NDMS Form P3 Complaint Challenging Conditions of Confinement (4/13)                         Instructions
UNITED STATES DISTRICT COURT
                                 NORTHERN DISTRICT OF MISSISSIPPI
     INSTRUCTIONS FOR COMPLAINTS UNDER 42 U.S.C. §1983
         CHALLENING CONDITIONS OF CONFINEMENT
1. All Complaints should be submitted on the Northern District of Mississippi’s Form P3,
       pursuant to the court’s Standing Order dated September 17, 1998. Complaints must be
       typewritten or legibly handwritten, and signed by you under penalty of perjury. Any
       false statement of a material fact may serve as the basis for prosecution and conviction
       for perjury. All questions must be answered concisely in the proper space of Form P3.
2. Use the spaces provided in Form P3 to present your case. Do not use additional pages except
       with respect to the facts upon which you rely to support your case. Citation of cases,
       statutes, or other authority is not required. Briefs and arguments are not required;
       however, if they are provided, they must be submitted in the form of a separate
       memorandum.
3. Mail Complaint to:
                    Pro Se Law Clerk, U.S. District Court
                    Post Office Box 704
                    Aberdeen, MS 39730
4. Only the original is to be filed with the court. If a file-stamped copy is to be returned, provide
       a copy of the complaint and a self-addressed stamped envelope with adequate postage to
       cover costs of mailing a file-stamped copy to you.
5. You must pay the filing fee of $400 ($350 filing fee + $50 administrative fee). If you
      cannot pay this fee, you may seek authorization to proceed in forma pauperis by
      completing the Pauperis Affidavit Form attached at the end of this form. If the Court
      grants in forma pauperis status, your prison account will be assessed the filing fee of
      $350.
                                                                                                       1
                       IN THE UNITED STATES DISTRICT COURT
                     FOR THE NORTHERN DISTRICT OF MISSISSIPPI
                           IMPORTANT NOTICE TO PRISONERS
                         FILING AN ACTION UNDER 42 U.S.C. §1983
        On April 26, 1996, the President of the United States signed into law certain amendments
to Title 28, United States Code, Section 1915 and Section 1932, entitled the Prison Litigation
Reform Act. The Governor of Mississippi also approved amendments passed by the Mississippi
Legislature to Section 47-5-138 of the Mississippi Code of 1972. These amendments may affect
your decision to continue with this lawsuit.
I. IMPOSITION OF FILING FEES
        In accordance with the 1996 amendments to the in forma pauperis (IFP) statute, as a
prisoner you will be obligated to pay the filing fee of $400 ($350 filing fee + $50 administrative
fee) for a civil action, $5.00 for a habeas corpus petition, or $455 for an appeal.
       1. If you have the money to pay the filing fee, you should immediately send a cashier’s
check or money order to the court.
         2. If you do not have enough money to pay the full filing fee the court will assess an
initial partial filing fee thirty (30) days from the filing of your complaint. The initial partial filing
fee will be equal to 20 percent of the average monthly deposits to your prison account for the last
six months or 20 percent of the average monthly balance in your prison account for the last six
months period, whichever is greater. The court will order the agency that has custody of you to
take that initial partial filing fee out of your prisoner account as soon as funds are available and
to forward the money to the court.
        After the initial partial filing fee has been paid, you will owe the balance of the filing fee.
Until the amount of the filing fee is paid in full, each month you will owe 20 percent of your
preceding month’s income credited to your prison account toward the balance. The agency that
has custody of you will collect that money and send payments to the court any time the amount
in your account exceeds $10.00.
        3. Regardless of whether some or all of the filing fee has been paid, the court is required
to screen your complaint and to DISMISS the complaint if:
                    a.   Your allegation of poverty is untrue
                    b.   The action is frivolous or malicious;
                    c.   Your complaint does not state a claim upon which relief can be granted; or
                    d.    You sue a defendant for money damages and that defendant is immune
                         from liability for money damages.
                                                                                                     2
         4. Judgments including costs – If a judgment is rendered against you that includes the
payment of costs, you will be required to pay the full amount of the costs ordered. You will be
required to make payments for costs in the same manner as is provided (above, page 1, section I.)
for filing fees.
