# Harris v. Denully

> District Court, S.D. New York · July 12, 2023

URL: https://www.frixlaw.com/law-library/cases/10352517

## Case

- **Court:** District Court, S.D. New York
- **Decided:** July 12, 2023
- **Opinion:** 100trialcourt
- **Cited by:** 0 later opinions in the Frix Law Library

## Citator (automated)

- No negative treatment found by the automated citator. That is not the same as a confirmation that the case is good law; read the citing cases.
- Full citator and citing cases: https://www.frixlaw.com/law-library/cases/10352517

## How later opinions describe it (automated extraction)

- holding that ADAs’ direction as to where criminal defendant would be arraigned was in preparation for a court proceeding in which the prosecutors were acting as advocates, and ADAs were therefore shielded by absolute immunity
- holding that legal aid organization ordinarily is not a state actor for purposes of § 1983
- affirming sua sponte dismissal of complaint as frivolous on statute of limitations grounds

## Opinion text

UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF NEW YORK
LAQUAN DEVOTA HARRIS,
Plaintiff,
-against-
23-CV-4601 (LTS)
SHANE DENULLY; P.O. MICHAEL
JORDAN; MICHAEL HERNANDEZ; NEIL ORDER OF DISMISSAL WITH LEAVE
GREENWELL; JUAN MERCHANT; TO REPLEAD
MEARIDITH T CHRISTOPHER; ROSEMARY
VASALLO,
Defendants.
LAURA TAYLOR SWAIN, Chief United States District Judge:
Plaintiff, who is appearing pro se, brings this action under the Court’s federal question
jurisdiction, alleging that Defendants violated his Fourth Amendment rights. By order dated June
14, 2023, the Court granted Plaintiff’s request to proceed in forma pauperis (IFP), that is,
without prepayment of fees. For the reasons set forth in this order, the Court dismisses this
action, but grants Plaintiff 60 days’ leave to replead his claims in an amended complaint.
STANDARD OF REVIEW
The Court must dismiss an IFP complaint, or any portion of the complaint, that is
frivolous or malicious, fails to state a claim on which relief may be granted, or seeks monetary
relief from a defendant who is immune from such relief. 28 U.S.C. § 1915(e)(2)(B); see
Livingston v. Adirondack Beverage Co., 141 F.3d 434, 437 (2d Cir. 1998). The Court must also
dismiss a complaint when the Court lacks subject matter jurisdiction of the claims raised. See
Fed. R. Civ. P. 12(h)(3).
While the law mandates dismissal on any of these grounds, the Court is obliged to
construe pro se pleadings liberally, Harris v. Mills, 572 F.3d 66, 72 (2d Cir. 2009), and interpret
them to raise the “strongest [claims] that they suggest,” Triestman v. Fed. Bureau of Prisons, 470
F.3d 471, 474 (2d Cir. 2006) (internal quotation marks and citations omitted) (emphasis in
original). But the “special solicitude” in pro se cases, id. at 475 (citation omitted), has its limits –
to state a claim, pro se pleadings still must comply with Rule 8 of the Federal Rules of Civil

Procedure, which requires a complaint to make a short and plain statement showing that the
pleader is entitled to relief.
Rule 8 requires a complaint to include enough facts to state a claim for relief “that is
plausible on its face.” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007). A claim is facially
plausible if the plaintiff pleads enough factual detail to allow the Court to draw the inference that
the defendant is liable for the alleged misconduct. In reviewing the complaint, the Court must
accept all well-pleaded factual allegations as true. Ashcroft v. Iqbal, 556 U.S. 662, 678-79
(2009). But it does not have to accept as true “[t]hreadbare recitals of the elements of a cause of
action,” which are essentially just legal conclusions. Twombly, 550 U.S. at 555. After separating
legal conclusions from well-pleaded factual allegations, the Court must determine whether those

facts make it plausible – not merely possible – that the pleader is entitled to relief. Id.
BACKGROUND
Plaintiff’s complaint, which is challenging to read because of illegible handwriting,
names the following defendants: (1) Police Officer (“P.O.”) Shane Denully; (2) P.O. Michael
Jordan; (3) P.O. Michael Hernandez; (4) New York County Assistant District Attorney Neil
Greenwell; (5) Judge Juan Merchant; (6) Legal Aid Attorney Rosemary Vassallo; and
(7) Mearidith T. Christopher.1 The underlying events allegedly took place on Centre Street in

