference that section.]

List ALL lawsuits you (and your co-plaintiffs, if any) have filed in any state or federal

court in the United States:

number: ?odll o, t-ocu 117?, t f ctl {AV

B. Approximatedateoffilinglawsuit: 7 /oq\* knout d lls

C.

A. Name of

(if you had laintiffs), inpludin

D. defendants:

E. Court in which the I t; ifstate court,

name the county):

ofjudge to whom case was assigned:

G. Basicclaim ^uae,lLe 

(lL,nS Vr\fY

Disposition of this case for ex

Is it still pending?) g

: Was the case dismissed? Was

€tnhas a,rlrt ?L i1 CV'3f

appealed?

F.

H.

Approximate date of disposition: i'n nel s-u/\a

IF YOU HAVE FILED MORE THAN ONE LAWSUIT, THEN YOU MUST DESCRIBE THE

ADDITIONAL LAWSUITS ON ANOTHER PIECE OF PAPER, USING THIS SAME

FORMAT. REGARDLESS OF HOW MANY CASES YOU HAVE PREVIOUSLY FILED,

YOU WILL NOT BE EXCUSED FROM FILLING OUT THIS SECTION COMPLETELY,

AND FAILURE TO DO SO MAY RESULT IN DISMISSAL OF YOUR CASE. COPLAINTIFFS MUST ALSO LIST ALL CASES THEY HAVE FILED.

Revised 9/2007

Uf you need additional space for ANY section, please attach an additional sheet and reference that section.l

Case: 1:20-cv-03948 Document #: 12 Filed: 06/28/21 Page 3 of 8 PageID #:44
ry.

ilf you need additional space for ANY section, please attach an additional sheet and reference that section.l

Statement of Claim:

State here as briefly as possible the facts of your case. Describe how each defendant is

involved, including names, dates, and places. Do not give any legal arguments or cite any

cases or statutes. If you intend to allege a number of related claims, number and set forth

each claim in a separate paragraph. (Use as much space as you need. Attach extra sheets

if necessary.)

U fli? D Ai^

Revised 9/2007

[lf you need additional space for ANY section, please attach an additional sheet and reference that section.]

Case: 1:20-cv-03948 Document #: 12 Filed: 06/28/21 Page 4 of 8 PageID #:45
[lfyou need additional space for ANY section, please attach an additional sheet and reference that section.]

'/ u"f

Revised 9/2007

[fyou need additional space for ANY section, please attach an additional sheet and reference that section.]

Case: 1:20-cv-03948 Document #: 12 Filed: 06/28/21 Page 5 of 8 PageID #:46
v.

ilf you need additional space for ANY section, please attach an additional sheet and reference that section.l

Relief:

State briefly exactly what you want the court to do for you. Make no legal arguments. Cite

no cases or statutes.

VI. The plaintiff demands that the case be tried by a jury. t t$ NO

CERTIFICATION

By signing this Complaint, I certit/ that the facts stated in this

Complaint are true to the best of my knowledge, information and

belief. I understand that if this certification is not correct, I may be

subject to sanctions by the Court.

Signed ,ni" 8+b aay of JnaL ,207[

ofpl or plaintiffs)

L*t.yavt jr,okGon gf,

(Print name)

Tolfl ol7 oo f

(I.D. Number)

77oo 5 ca itun i-a-

(Address)

5 Revised 9/2007

[lf you need additional space for ANY section, please attach an additional sheet and reference that section.l

)r

Case: 1:20-cv-03948 Document #: 12 Filed: 06/28/21 Page 6 of 8 PageID #:47
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Case: 1:20-cv-03948 Document