Source: https://docs.justia.com/cases/federal/district-courts/arizona/azdce/2:2013cv00603/768939/10
Timestamp: 2017-10-20 18:15:59
Document Index: 581903989

Matched Legal Cases: ['§ 1915', '§ 1915', '§ 1915', '§ 1915', '§ 1915', '§ 1915', '§ 1915', '§ 1983', '§ 1983', '§ 1915', '§ 1915', '§ 1915', '§ 1915', '§ 2254', '§ 2255', '§ 1915', '§ 1983', '§ 1997', '§ 1343', '§ 1983', '§ 1331']

ORDER The Show Cause Order is discharged for Garcia-Godoy v. Unknown Party et al :: Justia Dockets & Filings
Justia Dockets & Filings Ninth Circuit Arizona Arizona District Court Garcia-Godoy v. Unknown Party et al Filing 10
Garcia-Godoy v. Unknown Party et al
ORDER The Show Cause Order is discharged. (Doc. 7 .) Plaintiff' Application to Proceed In Forma Pauperis is granted. (Doc. 8 .) As required by the accompanying Order to the appropriate government agency, Plaintiff must pay the $350.00 fil ing fee and is not assessed an initial partial filing fee. The Complaint (Doc. 1 ) is dismissed for failure to state a claim. Plaintiff has 30 days from the date this Order is filed to file a first amended complaint in compliance with this Order. I f 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 with prejudice that states that the dismissal may count as a "strike" under 28 U.S.C. § 1915(g). The Clerk of Court must mail Plaintiff a court-approved form for filing a civil rights complaint by a prisoner. Signed by Judge David G Campbell on 10/3/2013. (KMG)
1 2 SC WO 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 8 9 Felix Garcia-Godoy, 10 11 12 No. CV 13-0603-PHX-DGC (JFM) Plaintiff, vs. ORDER CCI Florence Warden John Doe, et al., 13 Defendants. 14 15 Plaintiff Felix Garcia-Godoy, who was then-confined in the Giles W. Dalby 16 Correctional Institution in Post, Texas, filed a pro se civil rights Complaint pursuant to 17 Bivens v. Six Unknown Named Agents of Federal Bureau of Narcotics, 403 U.S. 388 18 (1971), and an Application to Proceed In Forma Pauperis. On April 8, 2013, Plaintiff 19 filed a Notice of Change of Address indicating he would be transferred from Dalby 20 Correctional Institution and deported. At that time, it appeared that Plaintiff had been 21 released. For that reason, the Court denied his in forma pauperis application and ordered 22 him to pay the $350.00 filing fee or show cause why he could not.1 (Doc. 6.) 23 Plaintiff filed two in forma pauperis applications to show cause why he could not 24 pay the $350.00 filing fee. Further, he submitted a letter with one of the applications in 25 which he explained that he was then held in the Metropolitan Detention Center in Los 26 Angeles for a probation violation and that he would be held there until December 2013. 27 28 JDDL-K 1 Plaintiff was convicted in this District of illegal re-entry and sentenced to serve 180 days, less presentence credit, on November 28, 2012. See United States v. GarciaGodoy, No. CR12-2274-TUC-DTF (D. Ariz. Nov. 28, 2012), doc. 12. 1 He further indicated that he filed the notice of change of address so that filings from the 2 Court would be forwarded to his daughter, who would in turn notify Plaintiff. The Court 3 will discharge the show cause Order and grant Plaintiff’s application to proceed in forma 4 pauperis. Plaintiff is warned that he is responsible for ensuring that he promptly and 5 timely meets deadlines in this case and he must promptly notify the Court when and if he 6 is released from incarceration. 7 I. Application to Proceed In Forma Pauperis and Filing Fee 8 Plaintiff’s Application to Proceed In Forma Pauperis will be granted. 28 U.S.C. 9 § 1915(a). Plaintiff must pay the statutory filing fee of $350.00. 28 U.S.C. § 1915(b)(1). 10 The Court will not assess an initial partial filing fee. 28 U.S.C. § 1915(b)(1). The 11 statutory fee will be collected monthly in payments of 20% of the previous month’s 12 income each time the amount in the account exceeds $10.00. 28 U.S.C. § 1915(b)(2). 13 The Court will enter a separate Order requiring the appropriate government agency to 14 collect and forward the fees according to the statutory formula. 15 II. Statutory Screening of Prisoner Complaints 16 The Court is required to screen complaints brought by prisoners seeking relief 17 against a governmental entity or an officer or an employee of a governmental entity. 28 18 U.S.C. § 1915A(a). The Court must dismiss a complaint or portion thereof if a plaintiff 19 has raised claims that are legally frivolous or malicious, that fail to state a claim upon 20 which relief may be granted, or that seek monetary relief from a defendant who is 21 immune from such relief. 28 U.S.C. § 1915A(b)(1), (2). 22 A pleading must contain a “short and plain statement of the claim showing that the 23 pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2) (emphasis added). While Rule 8 24 does not demand detailed factual allegations, “it demands more than an unadorned, the- 25 defendant-unlawfully-harmed-me accusation.” 