1 In this complaint Plaintiff does not clearly identify the Defendants, but he provides
more identifying information about some of them in another recently filed complaint. See Harris
v. Vassallo, ECF 1:23-CV-4440, 5 (LTS) (S.D.N.Y. July 7, 2023) (dismissing complaint and
granting leave to replead). Plaintiff has previously filed a number of pro se cases in this court.
New York City on November 19, 2018. (ECF 1 ¶ III.) Plaintiff alleges that Defendants violated
his Fourth Amendment rights, committed perjury, “gave false testimony”; “plotted” to falsely
accuse him of unspecified crimes, and stole his property. (Id. ¶ 1A.) In the “Injuries” section of
the complaint, Plaintiff alleges that he was “sexually assaulted in the bathroom of the 40th

command in the Bronx,” and that P.O. Jordan used physical force against him while he was
handcuffed. (Id. ¶ III.) Plaintiff seeks money damages. (Id. ¶ IV.)
DISCUSSION
A. Section 1983
The Court construes the complaint as asserting constitutional claims under 42 U.S.C.
§ 1983. To state a Section 1983 claim, a plaintiff must allege both that: (1) a right secured by the
Constitution or laws of the United States was violated, and (2) the right was violated by a person
acting under the color of state law, or a “state actor.” West v. Atkins, 487 U.S. 42, 48-49 (1988).
For the reasons set forth below, Plaintiff’s complaint does not contain sufficient facts to state a
viable Section 1983 claims against the named Defendants.
B. Statute of limitations
Plaintiff’s claims appear to be untimely. The statute of limitations for Section 1983

claims is found in the “general or residual [state] statute [of limitations] for personal injury
actions.” Pearl v. City of Long Beach, 296 F.3d 76, 79 (2d Cir. 2002) (quoting Owens v. Okure,

See Harris v. Fuster, ECF 1:18-CV-10196, 11 (CM) (S.D.N.Y. Mar. 29, 2019) (dismissing
complaint for failure to state a claim and for lack of subject matter jurisdiction), recons. denied,
(S.D.N.Y. Sept. 20, 2019); Harris v. Mt. Sinai St. Lukes , ECF 1:20-CV-00293, 7 (CM)
(S.D.N.Y. Feb. 21, 2020) (dismissing complaint for lack of subject matter jurisdiction); Harris v.
Gittens, ECF 1:20-CV-1306, 8 (CM) (S.D.N.Y. Mar. 20, 2020) (dismissing complaint for failure
to state a claim and on immunity grounds); Harris v. Harris, ECF 1:19-CV-11658, 8 (CM)
(S.D.N.Y. June 5, 2020) (dismissing complaint for failure to state a claim); Harris v. Denully,
ECF 1:20-CV-1307, 14 (S.D.N.Y. Dec. 30, 2020) (dismissing complaint for failure to state a
claim); Harris v. CYA Mgmt., ECF 1:23-CV-4599, 1 (S.D.N.Y. filed June 5, 2023).
488 U.S. 235, 249-50 (1989)). In New York, that period is three years. See N.Y. C.P.L.R.
§ 214(5). A Section 1983 claim generally accrues when a plaintiff knows or has reason to know
of the injury that is the basis of the claim. Hogan v. Fischer, 738 F.3d 509, 518 (2d Cir. 2013).
Plaintiff’s claims accrued on November 19, 2018, the date on which he suffered the

injuries that are the basis of his claims. See Pearl, 296 F.3d at 85 (explaining that claim accrued
when plaintiff was injured because he “was obviously aware of his cause of action for police
brutality at the time of the 1967 episode”). Plaintiff filed this complaint on May 30, 2023, more
than four years after the events giving rise to his claims occurred.
The doctrine of equitable tolling permits a court, “under compelling circumstances, [to]
make narrow exceptions to the statute of limitations in order ‘to prevent inequity.’” In re U.S.
Lines, Inc., 318 F.3d 432, 436 (2d Cir. 2003) (citation omitted). The statute of limitations may be
equitably tolled, for example, when a defendant fraudulently conceals from a plaintiff the fact
that the plaintiff has a cause of action, or when the plaintiff is induced by the defendant to forego
a lawsuit until the statute of limitations has expired. See Pearl, 296 F.3d at 82-83.

