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RECEIVED
USOC CLERK. GREENVILLE. SC

IN THE UNITED STATES DISTRICT COURT lOfB APR -2 PM I,: 02


FOR THE DISTRICT OF SOUTH CAROLINA

Complaint for Violation of Civil


Rights
(Prisoner Complaint)
(Write the full name of each plaintiff who is filing
this complaint. If the names ofall the plaintiffs
cannot fit in the space above, please write "see
Case No. ii,: I~-o<-! o~-TV\AC.,-\C.t=-IM
(to be filled in by the Clerk's Office)
attached" in the space and attach an additional
page with the full list of names.)
Jury Trial: ~ • No
(check one)
-against-

(Write the full name of each defendant who is


being sued If the names of all the defendants
cannot fit in the space above, please write "see
attached" in the space and attach an additional
page with the full list of names. Do not include
addresses here.)

NOTICE

Federal Rules of Civil Procedure 5.2 addresses the privacy and security concerns resulting from public
access to eleetronfo court files. Under this rule, papers filed with the court should not contain: an
individual's full social security number or full birth date; the full name of a person known to be a minor; or
a complete financial account number. A filing may include only: the last four digits of a social security
number; the year of an individual's birth; a minor's initials; and the last four digits of a financial account
number.

Except as noted in this form, plaintiff need not send exhibits, affidavits, grievance or witness statements, or
any other materials to the Clerk's Office with this complaint.

When submitted for filing, your complaint should be accompanied by the full filing fee or an application to
proceed in forma pauperis.
6:18-cv-00402-TMC-KFM Date Filed 02/09/18 Entry Number 1-2 Page 2 of 13

''

I. The Parties to This Complaint

A. The Plaintiff{s)

Provide the information below for each plaintiff named in the complaint. Attach
additional pages if needed.

Name ?Q<'fN= t}U~\['L


All other names by which you have been known:
s<./76oCf
~ d ~iv'w ('.6Yvedtntq,/ '5-vt.sf-✓
m Number ·/cltoo 7-?wvad l<t' v w 12d
1

Current Institution Co(tyn42/c; Sr C1 ;;;ll):J-/D


Address

B. The Defendant(s)

Provide the information below for each defendant named in the complaint, whether
the defendant is an individual, a government agency, an organization, or a
corporation. Make sure that the defendant(s) listed below are identical to those
contained in the above caption. For an individual defendant, include the person's job
or title (if known) and check whether you are bringing this complaint against them in
their individual capacity or official capacity, or both. Attach additional pages if
needed.

Defendant No. I
Name
Job or Title
(if known)
Shield Number
Employer
Address

~ndividual capacity ~fficial capacity

Defendant No. 2
Name

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6:18-cv-00402-TMC-KFM Date Filed 02/09/18 Entry Number 1-2 Page 3 of 13

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Job or Title
(if known)
Capf4in/tu11! Ma..vtq%t=
Shield Number SauJ-t. uiy-a/4,,4 'ZJ:ej?f of &vr
Employer lfcf# .&oad 7<1vev ~
Address

~ Individual capacity Ql..../Official capacity

Defendant No. 3
Name
Job or Title
(if known)
Shield Number
Employer
Address

qy-fridividual capacity 'VOfficial capacity

Defendant No. 4
Name
Job or Title Rss,- 5U)M__t Vitrec#rc sfq,/-e (/fp5
(if known)
Shield Number .Siul-h {!a,vtJ·/r"vt.q Pp/,tJfCarr
Employer '-lrfr/t/ fferoqd &'r'f/P~,,. l<.Q'
Address

av-fndividual capacity [D_--official capacity

II. Basis for Jurisdiction

Under 42 U.S.C. § 1983, you may sue state or local officials for the "deprivation of any rights,
privileges, or immunities secured by the Constitution and [federal laws]." Under Bivens v. Six
Unknown Named Agents of Federal Bureau of Narcotics, 403 U.S. 388 (I 971), you may sue
federal officials for the violation of certain constitutional rights.

3
6:18-cv-00402-TMC-KFM Date Filed 02/09/18 Entry Number 1-2 Page 4 of 13

,.

A. Are you bringing suit against (check all that apply):

D _.,,,Federal officials (a Bivens claim)


g/' State or local officials (a § 1983 claim)

B. Section 1983 allows claims alleging the "deprivation of any rights, privileges, or
immunities secured by the Constitution and [federal laws]." 42 U.S.C. § 1983. If you
are suing under section 1983, what federal constitutional or statutory right(s) do you
claim is/are being violated by state or local officials?

F1~ ~I £ i ~ (!wid ~

C. Plaintiffs suing under Bivens may only recover for the violation of certain
constitutional rights. If you are suing under Bivens, what constitutional right(s) do you
claim is/are being violated by federal officials?

