_________________________________________________ Full Name/Prisoner Number _________________________________________________ _________________________________________________ Complete Mailing Address IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW MEXICO Civil Action No. ______________________________ (To be supplied by the Court) ______________________________________________________________ ______________________________________________________________, Plaintiff(s), Full name(s) and prisoner number(s) (Do not use et al.) v. ______________________________________________________________ ______________________________________________________________, Defendant(s). (Do not use et al.) PRISONER'S CIVIL RIGHTS COMPLAINT A. PARTIES AND JURISDICTION 1. ____________________________________ is a citizen of __________________________ who (Plaintiff) (State) presently resides at _______________________________________________________________. (mailing address or place of confinement) 2. Defendant ______________________________________ is a citizen of ______________________ (name of first defendant) (State) whose address is_________________________________________________________________, and who is employed as ____________________________________. At the time the claim(s) (title and place of employment) alleged in this complaint arose, was this defendant acting under color of state law? ____Yes ____No. If your answer is "Yes," briefly explain: ____________________________________________________________________________________ ____________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com 3. Defendant ______________________________________ is a citizen of ______________________ (name of second defendant) (State) whose address is ____________________________________________________________ and who is employed as ____________________________________. At the time the claim(s) (title and place of employment) alleged in this complaint arose, was this defendant acting under color of state law? ____Yes ____No. If your answer is "Yes," briefly explain: ____________________________________________________________________________________ ____________________________________________________________________________________ (If more space is needed to furnish the above information for additional defendants, continue on a blank sheet which you should label "A. PARTIES." Be sure to include each defendant's complete address and title.) (CHECK ONE OR BOTH:) ______ Jurisdiction is asserted pursuant to 42 U.S.C. § 1983 (for state defendants) or Bivens v. Six Unknown Named Agents of Fed. Bureau of Narcotics, 403 U.S. 388 (1971) and 28 U.S.C. § 1331 (for federal defendants). ______ Jurisdiction also is invoked pursuant to 28 U.S.C. § 1343(a)(3). (If you wish to assert jurisdiction under different or additional statutes, you may list them below.) ____________________________________________________________________________________ ____________________________________________________________________________________ B. NATURE OF THE CASE BRIEFLY state the background of your case. C. CAUSE OF ACTION I allege that the following of my constitutional rights, privileges, or immunities have been violated and that the following facts form the basis of my allegations: (If more space is needed to explain any allegation or to list additional supporting facts, continue on a blank sheet which you should label "D. CAUSE OF ACTION.") Claim I: _______________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 2 American LegalNet, Inc. www.FormsWorkFlow.com 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.) Claim II: _________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Supporting Facts: 3 American LegalNet, Inc. www.FormsWorkFlow.com Claim III: _______________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 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 is "Yes," describe each lawsuit. (If there is more than one lawsuit, describe the additional lawsuits using this same format on a blank sheet which you should label "E. PREVIOUS LAWSUITS AND ADMINISTRATIVE RELIEF.") a. Parties to previous lawsuit: Plaintiff(s): ____________________________________________________________________ Defendant(s): _________________________________________________________________ b. Name and location of court and docket number ____________________________________ c. Disposition of lawsuit. (For example, was the case dismissed? Was it appealed? Is it still pending?) _____________________________________________________________________________________ d. Issues raised: __________________________________________________________________ e. Approximate date of filing lawsuit:____________________________ f. Approximate date of disposition: ______________________________ 2. I previously have sought informal or formal relief from the appropriate administrative officials regarding the acts complained of in Part D. ____Yes ____No. If your answer is "Yes," briefly describe how relief was sought and the results. 3. I have exhausted available administrative remedies. ____ Yes ____ No. If your answer is "Yes," briefly explain the steps taken. Attach proof of exhaustion. If your answer is "No," briefly explain why administrative remedies were not exhausted. 4 American LegalNet, Inc. www.FormsWorkFlow.com E. PREVIOUSLY DISMISSED ACTIONS OR APPEALS 1. If you are proceeding under 28 U.S.C. § 1915, please list each civil action or appeal you have brou