In addition, New York law provides by statute for other circumstances in which a
limitations period may be tolled. See, e.g., N.Y. C.P.L.R. § 204(a) (where commencement of an
action has been stayed by court order), id. at § 204 (where a dispute has been submitted to
arbitration but is ultimately determined to be non-arbitrable), id. at § 207(3) (defendant is outside
New York at the time the claim accrues), id. at § 208 (plaintiff is disabled by infancy or insanity),
id. at § 210 (death of plaintiff or defendant). See Wallace, 549 U.S. at 394 (“We have generally
referred to state law for tolling rules [for Section 1983 actions], just as we have for the length of
statutes of limitations.”).
Because the failure to file an action within the limitations period is an affirmative
defense, a plaintiff is generally not required to plead that the case is timely filed. See Abbas v.
Dixon, 480 F.3d 636, 640 (2d Cir. 2007). Dismissal is appropriate, however, where the existence
of an affirmative defense, such as the statute of limitations, is plain from the face of the pleading.

See Walters v. Indus. and Commercial Bank of China, Ltd., 651 F.3d 280, 293 (2d Cir. 2011)
(“[D]istrict courts may dismiss an action sua sponte on limitations grounds in certain
circumstances where the facts supporting the statute of limitations defense are set forth in the
papers plaintiff himself submitted.”) (internal quotation marks and citation omitted); Pino v.
Ryan, 49 F.3d 51, 53 (2d Cir. 1995) (affirming sua sponte dismissal of complaint as frivolous on
statute of limitations grounds); see also Abbas, 480 F.3d at 640 (concluding that district court
should grant notice and opportunity to be heard before dismissing complaint sua sponte on
statute of limitations grounds).
Plaintiff is granted leave to file an amended complaint to provide facts showing that his
claims should not be dismissed as time-barred.

C. Claims against the named defendants
Legal Aid Attorney Rosemary Vasallo
Absent special circumstances suggesting concerted action between an attorney and a state
representative, see Nicholas v. Goord, 430 F.3d 652, 656 n.7 (2d Cir. 2005) (citing Adickes v.
S.H. Kress & Co., 398 U.S. 144, 152 (1970)), the representation of a defendant by private
counsel in state criminal proceedings does not constitute the degree of state involvement or
interference necessary to establish a claim under Section 1983, regardless of whether that
attorney is privately retained, court-appointed, or employed as a public defender. See Bourdon v.
Loughren, 386 F.3d 88, 90 (2d Cir. 2004) (citing Polk Cnty. v. Dodson, 454 U.S. 312, 324-25
(1981)); see also Schnabel v. Abramson, 232 F.3d 83, 87 (2d Cir. 2000) (holding that legal aid
organization ordinarily is not a state actor for purposes of § 1983).
Defendant Rosemary Vasallo, who served as Plaintiff’s Legal Aid attorney, is a private
party who is not alleged to work for any state or other government body. Plaintiff thus has not

stated a claim against her under Section 1983.
Judge Merchant
Judges are absolutely immune from suit for damages for any actions taken within the
scope of their judicial responsibilities. Mireles v. Waco, 502 U.S. 9, 11 (1991). Generally, “acts
arising out of, or related to, individual cases before the judge are considered judicial in nature.”
Bliven v. Hunt, 579 F.3d 204, 210 (2d Cir. 2009). “Even allegations of bad faith or malice cannot
overcome judicial immunity.” Id. (citations omitted). This is because, “[w]ithout insulation from
liability, judges would be subject to harassment and intimidation . . . .” Young v. Selsky, 41 F.3d
47, 51 (2d Cir. 1994). In addition, Section 1983, as amended in 1996, provides that “in any
action brought against a judicial officer for an act or omission taken in such officer’s judicial
capacity, injunctive relief shall not be granted unless a declaratory decree was violated or