II. NOTICE AND WARNING
        1. Federal Law – Future Suits May be Barred
        Under the new amendments to 28 U.S.C. §1915, if a prisoner has, on 3 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, the prisoner will be barred from bringing any
further civil action or appeal a judgment in a civil action or proceeding unless the prisoner is
under imminent danger of serious physical injury. 28 U.S.C. §1915, 804(g)
        2. Federal Law – Loss of Good Time
        Under the new amendment to 28 U.S.C. §1932, in any civil action brought by an adult
convicted of a crime and confined in a Federal Correctional Facility, if the court finds that the
claim was filed for a malicious purpose, or the claim was filed solely to harass the party against
which it was filed, or the claimant testifies falsely or otherwise knowingly presents false
evidence or information to the court, the court may order the revocation of earned good time
credit under 18 U.S.C. §3624(b), that has not yet vested.
        3. State Law – Loss of Good Time
        Under the new amendments to Mississippi Code 47-5-138, if a lawsuit brought by an
inmate while the inmate was in the custody of the Department of Corrections is dismissed as
frivolous or malicious, by a final order, the department shall forfeit:
           a. Sixty (60) days of an inmate’s accrued earned time if the department has received
              one (1) final order;
           b. One hundred twenty (120) days of an inmate’s accrued earned time if the
              department has received two (2) final orders;
           c. One hundred eighty (180) days of an inmate’s accrued earned time if the
              department has received three (3) or more final orders.
       The Department may not restore earned time forfeited under this section.
       In light of the potential consequences of having your case dismissed as “frivolous” you
are advised that the term “frivolous” may have a legal meaning that is different from what you
consider this term to mean. Even though you are completely sincere in your suit, it may be
dismissed as “frivolous” if it lacks an arguable basis in law or fact. Thus, a case may be found to
be legally “frivolous” where it seeks to assert a “right” or address a “wrong” clearly not
recognized by federal law. See e.g., Neitzke v. Williams, 490 U.S. 319 (1989)
                                         David Crews
                                        Clerk of Court
1 ' 0 ,66 ) 2503 & 203/$,17& +$//(1*,1*& 21',7,2162)& 21),1(0(17                                  3 $*(
                                         81,7('67$7(6',675,&7&2857
                                        1257+(51',675,&72)0,66,66,33,
                                           3ODLQWLII
      Y                                                                                       & $ 6 ( 1 2 
                                       'HIHQGDQW