26 (2009). “Threadbare recitals of the elements of a cause of action, supported by mere 27 conclusory statements, do not suffice.” Id. 28 JDDL-K -2- Ashcroft v. Iqbal, 556 U.S. 662, 678 1 “[A] complaint must contain sufficient factual matter, accepted as true, to ‘state a 2 claim to relief that is plausible on its face.’” Id. (quoting Bell Atlantic Corp. v. Twombly, 3 550 U.S. 544, 570 (2007)). A claim is plausible “when the plaintiff pleads factual 4 content that allows the court to draw the reasonable inference that the defendant is liable 5 for the misconduct alleged.” Id. “Determining whether a complaint states a plausible 6 claim for relief [is] . . . a context-specific task that requires the reviewing court to draw 7 on its judicial experience and common sense.” Id. at 679. Thus, although a plaintiff’s 8 specific factual allegations may be consistent with a constitutional claim, a court must 9 assess whether there are other “more likely explanations” for a defendant’s conduct. Id. 10 at 681. 11 But as the United States Court of Appeals for the Ninth Circuit has instructed, 12 courts must “continue to construe pro se filings liberally.” Hebbe v. Pliler, 627 F.3d 338, 13 342 (9th Cir. 2010). A “complaint [filed by a pro se prisoner] ‘must be held to less 14 stringent standards than formal pleadings drafted by lawyers.’” Id. (quoting Erickson v. 15 Pardus, 551 U.S. 89, 94 (2007) (per curiam)). 16 If the Court determines that a pleading could be cured by the allegation of other 17 facts, a pro se litigant is entitled to an opportunity to amend a complaint before dismissal 18 of the action. See Lopez v. Smith, 203 F.3d 1122, 1127-29 (9th Cir. 2000) (en banc). The 19 Court should not, however, advise the litigant how to cure the defects. This type of 20 advice “would undermine district judges’ role as impartial decisionmakers.” Pliler v. 21 Ford, 542 U.S. 225, 231 (2004); see also Lopez, 203 F.3d at 1131 n.13 (declining to 22 decide whether the court was required to inform a litigant of deficiencies). The Court 23 will dismiss Plaintiff’s Complaint for failure to state a claim, but because the Complaint 24 may possibly be saved by amendment, the Court will dismiss the Complaint with leave to 25 amend. 26 III. Complaint 27 28 JDDL-K Plaintiff alleges one count for threat to safety or denial of medical care and negligence. Plaintiff sues John Doe 1, warden of “CCI-Florence” in Florence, Arizona, -3- 1 and CCI-Florence. Plaintiff seeks declaratory, injunctive, compensatory, and punitive 2 relief. 3 Plaintiff alleges the following in his Complaint: on November 2, 2012, Plaintiff 4 slipped and fell in water on the floor and injured his back. Sergeant Francisca sent 5 Plaintiff immediately to the medical department. A doctor recommended Anaprophen 6 220 grams. Plaintiff apparently also had x-rays taken of his back. Plaintiff was not 7 examined by an orthopedist. He claims Defendants failed to provide appropriate medical 8 treatment. Plaintiff asserts the warden of the facility and the facility are liable due to 9 negligence. After several days, Plaintiff was transferred to another facility. 10 IV. Failure to State a Claim 11 To state a Bivens claim, a plaintiff must allege that persons acting under color of 12 federal law violated a federal constitutional right. Martin v. Sias, 88 F.3d 774, 775 (9th 13 Cir. 1996) (citing Van Strum v. Lawn, 940 F.2d 406, 409 (9th Cir. 1991). Thus, an action 14 under Bivens is analogous to one brought pursuant to 42 U.S.C. § 1983, except for the 15 replacement of a state actor under § 1983 by a federal actor under Bivens. Id. 16 To state a valid constitutional claim, a plaintiff must allege that he suffered a 17 specific injury as a result of the conduct of a particular defendant, and he must allege an 18 affirmative link between the injury and the conduct of that defendant. Rizzo v. Goode, 19 423 U.S. 362, 371-72, 377 (1976). In addition, not every claim by a prisoner relating to 20 inadequate medical treatment states a violation of the Eighth or Fourteenth Amendment. 21 22 23 24 25 26 27 28 JDDL-K To state a medical claim, a plaintiff must show that the defendants acted with “deliberate indifference to serious medical needs.” Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006) (quoting Estelle v. Gamble, 429 U.S. 97, 104 (1976)). 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, 439 F.3d at 1096 (quotations omitted). -4- 1 “Deliberate indifference is a high legal standard.” Toguchi v. Chung, 391 F.3d 2 1051, 1060 (9th Cir. 2004). To act with deliberate indifference, a prison official must 3 both know of and disregard an excessive risk to inmate health; "the official must both be 4 aware of facts from which the inference could be drawn that a substantial risk of serious 5 harm exists, and he must also draw the inference.” Farmer v. Brennan, 511 U.S. 825, 6 837 (1994). 