Fill and Sign the Howlett V Rose Findlaw Cases and Codes Form

NameAddressUNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW MEXICO, PlaintiffCASE NO.(Full Name) (To be supplied by the Clerk) v. , Defendant(s)CIVIL RIGHTS COMPLAINT PURSUANT TO 42 U.S.C.§1983JURISDICTION A. 1) , is a citizen of ( State ) (Plaintiff) who presently resides at(Mailing address or place of confinement).is a citizen of Defendant 2)(Name of first defendant) , and is employed as(City, State).At the time the claim(s)( Position and title, if any) alleged in this complaint arose, was this defendant acting under color of state law? No If your answer is "Yes", briefly explain: Yes 2/78 XE-2CIVIL RIGHTS COMPLAINT (42 U.S.C. §1983) 3)(Use the back of this page to furnish the above information for additional defendants.)Jurisdiction is invoked pursuant to 28 U.S.C. §1343(3), 42U.S.C. §1983. (If you wish to assert Jurisdiction under different or additional statutes, you may list them below.) NATURE OF THE CASE B. Briefly state the background of your case. 1) XE-2-2- 2/78is a citizen of Defendant(Name of second defendant) , and is employed as(City, State).At the time the claim(s)( Position and title, if any) alleged in this complaint arose, was this defendant acting under color of state. lawNo If your answer is "Yes", briefly explain: Yes 4) C. CAUSE OF ACTION 1)I allege that the following of 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 up to two additional pages (8 1/2" x 11") to explain any allegation or to list additional supporting facts. A)(1) Count I: (2) Supporting Facts: (Include all facts you consider important, including names of persons involved, places and dates. Describe exactly how each defendant is involved. State the facts clearly in your own words without citing leagl authority or argument.)B)(1) Count II: (2) Supporting Facts:-3-XE-2 2/78 Supporting Facts: (2) PREVIOUS LAWSUITS AND ADMINISTRATIVE RELIEF D) 1) Parties to previous lawsuit. a) Plaintiffs: Defendants:Name of court and docket number: b) c) Issues raised: d)XE-2— 4 — 2/78 C)(1) Count III:Have you begun other lawsuits in state or federal court dealing with the same facts involved in this action or otherwise relating to the conditions of your imprisonment? Yes No If your answer is "YES", describe each lawsuit. (If there is more than one lawsuit, describe the additional lawsuits on another piece of paper, using the same outline.)Disposition (for example: Was the case dismissed? Was it appealed? Is it still pending? e) Approximate date of filing lawsuit:f) Approximate date of disposition:2) E. REQUEST FOR RELIEF I believe that I am entitled to the following relief: 1)Signature of Petitioner Signature of Attorney (if any) 2/78- 5 - XE-2I have previously sought informal or formal releif 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," briefly explain why administrative relief was not sought.Attorney's full address and telephone number. DECLARATION UNDER PENALTY OF PERJURYon Executed at 19 .(Location)(Date)(Signature) - - 6 - XE-2 2/78The undersigned declares under penalty of perjury that he is the plaintiff in the above action, that he has read the above complaint and that the information contained therein is true and correct. 28 U.S.C. Sec. 1746. 18 U.S.C. Sec. 1621.