                       3 5 , 6 2 1 ( 5 ¶6 & 203/$,17 & + $ / / ( 1 * ,1 * & 21',7,2162)& 2 1 ) , 1 ( 0 ( 1 7
      7KH 3ODLQWLII¶V IXOO OHJDO QDPH WKH QDPH XQGHU ZKLFK WKH 3ODLQWLII ZDV VHQWHQFHG WKH3ODLQWLII¶V
        LQPD WHLGHQWLILFDWLRQQXPEHUWKH3ODLQWLII¶VPDLOLQJDGGUHVVDQGWKH3ODLQWLII¶VSODFHRIFRQILQHPHQW
        DUHDVIROORZV
        $/HJDOQDPH
        %1DPHXQGHUZKLFKVHQWHQFHG
        &,QPDWHLGHQWLILFDWLRQQXP EHU
        '3ODLQWLII¶VPDLOLQJDGGUHVVVWUHHWRU
        SRVWRIILFHER[QXP EHUFLW\VWDWH=,3
        (3ODF HRIFRQ ILQHPH QW
      3ODLQWLIIQDPHVWKHIROORZLQJSHUVRQVDVWKH'HIHQGDQWVLQWKLVFLYLODFWLRQ
        1DPH
        7LWOH6XSHULQWHQGHQW6KH ULIIHWF
        'HIHQGDQW¶VPDLOLQJDGGUHVVVWUHHWRU
        SRVWRIILFHER[QXPEHUFLW\VWDWH=,3
1 ' 0 ,66 ) 2503 & 203/$,17& +$//(1*,1*& 21',7,2162)& 21),1(0(17                                   3 $*(
        1DPH
        7LWOH6XSHULQWHQGHQW6KH ULIIHWF
        'HIHQGDQW¶VPDLOLQJDGGUHVVVWUHHWRU
        SRVWRIILFHER[QXPEHUFLW\VWDWH=,3
        1DPH
        7LWOH6XSHULQWHQGHQW6KH ULIIHWF
        'HIHQGDQW¶VPDLOLQJDGGUHVVVWUHHWRU
        SRVWRIILFHER[QXPEHUFLW\VWDWH=,3
        1DPH
        7LWOH6XSHULQWHQGHQW6KH ULIIHWF
        'HIHQGDQW¶VPDLOLQJDGGUHVVVWUHHWRU
        SRVWRIILFHER[QXPEHUFLW\VWDWH=,3
        ,IDGGLWLRQ DO'HIH QGDQ WVDUHQ DPH GSURY LGHRQV HSDUD WHVVKH HWVRISDSHUWKHFRPSOHWHQDPHWLWOH
        DQGDGGUH VVLQIRUP DWLRQIRUH DFK& OHDUO\ODE HOHDFK DGGLWLRQ DOVKHH WDVEHLQJDFRQWLQXDWLRQRI
        4XHVWLRQ
      +DYH \RX FRPPHQFHG RWKHU ODZVXLWV LQ DQ\  RWKHU F RXUW
        VWDWH RUIHGHUDOGHDOLQJZLWKRUS HUWDLQLQJ WRWKHVD PHID FWV
                                                                                               <HV
                                                                                                                     1R
        WKDW\RXDOOHJHLQWKLVODZVXLWRURWKHUZLVHUHOD WLQJWR\RXU
        LPSULVR QPH QW"
      ,I\RXFKHFNHG³<HV´LQ4XHVWLRQGHVFULEHHDFK ODZVXLWLQWKHVSDFHEH ORZ,IWKHUHLVPRUHWKDQ
        RQH ODZVX LW GHVFULE H WKH DG GLWLRQDO ODZ VXLWV RQ  VHSD UDWH VK HHWV RI S DSHU FOHDUO\ ODEHO HDFK
        DGGLWLRQDOVKHHWDVEHLQJDFRQWLQXDWLRQRI4XHVWLRQ
        $3DUWLH VWRWKHOD ZVXLW
             3ODLQWLIIV
             'HIHQGDQ WV
        %&R XUW                                                                   &'R FNHW1 R
        '-XGJH¶V1DPH                                                             ('DWHVXLWILOHG
        )'DWHGHFLGHG                                          *5HVXOWDIILUPHGUHYHUV HGHWF
      ,VWKHUHDSULVRQHUJULHYDQFHSURFHGXUHRUV\V
        WHPLQWK HSODFH RI\RXU FRQILQH PHQ W"
                                                                                    <HV
                                                                                                                   1R
      ,I³<HV´GLG\RXSUHVHQWWRWKHJULHYDQFHV\V
        W H PWKHVDPHIDFWVDQGLVVXHV\RXD OOHJHLQ
                                                                                    <HV