D. Section 1983 allows defendants to be found liable only when they have acted "under
color of any statute, ordinance, regulation, custom, or usage, of any State or Territory
or the District of Columbia." 42 U.S.C. § 1983. If you are suing under section 1983,
explain how each defendant acted under color of state or local law. If you are suing
under Bivens, explain how each defendant acted under color of federal law. Attach
additional pages if needed.

III. Prisoner Status

Indicate whether you are a prisoner or other confined person as follows (check all that apply):

• Pretrial detainee
~ Civilly committed detainee
• Immigration detainee

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6:18-cv-00402-TMC-KFM Date Filed 02/09/18 Entry Number 1-2 Page 5 of 13

..

✓ Convicted and sentenced state prisoner

• Convicted and sentenced federal prisoner

• Other (explain) _ _ _ _ _ _ _ _ _ _ __

IV. Statement of Claim

State as briefly as possible the facts of your case. Describe how each defendant was
personally involved in the alleged wrongful action, along with the dates and locations of all
relevant events. You may wish to include further details such as the names of other persons
involved in the events giving rise to your claims. Do not cite any cases or statutes. If more
than one claim is asserted, number each claim and write a short and plain statement of each
claim in a separate paragraph. Attach additional pages if needed.

A. If the events giving rise to your claim arose outside an institution, describe where and
when they arose.

B. If the events giving rise to your claim arose in an institution, describe where and when
they arose.

cXL ;;;dvyrJ~#I

C. What date and approximate time did the events giving rise to your claim(s) occur?

D. What are the facts underlying your claim(s)? (For example: What happened to you?
Who did what? Was anyone else involved? Who else saw what happened?)

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6:18-cv-00402-TMC-KFM Date Filed 02/09/18 Entry Number 1-2 Page 6 of 13

,.

V. Injuries

If you sustained injuries related to the events alleged above, describe your injuries and state
what medical treatment, if any, you required and did or did not receive.

S-eL {;v-, hry w , ~ # t

VI. Relief

State briefly what you want the court to do for you. Make no legal arguments. Do not cite any
cases or statutes. If requesting money damages, include the amounts of any actual damages
and/or punitive damages claimed for the acts alleged. Explain the basis for these claims.

Sn Cu by wlU1Ak&u: # (

VII. Exhaustion of Administrative Remedies Administrative Procedures

The Prison Litigation Reform Act ("PLRA"), 42 U.S.C. § 1997e(a), requires that "[n]o action
shall be brought with respect to prison conditions under section 1983 of this title, or any other
Federal law, by a prisoner confined in any jail, prison, or other correctional facility until such
administrative remedies as are available are exhausted."
Administrative remedies are also known as grievance procedures. Your case may be
dismissed if you have not exhausted your administrative remedies.

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6:18-cv-00402-TMC-KFM Date Filed 02/09/18 Entry Number 1-2 Page 7 of 13

,.

A. Did your claim(s) arise while you were confined in a jail, prison, or other correctional
facility?

~Yes
• No

If yes, name the jail, prison, or other correctional facility where you were confined at
the time of the events giving rise to your claim(s).
~ d ~ vw Covr--ech•Aaf µ.,5fr'M ·zn..,

B. Does the jail, prison, or other correctional facility where your claim(s) arose have a
grievance procedure?

~Yes
• No
• Do not know

C. Does the grievance procedure at the jail, prison, or other correctional facility where
your claim(s) arose cover some or all of your claims?

~es
• No
• Do not know

If yes, [hic~laim(s)?
fH 6 ~

D. Did you file a grievance in the jail, prison, or other correctional facility where your
claim(s) arose concerning the facts relating to this complaint?

~ >es
~No

7
6:18-cv-00402-TMC-KFM Date Filed 02/09/18 Entry Number 1-2 Page 8 of 13

If no, did you file a grievance about the events described in this complaint at any other
jail, prison, or other correctional facility?

• Yes
~o

E. If you did file a grievance:

I• Where did you file the grievance?

2. What did you claim in your grievance?

3. What was the result, if any?

4. What steps, if any, did you take to appeal that decision? Is the grievance
process completed? If not, explain why not. (Describe all efforts to appeal to
the highest level of the grievance process.)

1 CauJd !Clot g_p.p!;JJJ


Y\ IQ ,\f g f 5i \(fM a._
19-u::o
gr',~Q,A/lC~
'e 1.
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WQS

8
6:18-cv-00402-TMC-KFM Date Filed 02/09/18 Entry Number 1-2 Page 9 of 13

F. If you did not tile a grievance:

I. lf there are any reasons why you did not tile a grievance, state them here:

~ 1).<l:"~Ct.Ml--s 'l oLuAg) CUA QJ


~~ -r-e._~'l-R... ±:o 5' v'g__ ·Y\M.. a '"'l,

2. If you did not tile a grievance but you did infonn officials of your claim, state
who you infonned, when and how, and their respo-nse, if any:
:I WVdfe N0vrd-t:v1 ,. Y-/gj>Aen a,.,y, o{

G. Please set forth any additional infonnation that is relevant to the exhaustion of your
administrative remedies .

.In//vtcd-...e_ '7?tf-i2re 5-evvl-t ·v-e in/2-v-t,Me,c/ QJ/

(Note: You may attach as exhibits to this complaint any documents related to the
exhaustion ofyour administrative remedies.)

