(Rev.10/2013)UNITEDSTATESDISTRICTCOURTFORTHEDISTRICTOFKANSASINFORMATIONANDINSTRUCTIONSFORPRISONERSFILINGCIVILRIGHTSCOMPLAINTSUNDER42U.S.C.2471983orBIVENSACTIONS1.FORMSTheattachedformistoassistyouinthepreparationofacomplaintseekingreliefforviolationofcivilrightsundereither42U.S.C.2471983(defendantsarestateofficials)oraBivensaction(defendantsarefederalofficials).Theseformsmaybefilledoutbytypewriterorbyhand.Handwritingmustbeclearandreadable.Everyquestionontheformsmustbeanswered,evenifyouransweris223no,224or223don222tknow.224TheuseofformsisrequiredbyD.Kan.Rule9.1(a).Donotwriteonthebackofthecomplaintforms.Ifyouneedmorespace,useadditionalsheetsofpaper.FederalrulesrequirethatthecomplaintbeaBRIEFstatement.Sticktothefacts(who,what,when,where,why,how).Alwaysincludedates,times,places,andnames.PursuanttoD.Kan.Rule7.1(e),theargumentandauthoritiessectionofabrieformemoranduminacivilactionmaynotexceed30pagesabsentanorderofthecourt.2.COPIESNOTREQUIREDPursuanttoD.Kan.Rule9.1(h),petitioners,movants,andplaintiffsneedonlysubmittheORIGINALpetition,motion,orcomplainttotheclerkforfiling.Additionalcopiesarenotrequired.Itisyourresponsibilitytokeepacopyforyourrecordsofeverycomplaintandotherdocumentorletterthatyousendtothecourt.3.SIGNATUREREQUIREDYoumustpersonallysignthecomplaint,motion,orpetition.Ifthereismorethanoneplaintiff,eachpersonmustsign.Youmaynotsignforanyoneelse.4.TENDEROFPLEADINGSWhenyourcomplaintorpleadingiscompleted,itshouldbetransmittedtotheclerkofthecourtwiththeappropriatefilingfeeorinformapauperismotion.Ifyouareincarceratedinafacilitywithmandatoryelectronicfiling,youshouldfollowinstructionsavailableatthefacilityfortransmittingthepleadingelectronicallytothecourt. American LegalNet, Inc. www.FormsWorkFlow.com (Rev.10/2013)Ifyouarenotsubjecttomandatoryelectronicfiling,youshouldmailthepleadingto:TIMOTHYM.O222BRIEN,CLERKOFCOURTUNITEDSTATESDISTRICTCOURT444S.E.QUINCYTOPEKA,KANSAS666835. FILINGFEESThecomplaintmustbeaccompaniedbyafilingfeeoramotionforleavetoproceedinformapauperis.Thestatutoryfilingfeeforcivilrightscomplaintsis$400.00.1Ifyoucannotaffordtoprepaythefilingfee,youmayrequestpermissiontoproceedinformapauperisbycompletingaformmotionavailablefromthecourtandsubmittingcertifiedcopiesofyourinstitutionalfinancialrecordsforthesixmonthsprecedingyourmotionforleavetoproceedinformapauperis.Afterreceivingthesematerials,thecourtwillassessaninitialpartialfilingfeethatisthegreaterof(a)20%oftheaveragemonthlydepositsinyouraccountforthepastsixmonths;OR(b)20%oftheaveragemonthlybalanceinyouraccountforthepastsixmonths.Ifyourmotionisgranted,youwillbeallowedtopaythefilingfeeininstallments,andyoumustpay20%ofeachmonth222sincomeineverymonthyourinstitutionalaccountbalanceexceedstendollars($10.00)untilthefullfilingfeeispaid.See28U.S.C.2471915(b).Thefinancialofficerofthefacilitywhereyouareincarceratedwillbedirectedtomakethesepayments,anditisyourresponsibilitytocooperatewithfacilitypersonneltoauthorizethesearrangements.Thefailuretocooperatemayresultinsanctionsbythecourt.Youmustpaythefullfilingfeeevenifyourcaseisdismissedbythecourt.Ifyouhavenoassets,youwillnotbeprohibitedfrombringinganactionwithoutpaymentofaninitialpartialfee.See28U.S.C.2471915(b)(4).However,whenyoureceiveassets,youmustpaythefilingfeeasdescribed.Ifyouhavehadthreeormorecivilactionsorappealsdismissedasfrivolous,malicious,orforfailuretostateaclaim,youarenolongereligibletoproceedwithoutprepaymentofthefullfilingfeeunlessyouareunderseriousdangerofseriousphysicalinjury.See28U.S.C.2471915(g).6. SERVICEOnceyouhavesubmittedtheportionofthefilingfeedirectedbythecourt,thecourtwillreviewyourclaimstodeterminewhethersummonsorwaiverofsummonsformsshouldbeissuedtothedefendants.Yourcomplaintshouldlistthecompletenameandaddressofeachpersonnamedasadefendant.Withoutthisinformation,theClerkcannotpreparesummonsorwaiversforissuancebytheMarshal.SeeRule4oftheFederalRulesofCivilProcedure. American LegalNet, Inc. www.FormsWorkFlow.com (Rev.10/2013)7.AFTERTHECOMPLAINTISFILEDYoumustcomplywithcourtrules,whichincludekeepingthecourtinformedinwritingofyourcurrentaddress.SeeD.Kan.R.5(c)(3).Ifyoufailtocomplywiththisoranyothercourtruleorfailtocomplywithanycourtimposeddeadline,yourcasemaybedismissedforwantofprosecution.Exhibitsincludedwiththecomplaintorapleadingareconsideredpartofthecourtrecordandwillnotbereturned.8.MOTIONSArequestforanytypeofreliefmustbeintheformofapropermotionbeginningwiththecasecaptionandtitleofthemotion.9.COMMUNICATIONWITHTHECOURTItisimpropertocommunicatedirectlywithaJudgeorMagistrateJudgeconcerningmatterswhichareormaybecomeasubjectinCourt.Proceduralquestionsmaybedirectedtotheclerk222soffice,butJudges,MagistrateJudges,andcourtstaffareprohibitedfromgivinglegaladvice.10.EXHAUSTIONOFADMINISTRATIVEREMEDIESUNDERTHEPRISONLITIGATIONREFORMACT(PLRA)Youmaynotbringanactionchallengingprisonconditionsunder42U.S.C.2471983oranyotherfederallawuntilyouhaveexhaustedavailableadministrativeremedies. 1EffectiveMay1,2013,thereisa$50generaladministrativefeeforfilingacivilaction,suit,orproceedinginadistrictcourt.Thisfeeisinadditiontotheexistingcivilfilingfeeof$350.Therefore,effectiveMay1,2013,thetotalfeeforfilinganewcivilcasewillbe$400.Thisnewfeeispartofthe223DistrictCourtMiscellaneousFeeSchedule224,establishedbytheJudicialConferenceoftheUnitedStates,pursuantto28U.S.C.2471914.Thisfeedoesnotapplytopersonsgrantedinformapauperisstatusunder28U.S.C.2471915. American LegalNet, Inc. www.FormsWorkFlow.com 1XE-2 8/82 CIVIL RIGHTS COMPLAINT 2471983 Name Address UNITED STATES DISTRICT COURT FOR THE DISTRICT OF KANSAS , Plantiff (Full Name) V. CASE NO. (To be supplied by the Clerk) , Defendant (s) CIVIL RIGHTS COMPLAINT PURSUANT TO 42 U.S.C. 2471983 A. JURISDICTION 1), is a citizen of (Plaintiff) (State)who presently resides at (Mailing address or place . of confinement.) 2)Defendant is a citizen of(Name of first defendant) , and is employed as (City, State) . At the time the (Position and title, if any) claim(s) alleged in this complaint arose, was this defendant acting under the color of state law? Yes No . If your answer is 223Yes224, briefly explain: American LegalNet, Inc. www.FormsWorkFlow.com 2XE-2 8/82 CIVIL RIGHTS COMPLAINT 2471983 3)Defendant is a citizen of(Name of second defendant) , and is employed as (City, state) . At the time the (Position and title, if any) claim (s) alleged in this complaint arose was this defendant acting under the color of state law? Yes No . If your answer is 223Yes224, briefly explain: (Use the back of this page to furnish the above information for additional defendants.) 4)Jurisdiction is invoked pursuant to 28 U.S.C. 2471343(3); 42 U.S.C. 2471983. (If you wish toassert jurisdiction under different or additional statutes, you may list them below.)B. NATURE OF THE CASE 1)Briefly state the background of your case: American LegalNet, Inc. www.FormsWorkFlow.com 3XE-2 8/82 CIVIL RIGHTS COMPLAINT 2471983 C. CAUSE OF ACTION 1) I allege that the following of my constitutional rights, privileges or immunities have been violated and that the following facts form the basis for my allegations: (If necessary you may attach up to two additional pages (8h224 x 11224) to explain any allegation or to list additional supporting facts.) A) (1) Count I: (2) Supporting Facts: (Include all facts you consider important, including names of persons involved, places and dates. Describe exactly how each defendant is involved. State the facts clearly in your own words without citing legal authority or argument.): B) (1) Count II: (2) Supporting Facts: American LegalNet, Inc. www.FormsWorkFlow.com 4XE-2 8/82 CIVIL RIGHTS COMPLAINT 2471983 C) (1) Count III: (2) Supporting Facts: D. PREVIOUS LAWSUITS AND ADMINISTRATIVE RELIEF 1) Have you begun other lawsuits in state or federal court dealing with the same facts involved in this action or otherwise relating to the conditions of your imprisonment? Yes No . If your answer if 223Yes224, describe each lawsuit. (If there is more than one lawsuit, describe the additional lawsuits on another piece of paper, using the same outline.) a) Parties to previous lawsuit: Plaintiffs: Defendants: b) Name of court and docket number c) Disposition (for example: Was the case dismissed? Was it appealed? Is it still pending?) d)