                                                                                                                   1R
        WKLVFRPSODLQW"6HH TXHVWLRQEHORZ 
      ,I\RXFKHFNHG³<HV´LQ4XHVWLRQDQVZHUWKHIROORZLQJ
        TXHVWLRQV
1 ' 0 ,66 ) 2503 & 203/$,17& +$//(1*,1*& 21',7,2162)& 21),1(0(17                              3 $*(
        $'RHVWKHJULHYDQFHV\VWHPSODFHDOLPLWRQWKH
        WLPHZLWKLQZKLFKDJULHYDQFHPXVWEHSUHVHQWHG"
                                                                                    <HV
                                                                                                          1R
        %,I\RXDQVZHUHG³<HV´GLG\RXILOHRUSUHVHQW\RXU
        JULHYDQFHZLWKLQWKHWLPHOLPLWDOORZHG"
                                                                                    <HV
                                                                                                          1R
        &7KHFRXUWPXVWILQGWKDW\RXH[KDXVWHGWKHSULVRQ¶VJULHYDQFHV\VWHPDQGDGPLQLVWUDWLYH
        UHPHGLHVEHIRUHLWFDQFRQVLGHUWKLV&RPSODLQW6WDWHHYHU\WKLQJ\RXGLGWRSUHVHQW\RXU
        JULHYD QFHV %HVS HFLILF,QFOX GHWKH GDWHV RQZK LFK\RX ILOHGRUSUH VHQWH G\RX UJULHYD QFHV WR
        SULVRQRIILFHUVLGHQWLI\WKHRIILFHUV6WDWH\RXUFODLPVH[DFWO\
        '6WDWHVSHFLILFDOO\ZKDWRIILFLDOUHVSRQVH\RXUJULHYDQFHUHFHLYHG,IWKHSULVRQSURYLGHVDQ
        DGPLQLVWUDWLYHUHYLHZRIWKHGHFLVLRQRQ\RXUJULHYDQFHVWDWHZKHWKHU\RXDSSOLHGIRUWKDW
        UHYLHZDQGZKDWWKHUHVXOWZDV
1 ' 0 ,66 ) 2503 & 203/$,17& +$//(1*,1*& 21',7,2162)& 21),1(0(17                                3 $*(
      6SHFLDO1RWH $WWDFKWR WKLV& RPS ODLQWDV H[KLE LWVFRP SOHWH FRSLH VRIDOO UHTXHVWV\RXPDGH
      IRU DGPLQLVWUDWLYH UHOLHI WKURXJK WKH JULHYDQFH V\VWHP DOO UHVSRQVHV WR \RXU UHTXHVWV RU
      JULHYDQFHVDOODGP LQLVWUDWLYH DSSH DOV\RX PDG HDOOUHVS RQVH VWR\RXUDSSHDOVDQGD OOUHFHLSWV
      IRUGRFXPHQWVWKDW\RXKDYH
      ,I\RXFKHFNHG³1R´LQ4XHVWLRQH[SODLQZK\\RXGLGQRWXVHWKHJULHYDQFHSURFHGXUHVRU
        V \ VW H P
      :ULWHEHORZDVEULHIO\DVSRVVLEOHWKHIDFWVRI\RXUFDVH'HVFULEHKRZHDFK'HIH QGD QWLV
        LQYROYHG:ULWHWKHQDPHVRIDOORWKHUSHUVRQVLQYROYHG,QFOXGHGDWHVDQGSUHFLVHSODFHVRI
        HYHQWV'RQRWJLYHDQ\OHJDODUJXPHQWRUFLWHDQ\OHJDODXWKRULW\,I\RXKDYHPRUHWKDQRQH
        FODLP WRSUH VHQW QXP EHUH DFKF ODLPLQ DVHS DUDWH SDUD JUDS K$WWD FKDG GLWLRQD OSDJH VRQO\ LI
        QHFHVVDU\ODEHODWWDFKHGSDJHVDVEHLQJFRQWLQXDWLRQVRI4XHVWLRQ
1 ' 0 ,66 ) 2503 & 203/$,17& +$//(1*,1*& 21',7,2162)& 21),1(0(17                                 3 $*(
     6WDWHEULHIO\ H[DFWO\ZKDW\RXZDQWWKHFRXUWWRGRIRU\RX'RQRWPDNHOHJDODUJXPHQWV'R
        QRWFLWHOHJDODXWKRULW\
7KLV&RP SODLQWZDVH[HFX WHGDWORFDWLRQ
DQG,GH FODUHR UFHUWLI\RUY HULI\RUVWD WHXQG HUSHQ DOW\RISH UMXU\WKD WWKLV&R PSOD LQWLVWUXHD QGFR UUHFW
'DWH
                                                                                      3ODLQWLII¶V6LJQDWXUH
1 ' 0 ,66 ) 2503 & 203/$,17& +$//(1*,1*& 21',7,2162)& 21),1(0(17   3 $*(