declaratory relief was unavailable.” 42 U.S.C. § 1983.
Judicial immunity does not apply when the judge takes action “outside” his judicial
capacity, or when the judge takes action that, although judicial in nature, is taken “in absence of
jurisdiction.” Mireles, 502 U.S. at 9-10; see also Bliven, 579 F.3d at 209-10 (describing actions
that are judicial in nature). But “the scope of [a] judge’s jurisdiction must be construed broadly
where the issue is the immunity of the judge.” Stump v. Sparkman, 435 U.S. 349, 356 (1978).
Plaintiff fails to allege any facts showing that Judge Merchant acted beyond the scope of
his judicial responsibilities or outside his jurisdiction. See Mireles, 509 U.S. at 11-12. Because
Plaintiff sues Judge Merchant for “acts arising out of, or related to, individual cases before him,”
he is immune from suit for such claims. Bliven, 579 F.3d at 210. The Court therefore dismisses
Plaintiff’s claims against Judge Merchant because they seek monetary relief against a defendant
who is immune from such relief, 28 U.S.C. § 1915(e)(2)(B)(iii), and, consequently, as frivolous,
28 U.S.C. § 1915(e)(2)(B)(i). See Mills v. Fischer, 645 F.3d 176, 177 (2d Cir. 2011) (“Any claim

dismissed on the ground of absolute judicial immunity is ‘frivolous’ for purposes of [the in
forma pauperis statute].”).
Assistant District Attorney Neil Greenwell
Prosecutors are immune from civil suits for damages for acts committed within the scope
of their official duties where the challenged activities are not investigative in nature but, rather,
are “‘intimately associated with the judicial phase of the criminal process.’” Giraldo v. Kessler,
694 F.3d 161, 165 (2d Cir. 2012) (quoting Imbler v. Pachtman, 424 U.S. 409, 430 (1976)); see
also Buckley v. Fitzsimmons, 509 U.S. 259, 269 (1993) (absolute immunity is analyzed under a
“functional approach” that “looks to the nature of the function performed, not the identity of the
actor who performed it” (internal quotation marks and citations omitted)). In addition,
prosecutors are absolutely immune from suit for acts that may be administrative obligations but

are “directly connected with the conduct of a trial.” Van de Kamp v. Goldstein, 555 U.S. 335,
344 (2009); see also Ogunkoya v. Monaghan, 913 F.3d 64, 70-72 (2d Cir. 2019) (holding that
ADAs’ direction as to where criminal defendant would be arraigned was in preparation for a
court proceeding in which the prosecutors were acting as advocates, and ADAs were therefore
shielded by absolute immunity).
Here, Plaintiff’s claims against Defendant Neil Greenwell are based on actions within the
scope of Defendant’s official duties and associated with the conduct of a trial. Therefore, these
claims are dismissed because they seek monetary relief against a defendant who is immune from
such relief, 28 U.S.C. § 1915(e)(2)(b)(iii), and, consequently, as frivolous, 28 U.S.C.
§ 1915(e)(2)(B)(i). See Collazo v. Pagano, 656 F. 3d 131, 134 (2d Cir. 2011) (holding that claim
against prosecutor is frivolous if it arises from conduct that is “intimately associated with the
judicial phase of the criminal process”).
Mearedith T Christopher.
To state a claim under Section 1983, a plaintiff must allege facts showing the defendants’

direct and personal involvement in the alleged constitutional deprivation. See Spavone v. N.Y.
State Dep’ t of Corr. Serv., 719 F.3d 127, 135 (2d Cir. 2013) (“It is well settled in this Circuit
that personal involvement of defendants in the alleged constitutional deprivations is a
prerequisite to an award of damages under § 1983.”) (internal quotation marks omitted). A
defendant may not be held liable under § 1983 solely because that defendant employs or
supervises a person who violated the plaintiff’s rights. See Ashcroft v. Iqbal, 556 U.S. 662, 676
(2009) (“Government officials may not be held liable for the unconstitutional conduct of their
subordinates under a theory of respondeat superior.”). Rather, “[t]o hold a state official liable
under § 1983, a plaintiff must plead and prove the elements of the underlying constitutional
violation directly against the official . . . .” Tangreti v. Bachmann, 983 F.3d 609, 620 (2d Cir.

