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Case 5:19-cv-00067-OLG-ESC Document 1 Filed 01/23/19 Page 1 of 6

FILED
PRISONER'S CiVIL RIGHTS COMPLAINT (Rev. 05/2015)
JAN 232019
IN TILE UNITED STATES DISTRICT COURT CLERK, U.S. DISTfTMOURT
FOR TILE W-fe't DISTRICT OF TE$4ESTERN OISTRI)MEXA
DIVISION DPUTYLERK
Lj5
Plaintiff's Name and ID NumlIer

Place of ConflnemerW SAI9CAOO67OG


CASE NO._______________
(Clerk will assign the number)

2M1/
Defendant's Nanijand Address
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Defendant's Name and Address
44Lf(r A.Av'vo,doIo3, avtcI. Jos e'I2-'3
Defendant's Name and Address
(DO NOT USE "ETAL.")

INSTRUTIONS - READ CAREFULLY


NOTICE:

Your complaint is subject to dismissal unless it conforms to these instructions and this form.

1. To start an action you must tile an original and one copy of your complaint with the court.
You should keei
a copy ofthe complaint for your own records.

2. Your complaint must be legibly handwritten, in ink, or typewritten. You, the plaintig
must sign and declan
under penalty ofperjuly that the facts are correct Ifyou need additional space, DO NOT USE
THE REVERSII
SIDE OR BACK SIDE OF ANY PAGE. ATTACH AN ADDi1ONAL BLANK PAGE AND
WRITE ON IT.
3. You must file a separate complaint for each claim you have unless the various claims are
all related to the same
incident or issue or are all against the same defendanl, Rule 18, Federal Rules of Civil Procedure.
Make a short and
plain statement of your claim, Rule 8, Federal Rules of Civil Procedure.

4. When these forms are completed, mail the original and one copy to the clerk of the United
States district court
for the appropriate district of Texas in the division where one or more named defendants are located,
or where the
incident giving rise to your claim for relief occurred. If you are confned in the Texas Department of
Criminal
Justice, Correctional Institutions Division (TDCJ-C]D), the list labeled as "VENUE LISV' is posted
in your unit
law library. It is a list ofthe Texas prison units indicating the appropriate district court, the division
and an address
list ofthe divisional clerks.
Case 5:19-cv-00067-OLG-ESC Document 1 Filed 01/23/19 Page 2 of 6

FILING FEE AND iN FORMA PAUFERJS (IF?)

1. In order for your complaint to be filed, it must be accompanied by the


statutory filing fee of $350.00 plus
administrative fee of $50.00 for a total fee of $400.00.

2. if you do not have the necessary funds to pay the fee in full at this time, you may request permission
informa pazipe2-is. In this event you must complete the application to proceed informa pauperis, to proce
setting fo
information to establish your inability to prepay the fees and costs or give security therefor. You
a current six-month history of your inmate trust account. If you are an inmate must also inclu
in TDCJ-CID, you can acquire t
application to proceed in farina pauperis and the certificate of inmate trust account, also
known as in forr4
pauper data sheet, from the law library at your prison, unit
3. The Prison Litigation Reform Act of 1995 (PLRA) provides "... if a
prisoner brings a civil action or files
appeal in forma pauperis, the prisoner shall be required to pay the full amount of a
filing fee." See 28 TJ.S.I
§ 1915. Thus, the court is required to assess and, when funds exist; collect; the entire filing
fee or an initial parti
filing fee and monthly installments until the entire amount of the filing fee has
been paid by the prisoner. If yc
submit the application to proceed In forma pauperis, the court will apply 28 U.S.C. 1915
§ and, if appropriat
assess and collect the entire filing fee or an initial partial filing fee, then monthly
installments from your inmate tm
account; until the entire $350.00 statutory filing fee has been paid. (The $50.00
administrative fee does not appi
to cases proceeding infonnapàuperis.)

4. if you intend to seek informapauperis status, do not send your complaint without an application to
informapauperis and the certificate of inmate trust account Complete all essential paperwork before procee
itto the court. submittin

CHANGE OF ADDRESS

It is your responsibility to inform the court of any change of address and its effective
date. Such notice should b
marked "NOTICE TO TILE COURT OF CHANGE OF ADDRESS" and shall not
include.any motion for an
other relief. Failure to file a NOTICE TO THE COURT OF CHANGE OF ADDRESS may
result in the disrnjssa.
of your complaint pursuant to Rule 41(b), Federal Rules of Civil Procedure.