                                 ,16758&7,216)25&203/(7,1*027,21)25
                                   /($9(72352&((',1)250$3$83(5,6
7KHIROORZLQJIRUPLVGHVLJQHGWRDVVLVW\RXLQDSSO\LQJWRWKHFRXUWIRUOHDYHWRSURFHHG
LQIRUPDSDXSHULV
5HVSRQGWRHYHU\TXHVWLRQLQWKLV0RWLRQIRUP'RQRWOHDYHDQ\EODQNV
7KHFKHFNER[HVDVNIRU³<HV´RU³1R´UHVSRQVHV3ODFHDFKHFNU LQWKHDSSURSULDWH
ER[IRUHYHU\TXHVWLRQ'RQRWOHDYHDQ\EODQNV
,I\RXUUHVSRQVHRUDQVZHUWRDTXHVWLRQLV³]HURRU³1RW$SSOLFDEOH´1$ZULWHLQ
WKDWUHVSRQVH
,I\RXQHHGPRUHVSDFHWRDQVZHURUUHVSRQGWRDTXHVWLRQDWWDFKDVHSDUDWHVKHHWRI
SDSHUODEHOHGZLWK\RXUIXOOQDPH\RXUFDVH¶VGRFNHWQXPEHUWKHTXHVWLRQQXPEHUIURP
WKH0RWLRQDQG\RXUDQVZHURUUHVSRQVH
3ULQWOHJLEO\RUW\SHZULWH
6LJQDQGGDWHWKH0RWLRQRQWKHODVWSDJH
7ZR)RUPVDQ Authorization for Release of Institutional Account Information and
Payment of the Filing FeeDQGDCertificate²DUHDWWDFKHGWRWKLV PRWLRQ<RXmust
FRPSOHWHWKHAuthorization for Release of Institutional Account Information and Payment
of the Filing Fee<RXPXVWDOVRVXEPLWWKHFHUWLILFDWHRQSDJHWRWKHFXVWRGLDQRI\RXU
LQPDWHDFFRXQWIRUFRPSOHWLRQ%RWKIRUPVDUHWREHVXEPLWWHGWRWKH&OHUNRI&RXUW
ZKHQ\RXILOH\RXU0RWLRQIRU/HDYHWR3URFHHG,Q)RUPD3DXSHULV
1 ' 0 ,66 ) 2503 & 203/$,17& +$//(1*,1*& 21',7,2162)& 21),1(0(17                                             3 $*(
                                               8 1 , 7 ( ' 6 7 $ 7 ( 6 ' ,675,&7& 2 8 5 7
                                              1 2 5 7 + ( 5 1 ' ,675,&72)0 , 6 6 , 6 6 ,3 3 ,
                                                                                    'LYLVLRQ
                        $ ) ) , ' $ 9, 7 ,1 6 8332572) 0 2 7 , 2 1 7 2 3 5 2 & ( ( ' ,1 ) 2 5 0 $ 3 $83 (5,6
      ,VZHDURUDIILUPXQGHUSHQDOW\RISHUMXU\DVIROORZV
        $ %HFDXVH  RI P\ SRYHUW\ , FDQQ RW SUHSD\ RU JLYH VH FXULW\ IRU WKHILO LQJ IHHV DQG FRVWV I RU  P \
        FRP SODLQWR UDSS HDO
        %,EHOLHYH,DPHQWLWOHGWROHJDOUHGUHVV
        &,VZHDURUDIILUPXQGHUSHQDOW\RISHUMXU\WKDWP\DQVZHUVDQGUHVSRQVHVRQWKLV0RWLRQDQG
        $IILGDYLWDUHWUXHDQGFRUUHFW8 6& 86& 
                                                                                                         0RYDQ W¶V6LJQDWXUH
      0\IXOOQDPHDQGPDLOLQJDGGUHVVDUHDVIROORZV
        1DPH
        $GGUHVV
        7HO1R                                              'DWHRI%LUWK
      $UH\RXSUHVHQWO\HPSOR\HG"                       <HV                          1R
        D       ,I \RX FKHFNHG ³<HV´ VWDWH WKH DPRXQW RI \RXU
                 VDODU\  ZDJHV RU RWKHU FRP SHQV DWLRQ SH U PRQ WK
                 DQGJLYHWKHQD PHDQG DGGUHVVRI\RX UHPSOR\HU
        E       ,I \RX FKHFNHG ³1R´ VWDWH WKH GDWH RI \RXU ODVW
                 HPSOR\PHQWDQGWKHDPRXQWRIWKHVDODU\ZDJHVRU
                 RWKHUFRPSHQVDWLRQ\RXUHFHLYHGSHUPRQWK
      +DYH\RXUHFHLYHGZLWKWKHSDVWPRQWKVDQ\PRQH\IURPDQ\RIWKHIROORZLQJVRXUFHV
        D       %XVLQHVVSURIHVVLRQRUIRUP RIVHOI
                 HPS OR\PH QW"