2020).
Plaintiff names Mearedith T Christopher as a defendant in the caption of the complaint,
but he does not identify this Defendant or clarify how this Defendant was involved in the alleged
deprivation of Plaintiff’s rights. The Court grants Plaintiff leave to file an amended complaint to
detail his claims against Christopher.
Police Officers Denully, Jordan and Hernandez
Plaintiff names P.O. Hernandez and P.O. Denully, but provides no facts about what those
officers did or failed to do that violated Plaintiff’s constitutional rights. Plaintiff alleges in the
“Injuries” section of the complaint that P.O. Jordan used excessive force against him, but he
provides no other facts about that incident. Finally, Plaintiff claims that he was sexually
assaulted in the “40th command” in the Bronx, but he does not provide any other facts about the
incident, including the identity of the perpetrator. The Court grants Plaintiff leave to file an
amended complaint to detail his claims agains the police officer defendants.

D. State law claims
Although Plaintiff has not invoked state law, a pro se litigant’s complaint generally must
be liberally construed as including related state law claims. See McLeod v. Jewish Guild for the
Blind, 864 F.3d 154, 158 (2d Cir. 2017). A district court may decline to exercise supplemental
jurisdiction over state-law claims, however, when it “has dismissed all claims over which it has
original jurisdiction.” 28 U.S.C. § 1367(c)(3). Generally, “when the federal-law claims have
dropped out of the lawsuit in its early stages and only state-law claims remain, the federal court
should decline the exercise of jurisdiction.” Carnegie-Mellon Univ. v. Cohill, 484 U.S. 343, 350
n.7 (1988)).

Having dismissed the federal claims over which the Court has original jurisdiction, the
Court declines to exercise its supplemental jurisdiction of any state law claims that Plaintiff may
be asserting. See Kolari v. New York-Presbyterian Hosp., 455 F.3d 118, 122 (2d Cir. 2006)
(“Subsection (c) of § 1367 ‘confirms the discretionary nature of supplemental jurisdiction by
enumerating the circumstances in which district courts can refuse its exercise.’”) (quoting City of
Chicago v. Int’l Coll. of Surgeons, 522 U.S. 156, 173 (1997)).
LEAVE TO REPLEAD
District courts generally grant a pro se plaintiff leave to amend a complaint to cure its
defects, but leave to amend may be denied if the plaintiff has already been given an opportunity

to amend but has failed to cure the complaint’s deficiencies. See Ruotolo v. City of New York,
514 F.3d 184, 191 (2d Cir. 2008); Salahuddin v. Cuomo, 861 F.2d 40, 42 (2d Cir. 1988). In light
of Plaintiff’s pro se status, the Court grants Plaintiff leave to replead his excessive force claim in
an amended complaint.
CONCLUSION
Plaintiff’s complaint, filed IFP under 28 U.S.C. § 1915(a)(1), is dismissed pursuant to 28

U.S.C. § 1915(e)(2)(B)(ii), (iii).
The Court grants Plaintiff 60 days’ leave to replead his claims under Section 1983 in an
amended complaint. Plaintiff must submit the amended complaint to this Court’s Pro Se Intake
Unit within 60 days of the date of this order, caption the document as an “Amended Complaint,”
and label the document with docket number 23-CV-4601 (LTS). If Plaintiff fails to file an
amended complaint within the prescribed time and he cannot show good cause for such failure,
the Court will enter judgment dismissing the action, and declining to exercise supplemental
jurisdiction of any state law claims Plaintiff may be asserting, 28 U.S.C. § 1367(c)(3).
An amended complaint form is attached to this order.
The Court certifies under 28 U.S.C. § 1915(a)(3) that any appeal from this order would
not be taken in good faith, and therefore IFP status is denied for the purpose of an appeal. See
Coppedge v. United States, 369 U.S. 438, 444-45 (1962).
SO ORDERED.

Dated: July 12, 2023
New York, New York

/s/ Laura Taylor Swain
LAURA TAYLOR SWAIN
Chief United States District Judge
UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF NEW YORK

_____CV_______________
(Include case number if one has been
Write the full name of each plaintiff.
assigned)

AMENDED
-against-

COMPLAINT

Do you want a jury trial?
☐ Yes ☐ No

Write the full name of each defendant. If you need more
space, please write “see attached” in the space above and
attach an additional sheet of paper with the full list of
names. The names listed above must be identical to those
contained in Section II.