I. PREVIOUS LAWSUITS:
A. Have you ified any other lawsuit in state or federal court relating to your
imprisonment? YES JNO
B. If your answer to "A" is "yes," describe each lawsuit in the space below. (If there is
more than one
lawsuit, describe the additional lawsuits on another piece of paper, giving the same
information.)
1. Approximate date offiling lawsuit:
2. Parties to previous lawsuit:
Plaintiff(s)
Defendant(s)
3. Court: (if federal, name the district; if state, name the county
4. Cause number.
5. Name of judge to whom case was assigned:
6. Disposition: (Was the case dismissed, appealed, still pending?)
7. Approximate date of disposition:______________________

2
Case 5:19-cv-00067-OLG-ESC Document 1 Filed 01/23/19 Page 3 of 6
U. PLACEOFPRESENTCONFINEMENT: &)<4( C4ui dt;ti I

[II. EXHAUSTION OF GRIEVANCE PROCEDURES:


Have you exhausted all steps of the institutional grievance procedure?
/
JYES
Attach a copy of your final step of the grievance procedure with the response supplied
by the institutic
AU ro evf 1'4 bj CXI) - n.eey c(. lt0tjL
[V. PARTIES TO THIS SUIT:
LM s AyJiyo Ayyovok5..l-,cz 4
A. Nameandaddressofp1aintiff' _-Jer Gwt-t11 Jafl '- t1--Cnt4 .t. 7i3
j Ve. ° B. Full name ofeach defendant,his official position, his place of employmeiit, and his
full mailing addre

Defeadant#l:
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Briefly describe the act(s) or omission(s) of this defendant which you claimed harmed
U you.
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Briefly describe the act(s) or omission(s) of this defendant which you claimed harmed
you.
C'ie I c.e(f fric4ea .

Defeudant#3: I3ey( Couvj Jc4fsS icx CMri*'1 f. Sii) Zo73cw-j Teci


rek C. Sctu,de,vs
Briefly describe the act(s) or omission(s) ofthis defendant which you claimed harmed you.
Ca4-Hc, Iv.I-v cdl .
me... r J,f1/ DlAhJiie(J 11'Le. rviz,A.O ti'

Defendant#4: &y'Jcik ioo Cm


1AM MMi&1& A. A'y.edirvAo 4o>
Briefly describe the act(s) or omission(s) of this defendant which you claimed harmed
you.
b e(( a,nL dtecL v'w

Defendant#5; ew Cou$i1 -OO Nl Orc& $t- 7's SE1Lr


Mh4I3E1Z Jose.. 7zil3
Briefly describe the act(s) or omission(s) of this defendant which you claimed harmed
you.
fb c(( Iicet
Case 5:19-cv-00067-OLG-ESC Document 1 Filed 01/23/19 Page 4 of 6
V. STATEMENT OF CLAIM:
State here in a short and plain statement the facts of your case, that is, what happened,
where did it happ
when did it happen, and who was involved. Describe how defendant is involved. You need nog
any legal arguments or cite any cases or statutes. Jfyou intend to allege a number of related
claims, num
and set forth each claim in a separate paragraph. Attach extra pages if necessary, but
remember

4vjern
complaint must be stated briefly and concisely. IF YOU VIOLATE THIS R14J,% ThE
STRIKE YOUR COMPLA[NT. flt a. sAorf / /et /tfv
COURT Mi
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VT. RELIEF:
State briefly exactly what you want the court to do for you. Make no legal arguments.
Cite no cases c
statutes.

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GENERAL BACKGROUND INFORMATIO
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C.

A. State, in complete form, all names you have ever used or been known by including any
and all aliases
'-it/A
B. List all TDCJ-CID identification numbers you have ever been assigned and all other
state or federal
prisonorFBlnumbcrseverassigncdtoyou. rix.-j Il)
r//2qq/ Fgt/7/
VIlE. SANCTIONS:
A. Have you been sanctioned by any court as a result of any lawsuit you have flied?
.YES s/NO
B. If your answer is "yes," give the following information for every lawsuit in which
sanctions were
imposed. (Ifmore than one, use another piece of paper and answer the same questions.)
1. Court that imposed sanctions (if federal, give the district and division):
2. Case number:
3. Appioximate date sanctions were imposed:_______________________________________
4. Have the sanctions been lifted or otherwise satisfied?
YES NO

4
Case 5:19-cv-00067-OLG-ESC Document 1 Filed 01/23/19 Page 5 of 6

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Case 5:19-cv-00067-OLG-ESC Document 1 Filed 01/23/19 Page 6 of 6