7 purposeful act or failure to respond to a prisoner’ s pain or possible medical need and 8 harm caused by the indifference. Jett, 439 F.3d at 1096. Deliberate indifference may 9 also be shown when a prison official intentionally denies, delays, or interferes with 10 medical treatment or by the way prison doctors respond to the prisoner’s medical needs. 11 Estelle, 429 U.S. at 104-05; Jett, 439 F.3d at 1096. Negligence is not sufficient to state a 12 claim. Daniels v. Williams, 474 U.S. 327, 330-31 (1986). Deliberate indifference in the medical context may be shown by a 13 Plaintiff alleges that he slipped and fell in water on the floor at CCI-Florence. 14 Plaintiff appears to be referring to a Corrections Corporation of America (CCA) facility 15 in Florence, Arizona, where he was held under a contract with the federal government. 16 Plaintiff fails to state a claim for several reasons. First, his allegations concerning 17 the fall support and subsequent treatment support nothing more than negligence. As 18 noted above, negligence is not a basis for relief under Bivens. Moreover, a Bivens claim 19 may only be maintained against officials acting under color of federal law in their 20 individual capacities; neither the United States, nor an agency or penitentiary, is a proper 21 defendant for Bivens claims. See FDIC v. Meyer, 510 U.S. 471, 486 (1994) (federal 22 agencies are not proper defendants in a Bivens action); Myers v. U.S. Marshals Serv., No. 23 CV10-2662, 2011 WL 671998, at *2 (S.D. Cal. Feb. 15, 2011). In addition, the United 24 States Supreme Court has declined to expand Bivens to include a private right of action 25 against a private entity under contract with the federal government. Correctional Servs. 26 Corp. v. Malesko, 534 U.S. 61, 70-71 (2001). For that reason, Plaintiff may not seek 27 relief against CCA or against a CCA facility in an action under Bivens. 28 JDDL-K -5- 1 Further, Plaintiff appears to be seeking relief for alleged violations of his 2 constitutional rights against employees of a private prison operating under contract with 3 the federal government. In Minneci v. Pollard, 132 S.Ct. 617, 623 (2012), the Supreme 4 Court declined to expand Bivens to include a private right of action for damages against 5 employees of a private entity under contract with the federal government where state tort 6 law provides an alternative, existing process capable of protecting the constitutional 7 interests at stake. Arizona tort law provides such an alternative for denial of adequate 8 medical care. Thus, to the extent that Plaintiff is attempting to allege a constitutional 9 violation against any CCA employee, including the warden, he cannot maintain a Bivens 10 claim. 11 Although it appears that Plaintiff cannot amend his Complaint to name a proper 12 defendant under Bivens for any constitutional violation, in an abundance of caution, the 13 Court will dismiss the Complaint with leave to amend. In any amended complaint, 14 Plaintiff must name a defendant, who can be sued under Bivens, and allege facts to 15 support that such defendant violated his constitutional rights. 16 V. Leave to Amend 17 For the foregoing reasons, Plaintiff’s Complaint will be dismissed for failure to 18 state a claim upon which relief may be granted. Within 30 days, Plaintiff may submit a 19 first amended complaint to cure the deficiencies outlined above. The Clerk of Court will 20 mail Plaintiff a court-approved form to use for filing a first amended complaint. If 21 Plaintiff fails to use the court-approved form, the Court may strike the amended 22 complaint and dismiss this action without further notice to Plaintiff. 23 Plaintiff must clearly designate on the face of the document that it is the “First 24 Amended Complaint.” The first amended complaint must be retyped or rewritten in its 25 entirety on the court-approved form and may not incorporate any part of the original 26 Complaint by reference. Plaintiff may include only one claim per count. 27 28 JDDL-K 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 -6- 1 F.2d 1542, 1546 (9th Cir. 1990). After amendment, the Court will treat an original 2 complaint as nonexistent. Ferdik, 963 F.2d at 1262. Any cause of action that was raised 3 in the original complaint is waived if it is not raised in a first amended complaint. King v. 4 Atiyeh, 814 F.2d 565, 567 (9th Cir. 1987). 5 VI. Warnings 6 A. 7 Plaintiff must pay the unpaid balance of the filing fee within 120 days of his 8 release. Also, within 30 days of his release, he must either (1) notify the Court that he 9 intends to pay the balance or (2) show good cause, in writing, why he cannot. Failure to 10 Release comply may result in dismissal of this action. 