Free Complaint - District Court of Delaware - Delaware

Case 1 :06-cv—00008-GIVIS Document 2 Filed 01/05/2006 Page 1 of 4
(Rev, 5/05)
FORM TO BE USED BY A PRISONER IN FILING A COMPLAINT .
UNDER THE CIVH, RIGHTS ACT, 42 U.S.C. §1983
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF DELAWARE
(1) ;)cm<;l/qi §· lQbij);{i ;
(Name of Plaintiff) (Inmate Number) ;
LIOO3 G Ygcg¤“l0.0 L.; goal/1 , .
'_ _ (Complete Address with zip code) :
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(2) j O 6 O O B
/ (Name of Plaintiff) (Inmate Number) : (Case Number)
: ( to be assigned by U.S. District Court)
(Complete Address with zip code)
(Each named party must be listed, and all names
must be printed or typed. Use additional sheets if needed) :
vs. ; CIVIL COMPLAINT
(1) {2.331; /l/lqrggg; n Q
<2> Aagat [om L,j)gc.¤l0§ Q @/
l » : Jury Trial Requested
is gi%£A;<;t~.;®ua§ has ,
(Names of Defendants) :
(Each named party must be listed, and all names
must be printed or typed. Use additional sheets if needed) :
I. 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 name of the judicial officer to whom it was assigned:

Case 1:06-cv—00008-Gl\/IS Document 2 Filed 01/05/2006 Page 2 of 4
II. EXHAUSTION OF ADMINISTRATIVE REMEDIES
ln order to proceed in federal court, you must fully exhaust any available administrative remedies as to
each ground on which you request action.
A. Is there a prisoner grievance procedure available at your present institution? D Yes D No /U/,4
B. Have you fully exhausted your available administrative remedies regarding each of your present
claims? E] Yes CI No _
C. If your answer to "B" is xg:
l. What steps did you take?
2. What was the resulti?
D. If your answer to "B" is @, explain why not:
III. DEFENDANTS (in order listed on the caption)
(1) Name of first defendant: n i E Q I gz { Lg { ‘
Employed as gf)! ( CC ® '€€ { at T Qbbyyt ei '; 28- l /1/\qf
Mailing address with zip code: I Z )‘ fl [$5 I Qi Udlfl (QQ
· QQ?) ‘}.Q.(/V\g( l,2gl>g;i}d{C gl%7gF;ilGé;{Q/
(2) Name of second defendant: _ " (D wjél QD
Employedas { Lévf [ Q AFQQVFP at L )(`¢/L; E_fl?OC CG
Mailing address with zip code: L-/( ¢ S ¢ Q·E Q6 ,`·)(/( g )
pf fig. 5 lx! \.>ct/i tug _¢4g)»z' UIQ {Q was/b t,/igrfe/1 /0, Cn, 7*75- SQ
(3) Name ofthird defendaritjg ji!-if Cb? if Q U Q5 \ l/I 'O I
Employedas EE A`§'QA{* at 2 FU; Eg; {FQ CCQ &l@g_(-I /L}S;€fl·C,\f
Mailing address with zip code: Ulf 4 QQ Q SM $4(—’CT' CD Lipbw/}5`/V
il/, ZM ¢ We 5 lo ·1»i%~‘l2sg O 4. Q 0 5 5 0
(List any additional defendants, their employme t, and addresses with zip codes, on extra sheets if necessary)
2

Case 1:06-cv—00008-Gl\/IS Document 2 Filed 01/05/2006 Page 3 of 4
1v. STATEMENT on CLAIM
(stare as briefly as persrue me facts of your ease. Describe how each defendant is rrrwnvea, including dates and
places. Do not give any legal arguments or cine any cases or statutes. Attach no more than three extra sheets of paper
if necessary.)
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and +t¢~&<\ )€<>p¤<`§ fl? my lr-{scf Se
V. RELIEF LO.? ll log lng
g?;$;;§iefL)Q=:xact1y what you want the Court to do for you. Make no legal arguments. Cite no cases or
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{ Case 1:06-cv—00008-Gl\/IS Document 2 Filed 01/05/2006 Page 4 of 4
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I declare under penalty of perjury that the foregoing is tmc and correct.
Signedtis gg · dayof Q §§§-LS Xi ,2( )§;]l G3.
l / 1 A (Signature of Plaintiff 1)
(Signature of Plaintiff 2) `
(Signature of Plaintiff 3)
S 4