Free Complaint - District Court of Delaware - Delaware

Case 1:08—cv—00279-JJF Document 2 Filed 05/13/2008 Page 1 of 4
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FORM TO BE USED BY A I>RISONER IN FILING A CoIvII>LAIN1} Il l· J3
UNDER THE CIVIL RIGHTS ACT, 42 U.s.C. §1983
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF DELAWARE
I l r »
(1) ¢>% VQ OI) ;
(Name of Plaintif (Inmate Number) :
in I l“¤ tml Irlewvellxi.
(Complet Ad ress with zip code) R [Q10-; :
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(2) A :
(Name of Plaintiff`) (Inmate Number) : (Case Number)
: ( to be assigned by U.S. Distiict Court)
l°»c>l M (tt l°l'l0Z, .
(Complete Address with z` code) :
(Each named party must be listed, and all names
must be printed or typed. Use additional sheets if needed) :
vs. z CIVIL COMPLAINT
K"!.) :
(I) §5gg;@\e<>.lQK),Q;l»e5@[;XgyAgt;_<& ;
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(2) CC) I/`\ I l I :
US) _ _ 2 ° ° Jury Trial Requested
(2) F QI li (MIUQ ;
( ame ofD fe t) _ Y . :
S ° “EI5`(§ti,¤¤A¤mt¤¢ittts mma) ,
(Each named party must be listed, and all names :
must be printed or typed. Use additional sheets if needed) :
I. PREVIOUS LAWSUITS
A. lf 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 name of thejudicial officer to whom it was assigned:
(lose Iiumhgj 01o&0Egi®) ,. 3[ljq;2 Vélljit ohleol. m@niL om) (fig
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Case 1:08—cv—00279-JJF Document 2 Filed 05/13/2008 Page 2 of 4
II. EXHAUSTION OF ADMINISTRATIVE REMEDIES
In order to proceed in federal court, you must fully exhaust any available administrative remedies as to
each ground on which you request action.
A. ls there a prisoner grievance procedure available at your present institution? ·% Yes • · No
B. Have you fully exhausted your available administrative remedies regarding each of your present
claims? Yes · •No
C. lf your answer to "B" is Xg:
l. What steps did you take? li Q 5; iii Qfur (EWS]
§3;gQ§mgg@§( ;i-gggjjgiiggod ;%ch$, i0twl5i)ro\x%',€) 2. What was the result? i lg M
D. If your answer to "B" is xg, explain why not:
III. DEFENDANTS (in order listed on the caption) ‘
°" L i CD G) ll
(l) Name ofiirst defendant: t X cw '
Employedas 3 ' R \ •·` _j• at \\;.,L[Q ’ LAD.; 3 YA X.I\€*§\;i\\)'i'i\`ll
. ~ * •
Mailing address with zip code: ` jih A " I K} \ · O
(2) Name ofsecond defendant: ( Q Qi A3']
Employed as [E$)Y§QQ£)(y[I)i at \' QD Q6 h l `XVXQOYN
Mailing address with zip code: Q . ’\ ` Q
tiii L7) _ I . [ A
(3) Name ofthird defendant: 3 · _ 'A..•.· 4 I.Q F _.· _I Di li.
.,cd ..S it .. (Oli
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Mailing address with zip code: A . ·_ All!} I_ ul i fo •
(List any additional defendants, their employment, and addresses with zip codes, on extra sheets if necessary)
2

Case 1:08—cv—00279-JJF Document 2 Filed 05/13/2008 Page 3 of 4
IV. STATEMENT OF CLAIM I
(State as brietly as possible the facts of your case. Descnbe how each defendant is involved, including dates and
places. Do not give any legal arguments or cite any cases or statutes. Attach no more than three extra sheets of paper
if necessary.)
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V. RELIEF \
(State briefly exactly what y0u want the Court t0 do for you. Make no legal arguments. Cite no cases or
statutes.)
i. • X A — u os uooo\ \xl/we
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Case 1:08—cv—00279-JJF Document 2 Filed 05/13/2008 Page 4 of 4
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I declare under penalty of perjury that the foregoing is true and correct.
Signed this day of , 2 OO .
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I ; a e lain 'ff 2)
(4¤u14;¤124’1_ /1 All .
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4

Case 1:08-cv-00279-JJF

Document 2

Filed 05/13/2008

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Case 1:08-cv-00279-JJF

Document 2

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Case 1:08-cv-00279-JJF

Document 2

Filed 05/13/2008

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Case 1:08-cv-00279-JJF

Document 2

Filed 05/13/2008

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