Larsen v. Larsen et al, No. 2:2024cv00004 - Document 7 (D. Utah 2024)

Court Description: MEMORANDUM DECISION AND ORDER TO CURE DEFICIENT 5 Complaint. Plaintiff must within thirty days form the date of this order, cure the Complaint's deficiencies by filing an Amended Complaint on the proper form. The Clerk's Office shall mail Plaintiff the Pro Se Litigant Guide with a blank-form complaint which Plaintiff must use if she wishes to pursue another amended complaint. If Plaintiff fails to timely cure the deficiencies in her Complaint, this action will be dismissed. Signed by Magistrate Judge Dustin B. Pead on 1/16/2024. (Attachments: # 1 Pro Se Litigant Guide, # 2 Civil Rights Complaint)(mh)

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Larsen v. Larsen et al Doc. 7 Att. 2 Name: Address: Telephone: UNITED STATES DISTRICT COURT FOR THE DISTRICT OF UTAH DIVISION (Full Name) PLAINTIFF CIVIL RIGHTS COMPLAINT (42 U.S.C §1983, §1985) vs. CIVIL NO. (Supplied by Clerk) DEFENDANTS A. JURISDICTION 1. Jurisdiction is proper in this court according to: a. b. c. 2. 42 U.S.C. §1983 42 U.S.C. §1985 Other (Please Specify) NAME OF PLAINTIFF _____________________________________________ IS A CITIZEN OF THE STATE OF ___________________________________ PRESENT MAILING ADDRESS: ____________________________________ ____________________________________ Dockets.Justia.com 3. NAME OF FIRST DEFENDANT IS A CITIZEN OF (City and State) IS EMPLOYED AS at . (Position and Title if Any) (Organization) Was the defendant acting under the authority or color of state law at the time these claims occurred? YES NO . If your answer is "YES" briefly explain. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 4. NAME OF SECOND DEFENDANT (If applicable) IS A CITIZEN OF (City and State) IS EMPLOYED AS at . (Position and Title if Any) (Organization) Was the defendant acting under the authority or color of state law at the time these claims occurred? YES NO . If your answer is "YES" briefly explain. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 5. NAME OF THIRD DEFENDANT (If applicable) IS A CITIZEN OF (City and State) IS EMPLOYED AS (Position and Title if Any) at (Organization) . Was the defendant acting under the authority or color of state law at the time these claims occurred? YES NO . If your answer is "YES" briefly explain. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 6. NAME OF FOURTH DEFENDANT (If applicable) IS A CITIZEN OF (city and State) IS EMPLOYED AS at . (Position and Title if Any) (Organization) Was the defendant acting under the authority or color of state law at the time these claims occurred? YES NO . If your answer is "YES" briefly explain. __________________________________________________________________ __________________________________________________________________ ___________________________________________________________________ (Use additional sheets of paper if necessary.) B. NATURE OF CASE 1. Why are you bringing this case to court? Please explain the circumstances that led to the problem. C. CAUSE OF ACTION 1. I allege that my constitutional rights, privileges or immunities have been violated and that the following facts form the basis for my allegations: (If necessary you may attach additional pages) a. b. c. (1) Count I: (2) Supporting Facts: (Describe exactly what each defendant did or did not do. State the facts clearly in your own words without citing legal authority or arguments.) (1) Count II: (2) Supporting Facts: (1) Count III: (2) Supporting Facts: D. INJURY 1. How have you been injured by the actions of the defendant(s)? ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ _____________________________________________________________ E. PREVIOUS LAWSUITS AND ADMINISTRATIVE RELIEF 1. Have you filed other lawsuits in state or federal court that deal with the same facts that are involved in this action or otherwise relate to the conditions of your imprisonment? YES / NO . If your answer is "YES," describe each lawsuit. (If there is more than one lawsuit, describe additional lawsuits on additional separate pages, using the same outline.) a. Parties to previous lawsuit: Plaintiff(s): Defendant(s): b. Name of court and case or docket number: 2. c. Disposition (for example: Was the case dismissed? Was it appealed? Is it still pending?) d. Issues raised: e. When did you file the lawsuit? f. When was it (will it be) decided? __________________________________ __________________________________ Date Month Year Have you previously sought informal or formal relief from the appropriate administrative officials regarding the acts complained of in Part C? YES / NO . If your answer is "YES" briefly describe how relief was sought and the results. If your answer is "NO" explain why administrative relief was not sought. F. REQUEST FOR RELIEF 1. I believe that I am entitled to the following relief: DECLARATION UNDER PENALTY OF PERJURY The undersigned declares under penalty of perjury that he/she is the plaintiff in the above action, that he/she has read the above complaint, and that the information contained therein is true and correct. 28 U.S.C. §1746; 18 U.S.C §1621. Executed at on (Location) Signature 20___. (Date)

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