C. Has any court ever warned or notified you that sanctions could be imposed?

D. Ifyour answer is "yes," give the following information for every lawsuit in which a
warning was issu
(If more than one, use another piece of paper and answer the same questions.)
1. Court that issued warning (iffederal, give the district and division):
2. Case number:
3. :Approxiniate date warning was issued:

Executed on:
DATE

(Signature of Plaintifi)

PLAINTWF'S DECLA1ATIONS

1. I declare under penalty of perjury all facts presented in this complaint and attachments
thereto are tru
and correct
2. I understand, if I am released or transferred, it is my responsibility to keep the court
informed of ur
current mailing address and failure to do so may result in the dimissa1 ofthis lawsuit
3. I understand I must exhaust all available administrative remedies prior to filing
this lawsuit.
4. 1 understand I am prohibited from
bringing an informapauperis lawsuit if I have brought three or mon
civil actions or appeals (from a judgment in a civil actiOn) in a court of the
United States whih
incarcerated or detained in any facility, which lawsuits were dismissed on the
ground they werc
frivolous, malicious, or failed to state a claim upon whioh relief may be granted,
unless I am undei
imminent danger of serious physical injury.
5. I understand even if I am allowed to proceed without prepayment ofcosts, I am
responsible for the entire
fflirig fee and costs assessed by the court; which shall be deducted in accordance
with the law from my
inmate trust account by my custodian until the filing fee is paid.

Signed this dayof ,2O_____


(Day) (month) (year)

(Signature of Plaintiff)

WARNING: Plaintiff is advised any false or deliberately misleading information provided in


response to the
above questions may result in the imposition of sanctions. The sanctions the court may impose
are not limited to, monetary sanctions and the dismissal of this action with prejudice. include, but
Case 5:19-cv-00067-OLG-ESC
JS 44 (Rev. 12/07)
CIVIL Document 1-1 Filed 01/23/19 Page 1 of 1 COVER SHEET
The JS 44 civil cover sheet and the information contained herein neither replace nor supplement the filing and service ofpleadings or other papers as required by law, except as provide
by local rules of court. This form, approved by the Judicial Conference of the United States in September 1974, is required for the use of the Clerk of Court for the purpose of initiatin
the civil docket sheet. (SEE INSTRUCTIONS ON THE REVERSE OF THE FORM.)

I. (a) PLAINTIFFS DEFENDANTS


LUIS ANTONIO ARROYO, #575952 BEXAR COUNTY JAIL; et al.

(b) County of Residence of First Listed Plaintiff BEXAR County of Residence of First Listed Defendant
(EXCEPT IN U.S. PLAINTIFF CASES) (IN U.S. PLAINTIFF CASES ONLY)
NOTE: IN LAND CONDEMNATION CASES, USE THE LOCATION OF THE
LAND INVOLVED.

c) Attorney's Firm Name Address and Telephone Number) Attorneys (If Known)
B XAR COUN ADULT DEtENTION CENTER
200 N. COMAL STREET

II. BASIS OF JURISDICTION (Place an "X" in One Box Only) CITIZENSHIP OF PRINCIPAL PARTIES(Plaee an "X" in One Box for Plaintifl
(For Diversity Cases Only) and One Box for Defendant)
1 U.S. Government 3 Federal Question PTF DEF PTF DEF
Plaintiff (U.S. Government Not a Party) Citizen of This State 1 Il 1 Incorporated or Principal Place D 4 4
of Business In This State
2 U.S. Government 4 Diversity Citizen of Another State C5 2 2 Incorporated and Principal Place fJ 5 0 5
Defendant of Business In Another State
(Indicate Citizenship of Parties in Item III)