11 B. 12 Plaintiff must file and serve a notice of a change of address in accordance with 13 Rule 83.3(d) of the Local Rules of Civil Procedure. Plaintiff must not include a motion 14 for other relief with a notice of change of address. Failure to comply may result in 15 dismissal of this action. Address Changes 16 C. 17 Plaintiff must submit an additional copy of every filing for use by the Court. See 18 LRCiv 5.4. Failure to comply may result in the filing being stricken without further 19 notice to Plaintiff. Copies 20 D. 21 Because the Complaint has been dismissed for failure to state a claim, if Plaintiff 22 fails to file an amended complaint correcting the deficiencies identified in this Order, the 23 dismissal may count as a “strike” under the “3-strikes” provision of 28 U.S.C. § 1915(g). 24 Under the 3-strikes provision, a prisoner may not bring a civil action or appeal a civil 25 judgment in forma pauperis under 28 U.S.C. § 1915 “if the prisoner has, on 3 or more 26 prior occasions, while incarcerated or detained in any facility, brought an action or appeal 27 in a court of the United States that was dismissed on the grounds that it is frivolous, Possible “Strike” 28 JDDL-K -7- 1 malicious, or fails to state a claim upon which relief may be granted, unless the prisoner 2 is under imminent danger of serious physical injury.” 28 U.S.C. § 1915(g). 3 E. 4 If Plaintiff fails to timely comply with every provision of this Order, including 5 these warnings, the Court may dismiss this action without further notice. See Ferdik, 963 6 F.2d at 1260-61 (a district court may dismiss an action for failure to comply with any 7 order of the Court). 8 IT IS ORDERED: Possible Dismissal 9 (1) The Show Cause Order is discharged. (Doc. 7.) 10 (2) Plaintiff’ Application to Proceed In Forma Pauperis is granted. (Doc. 8.) 11 (3) As required by the accompanying Order to the appropriate government 12 agency, Plaintiff must pay the $350.00 filing fee and is not assessed an initial partial 13 filing fee. 14 (4) The Complaint (Doc. 1) is dismissed for failure to state a claim. Plaintiff 15 has 30 days from the date this Order is filed to file a first amended complaint in 16 compliance with this Order. 17 (5) If Plaintiff fails to file an amended complaint within 30 days, the Clerk of 18 Court must, without further notice, enter a judgment of dismissal of this action with 19 prejudice that states that the dismissal may count as a “strike” under 28 U.S.C. § 1915(g). 20 21 22 (6) The Clerk of Court must mail Plaintiff a court-approved form for filing a civil rights complaint by a prisoner. Dated this 3rd day of October, 2013. 23 24 25 26 27 28 JDDL-K -8- 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 Fee. The filing fee for this action is $350.00. If you are unable to immediately pay the filing fee, 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. 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 $350 filing fee or the application to proceed in forma pauperis to: Revised 3/9/07 1 Phoenix & Prescott Divisions: OR U.S. District Court Clerk U.S. Courthouse, Suite 130 401 West Washington Street, SPC 10 Phoenix, Arizona 85003-2119 Tucson Division: U.S. District Court Clerk U.S. Courthouse, Suite 1500 405 West Congress Street 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. 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 courtapproved civil rights complaint form. You may file one amended complaint without leave (permission) of Court before any defendant has answered your original complaint. See Fed. R. Civ. P. 15(a). After any defendant has filed an answer, 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. 2 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 “1A” 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,” “2B,” 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. 3 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. 4 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, vs. (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. 2. 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: . Institution/city where violation occurred: . Revised 3/9/07 1 550/555 B. DEFENDANTS 1. Name of first Defendant: at . The first Defendant is employed as: . (Position and Title) 2. (Institution) Name of second Defendant: at . The second Defendant is employed as: . (Position and Title) 3. (Institution) Name of third Defendant: at . The third Defendant is employed as: . (Position and Title) 4. (Institution) Name of fourth Defendant: at . The fourth Defendant is employed as: . (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? 2. If yes, how many lawsuits have you filed? G Yes G No . 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: v. 1. Parties: 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. 2 D. CAUSE OF ACTION 1. COUNT I 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 G Yes G No at your institution? 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. . 3 1. COUNT II 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. . 4 1. COUNT III 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 G Yes G No at your institution? 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. 5 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. 6