Free Complaint - District Court of Delaware - Delaware

Q Case 1 :06-cv500141-JJ F Document 2 Filed 03/01 /2006 Page 1 of 4. - _
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FORM TO BE USED BY A PRISONER IN FILING A COMPLAINT
O UNDER THE CIVIL RIGHTS ACT, 42 U.S. C. §1983
l IN THE UNITED STATES DISTRICT COURT (
FOR THE DISTRICT OF DELAWARE
(1)QL] l389'-{3 z n .
(Name of Plaintiff`) (Inmate Number) :
PO Box °i5é»l·|—lRYCI t l
1/Ji m n 9809 ;
. (Com Address with zip code) :
(2)§2]=]QL[EB lSgg°l3 E 06- 141
(Name of Plaintiff) (Imnate Number) : (Case Number) 1
2 2 2 N C [ Y] S Tre E1- : ( to be assigned by U.S. District Court) E
Wglmigglgg QZ); L°l5CJ5' i
(Compl Address with zip code) :
(Each narned party must be listed, and all names
must be printed or typed. Use additional sheets if needed) :
vs. ¤ CIVIL COMPLAINT
S 1
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(2) Dr YQQHI §;[fLS ; ` `
: ° ‘ Jury. Trial Requested
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(Names of Defendants) :
(Each named party must be listed, and all names I
must be printed or typed. Use additional sheets if needed) :
I. · PREVIOUS LAWSUITS
A. If you have Filed any other lawsuits in federal court while a prisoner, please list the caption and case number
including year, as well as the nmne ofthe judicial efficer to whom it was assigned: -
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- —` Case 1 :06-cv~OO141-JJF Docurnent 2 Filed .03/O1/2006 Page 2 of 4 _ . ‘
`T · H. EXHAUSTION OF ADMINISTRATIVE REMEDIES. P _ A ( " ‘
In order to proceed in federal court, you must fully exhaust any available administrative remedies as to - `
‘ each ground on which you request action.
l l Is there a prisoner grievance procedure available at your present institution? • @ • • No
· B. Have you full exhausted your available administrative remedies regarding each of your present
claims? • @ • ·No ·
C. If your answer to “B" is @_: p I
; .4 J; {9 . mg;
- 1. What steps did you take? LC'] Bw rm € COI: If E E i
( HL e med r e re U M .
2. What was the result? C. Q. iq!
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bC.,[fg,1fQ¤;+QD, y
D. If your answer to "B" is Eg, explain why not: p
l
III. DEFENDANTS (in order listed on the caption)
(1)·Name oftirst defendant: f [5
Employed as o1°Ca·r; i;1t Holhlgfgl R HGUHQ CGKFL lLQL(:·|`hly _
Mailingaddresswithzipcode: I E ;51I’§Q—t (I! B0! I
r gtgyg; Mimi-[329TQg [t,»;lQ,,Mgg;e IQSOQ t Q
(2) Name of second defendant: D [ YQ M ,:1-
‘ Employedas at
Mailing address with zip code: E . or O Bog {
y tgt @(5;]; l¤(.‘!m{Q§Ton Dglarmtge Hlsoil .
_ (3) Name of third defendant: [ Q ILONAJ
l Employedas 1 IQJ QQ] Qhti oi: COPY`,-frat I
Mailing address with zip code: [ E rgfirge-lr C7] [BOX 6 I .
· C[ QQ: IVYIHIQIZOYI D¤E,i&|A/Q5,V`©
` (List any additional defendants, their em yment, and addresses with zip codes, on extra sheets if necessary)
2

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(State as eaeay as possible the facts of your eeee. Describe how each defendant is leeervee, leeleaeg dates and ·
places. D0 not give any legal arguments or cite any cases or statutes. Attach no more than three extra sheets of paper
ifnecessary.) h . y y
c t L alas tygtcfegjlae game, QE degree diegotl
medical 5,g;.;;l;;g_g by; J)r~ `{gghi rhjlgtg t‘`t
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[;I”\·IY\#CA-Z9; e
v. RELIEF y
_ _ (State briefly exactly what you want the Court to do for you. Make no legal arguments. Cite no eases or
STLHUIIGS.) V
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: ( Case 1 :06-cv-0‘0141-JJF Document 2 Fi|ed_ 03/01 /2006 ( Page 4 of 4 _ ‘
3. 1
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iI`declzu·e under penalty of peijury that the foregoing is mae and correct. . `
signcathn 3 9 day of Lj`6U/\U·QY`¥ ’ , 2 (220 {5
V of Pljntiff 1) f
(Si re of Plaintiff 2)
I . (Signature of Plaintiff 3)