CitizenorSubjectofa 0 3 0 3 ForeignNation 0 6 0 6
Foreign Country
IV. NATIJRE OF SuIT Pl'e in "Y"
CONTRACT TORTS FORFUTURE/PENAL1\ BANKRUPTCY OTHER STATUTES
0 110 Insurance PERSONAL INJURY PERSONAL INJURY 0 610 Agriculture 0 422 Appeal 28 USC 158 0 400 State Reapportionment
0 120 Marine 0 310 Airplane 362 Personal Injury - 0 620 Other Food & Drug 0 423 Withdrawal 0 410 Antitrust
0 130 Miller Act 0 315 Airplane Product Med. Malpractice 0 625 Drug Related Seizure 28 USC 157 0 430 Banks and Banking
0 140 Negotiable Instrument Liability 0 365 Personal Injury - of Property 21 USC 881 0 450 Commerce
0 150 Recovery of Overpayment 0 320 Assault, Libel & Product Liability 0 630 Liquor Laws PROPERTY RIGHTS Cl 460 Deportation
& Enforcement of Judgment Slander Cl 368 Asbestos Personal 0 640 R.R. & Truck Cl 820 Copyrights 0 470 Racketeer Influenced and
Cl 151 Medicare Act Cl 330 Federal Employers' Injury Product Cl 650 Airline Regs. 0 830 Patent Corrupt Organizations
Cl 152 Recovery of Defaulted Liability Liability 0 660 Occupational 0 840 Trademark 0 480 Consumer Credit
Student Loans 0 340 Marine PERSONAL PROPERTY Safety/Health Cl 490 Cable/Sat TV
(Excl. Veterans) Cl 345 Marine Product 0 370 Other Fraud Cl 690 Other Cl 810 Selective Service
0 153 Recovery of Overpayment Liability 0 371 Truth in Lending LAIIR SOCIAL SECURITY Cl 850 Securities/Commoditiesl
of Veteran's Benefits Cl 350 Motor Vehicle 0 380 Other Personal 0 710 Fair Labor Standards Cl 861 HIA (139511) Exchange
Cl 160 Stockholders' Suits 0 355 Motor Vehicle Property Damage Act Cl 862 Black Lung (923) 0 875 Customer Challenge
Cl 190 Other Contract Product Liability Cl 385 Property Damage 0 720 Labor/Mgmt. Relations Cl 863 DIWC/DIWW (405(g)) 12 USC 3410
O 195 Contract Product Liability Cl 360 Other Personal Product Liability 0 730 Labor/Mgmt.Reporting Cl 864 SSID Title XVI 0 890 Other Statutory Actions
0 196 Franchise Injury & Disclosure Act 0 865 RSI (405(g)) 0 891 Agricultural Acts
I RAL PROPERTY CIVIL RIGHTS PRiSONER PETITIONS Cl 740 Railway Labor Act FEDERAL TAX SUITS Cl 892 Economic Stabilization Act
Cl 210 Land Condemnation Cl 441 Voting 0 510 Motions to Vacate Cl 790 Other Labor Litigation Cl 870 Taxes (U.S. Plaintiff 0 893 Environmental Matters
0 220 Foreclosure Cl 442 Employment Sentence Cl 791 Empl. Ret. Inc. or Defendant) 0 894 Energy Allocation Act
O 230 Rent Lease & Ejectment 0 443 Housing/ Habeas Corpus: Security Act 0 871 IRSThird Party 0 895 Freedom of Information
Cl 240 Torts to Land Accommodations 0 530 General 26 USC 7609 Act
Cl 245 Tort Product Liability 0 444 Welfare 0 535 Death Penalty IMMiGRATION 0 900Appeal of Fee Determinatio
O 290 All Other Real Property Cl 445 Amer. w/Disabilities - 0 540 Mandamus & Other 0 462 Naturalization Application Under Equal Access
Employment X 550 Civil Rights 0 463 Habeas Corpus - to Justice
0 446 Amer. w/Disabilitiea - Cl 555 Prison Condition Alien Detainee 0 950 Constitutionality of
Other 0 465 Other hmnigration State Statutes
0 440 Other Civil Rights Actions

V. ORIGIN (Place an "X" in One Box Only) Apoeal to District


Original 2 Removed from Remanded from 4 Reinstated or Transferred from Judge from
1 CJ 3 5 another district J 6 Multidistrict Magistrate
Proceeding State Court Appellate Court Reopened Litigation
(soecifv) Judument
Cite the U.S. Civil Statute under which you are filing (Do not cite jurisdictional statutes unless diversity)
Vt. CAUSE OF ACTION
IBrief description of cause:

VII. REQUESTED IN I] CHECK IF THIS IS A CLASS ACTION DEMAND $ CHECK YES only if demanded in complaint:
COMPLAINT: UNDER F.R.C.P. 23 JURY DEMAND: 0 Yes No
VIII. RELATED CASE(S)
(See instructions):
IF ANY JUDGE DOCKET NUMBER
DATE SIGNATURE OF ATTORNEY OF RECORD
0 1/23/2019 Diana Garcia, Deputy Clerk
FOR OFFICE USE ONLY

RECEIPT # AMOUNT APPLYING IFP JUDGE MAG. JUDGE 1"l J ES C


LusAArco
Case 5:19-cv-00067-OLG-ESC Document 1-2 Filed 01/23/19 Page 1 of 1

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