VIII. Previous Lawsuits

The ''three strikes rule" bars a prisoner from bringing a civil action or an appeal in federal
court without paying the filing fee if that prisoner has "on three or more prior occasions, while
incarcerated or detained in any facility, brought an action or appeal in a court of the United
States that was dismissed on the grounds that it is frivolous, malicious, or fails to state a claim
upon which relief may be granted, unless the prisoner is under imminent danger of serious
physical injury." 28 U.S.C. § 1915(g).

To the best of your knowledge, have you had a case dismissed based on this ''three strikes
rule"?

• Yes
~

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6:18-cv-00402-TMC-KFM Date Filed 02/09/18 Entry Number 1-2 Page 10 of 13

If so, state which court dismissed your case, when this occurred, and attach a copy of the
order if possible.

A. Have you filed other lawsuits in state or federal court dealing with the same facts
involved in this action?

• Yes
~
B. If your answer to A is yes, describe each lawsuit by answering questions 1 through 7
below. (If there is more than one lawsuit, describe the additional lawsuits on another
page, using the same format.)

I. Parties to the previous lawsuit


Plaintiff(s)
Defendant(s)

2. Court (if federal court, name the district,· if state court, name the county and
State)

3. Docket or index number

4. Name of Judge assigned to your case

5. Approximate date of filing lawsuit

6. Is the case still pending?

D Yes
D No

If no, give the approximate date of disposition. _ _ _ _ _ _ _ __

IO
6:18-cv-00402-TMC-KFM Date Filed 02/09/18 Entry Number 1-2 Page 11 of 13

7. What was the result of the case? (For example: Was the case dismissed? Was
judgment entered in your favor? Was the case appealed?)

C. Have you filed other lawsuits in state or federal court otherwise relating to the
conditions of your imprisonment?

• ys
~No

D. If your answer to C is yes, describe each lawsuit by answering questions I through 7


below. (If there is more than one lawsuit, describe the additional lawsuits on another
page, using the same format.)

1. Parties to the previous lawsuit

Plaintiff(s)
Defendant(s)

2. Court (if federal court, name the district; if state court, name the county and
State)

3. Docket or index number

4. Name of Judge assigned to your case

5. Approximate date of filing lawsuit

6. Is the case still pending?

D Yes
• No

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6:18-cv-00402-TMC-KFM Date Filed 02/09/18 Entry Number 1-2 Page 12 of 13

lf no, give the approximate date of disposition. _ _ _ _ _ _ _ __

7. What was the result of the case? (For example: Was the case dismissed? Was
judgment entered in your favor? Was the case appealed?)

IX. Certification and Closing

Under Federal Rule of Civil Procedure 11, by signing below, I certify to the best of my
knowledge, information, and belief that this complaint: ( l) is not being presented for an
improper purpose, such as to harass, cause unnecessary delay, or needlessly increase the cost
of litigation; (2) is supported by existing law or by a nonfrivolous argument for extending,
modifying, or reversing existing law; (3) the factual contentions have evidentiary support or,
if specifically so identified, will likely have evidentiary support after a reasonable opportunity
for further investigation or discovery; and (4) the complaint otherwise complies with the
requirements of Rule 11.

A. For Parties Without an Attorney

I agree to provide the Clerk's Office with any changes to my address where case-
related papers may be served. I understand that my failure to keep a current address
on file with the Clerk's Office may result in the dismissal of my case.

Date of signing: f\,1.a.v-d-, )3, 20.Ll-

Signature of Plaintiff
Printed Name of Plaintiff
Prison Identification #_.;:,...;~....::s::~+--=,-----i=:::---:----------
Prison Address

City State Zip Code


B. For Attorneys

Date of signing: _ _ _ __. 20_.

Signature of Attorney
Printed Name of Attorney
Bar Number
Name of Law Firm

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6:18-cv-00402-TMC-KFM Date Filed 02/09/18 Entry Number 1-2 Page 13 of 13

Address
Telephone Number
E-mail Address

13
6:18-cv-00402-TMC-KFM Date Filed 02/09/18 Entry Number 1-3 Page 1 of 2

RECEIVED
USOC CLERK. GREEHVILLE. SC

2018 APR-2 PH t.: 02

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6:18-cv-00402-TMC-KFM Date Filed 02/09/18 Entry Number 1-3 Page 2 of 2

USOC CLERK,
RECEIVED
GREENVILLE, SC

2018APR -2 PH If: 02

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