NOTICE
The public can access electronic court files. For privacy and security reasons, papers filed
with the court should therefore 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.
See Federal Rule of Civil Procedure 5.2.
I. BASIS FOR JURISDICTION
Federal courts are courts of limited jurisdiction (limited power). Generally, only two types of
cases can be heard in federal court: cases involving a federal question and cases involving
diversity of citizenship of the parties. Under 28 U.S.C. § 1331, a case arising under the United
States Constitution or federal laws or treaties is a federal question case. Under 28 U.S.C. § 1332,
a case in which a citizen of one State sues a citizen of another State or nation, and the amount
in controversy is more than $75,000, is a diversity case. In a diversity case, no defendant may
be a citizen of the same State as any plaintiff.
What is the basis for federal-court jurisdiction in your case?
☐ Federal Question
☐ Diversity of Citizenship
A. If you checked Federal Question
Which of your federal constitutional or federal statutory rights have been violated?

B. If you checked Diversity of Citizenship
1. Citizenship of the parties
Of what State is each party a citizen?
The plaintiff , , is a citizen of the State of
(Plaintiff’s name)

(State in which the person resides and intends to remain.)
or, if not lawfully admitted for permanent residence in the United States, a citizen or
subject of the foreign state of
.
If more than one plaintiff is named in the complaint, attach additional pages providing
information for each additional plaintiff.
If the defendant is an individual:

The defendant, , is a citizen of the State of
(Defendant’s name)

or, if not lawfully admitted for permanent residence in the United States, a citizen or
subject of the foreign state of
.
If the defendant is a corporation:
The defendant, , is incorporated under the laws of
the State of
and has its principal place of business in the State of
or is incorporated under the laws of (foreign state)
and has its principal place of business in .
If more than one defendant is named in the complaint, attach additional pages providing
information for each additional defendant.

II. PARTIES
A. Plaintiff Information
Provide the following information for each plaintiff named in the complaint. Attach additional
pages if needed.

First Name Middle Initial Last Name

Street Address

County, City State Zip Code

Telephone Number Email Address (if available)
B. Defendant Information
To the best of your ability, provide addresses where each defendant may be served. If the
correct information is not provided, it could delay or prevent service of the complaint on the
defendant. Make sure that the defendants listed below are the same as those listed in the
caption. Attach additional pages if needed.
Defendant 1:
First Name Last Name

Current Job Title (or other identifying information)

Current Work Address (or other address where defendant may be served)

County, City State Zip Code
Defendant 2:
First Name Last Name

Current Job Title (or other identifying information)

Current Work Address (or other address where defendant may be served)

County, City State Zip Code
Defendant 3:
First Name Last Name

Current Job Title (or other identifying information)

Current Work Address (or other address where defendant may be served)

County, City State Zip Code
Defendant 4:
First Name Last Name

Current Job Title (or other identifying information)

Current Work Address (or other address where defendant may be served)

County, City State Zip Code
III. STATEMENT OF CLAIM
Place(s) of occurrence:

Date(s) of occurrence:
FACTS:
State here briefly the FACTS that support your case. Describe what happened, how you were
harmed, and what each defendant personally did or failed to do that harmed you. Attach
additional pages if needed.
INJURIES:
If you were injured as a result of these actions, describe your injuries and what medical
treatment, if any, you required and received.

IV. RELIEF
State briefly what money damages or other relief you want the court to order.
V. PLAINTIFF’S CERTIFICATION AND WARNINGS
By signing below, I certify to the best of my knowledge, information, and belief that: (1) the
complaint is not being presented for an improper purpose (such as to harass, cause
unnecessary delay, or needlessly increase the cost of litigation); (2) the claims are supported
by existing law or by a nonfrivolous argument to change 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 Federal Rule of Civil
Procedure 11.
I agree to notify the Clerk's Office in writing of any changes to my mailing address. 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.
Each Plaintiff must sign and date the complaint. Attach additional pages if necessary. If seeking to
proceed without prepayment of fees, each plaintiff must also submit an IFP application.

Dated Plaintiff’s Signature

First Name Middle Initial Last Name

Street Address

County, City State Zip Code

Telephone Number Email Address (if available)

I have read the Pro Se (Nonprisoner) Consent to Receive Documents Electronically:
☐ Yes ☐ No
If you do consent to receive documents electronically, submit the completed form with your
complaint. If you do not consent, please do not attach the form.

---

Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/10352517. Public record. Not legal advice.