                                                                        <HV                                1R
1 ' 0 ,66 ) 2503 & 203/$,17& +$//(1*,1*& 21',7,2162)& 21),1(0(17                                3 $*(
        E       5HQWSD\PHQWVLQWHUHVWRU
                 GLYLGHQGV"
                                                                    <HV                    1R
        F       3HQVLRQVDQ QXLWLHVRUOLIHLQVXU
                 DQFHSD\PHQWV"
                                                                    <HV                    1R
        G       *LIWVRULQKHULWDQFHV"                             <HV                    1R
        H       $Q\RWKHUVRXUFH"                                  <HV                    1R
        ,IWKHDQVZHUWRDQ\RIWKHDERYHLV³<HV´GHVFULEHHDFKVRXUFHRIPRQH\DQG
        VWDWHWKHDPRXQW\RXUHFHLYHGIURPHDFKGXULQJWKHSDVWPRQWKV
      'R\RXRZQDQ\FDVKRUGR\RXKDYHDQ\PRQH\LQDFKHFNLQJ
        RUDVDYLQJVDFFRXQWLQFOXGLQJDQ\IXQGVLQSULVRQDFFRXQWV"
                                                                                      <HV
                                                                                      1R
        ,I\RXUDQVZHU³<HV´VWDWHWKHWRWDOYDOXHRIWKHLWHPVRZQHG               
      'R\RXRZQUHDOHVWDWHVWRFNVERQGVQRWHVDXWRPRELOHVRU
        RWKHUYDOXDEOHSURSHUW\H[FOXGLQJRUGLQDU\KRXVHKROGIXUQLVK
                                                                                      <HV
        LQJVDQGFORWKLQJ"
                                                                                      1R
        ,I \RXU D QVZH U ³<HV´ G HVFULE H WKH SURSHUW\  DQG VWD WH LWV
        DSSUR[LPDWHYDOXH                                                            
      /LVWWKHS HUVRQ VZKR UHO\RQ\ RXIRUV XSSR UW
                                                                                                    $PRXQW\RX
                                                                                                  FRQWU LEXWHWR WKLV
        1DPH                                                           5HODWLRQVKLS	$JH         SHUVRQ¶VV XSSRUW
,GHFODUHRUFHUWLI\RUYHULI\RUVWDWHXQGHUSHQDOW\RISHUMXU\WKDWWKHIRUHJRLQJLVWUXHDQGFRUUHFW86&
8 6& 
'DWH
                                                                                      0RYDQ W¶V6LJQDWXUH
1 ' 0 ,66 ) 2503 & 203/$,17& +$//(1*,1*& 21',7,2162)& 21),1(0(17                                                             3 $*(
                                 7 + , 6 ) 2 5 0 , 6 7 2 % ( & 2 0 3 / ( 7 ( ' % < 7 + ( 3 /$,17,))0 2 9 $ 1 7
               $87+25,=$7,21)255(/($6(2),167,787,21$/$&&2817,1)250$7,21
                               $1'3$<0(172)7+( ),/,1*)((
    ,                                                                                                                    KHUHE\GLUHFW
                                 0RYDQW¶V1DPHDQG3ULVRQ5HJLVWHURU, GHQWLILF DWLRQ1XPEHU
    DQGDXWKRUL]HWKHFXVWRGLDQRIP\LQPDWHDFFRXQWWRSURYLGHWKH&OHUNRIWKH8QLWHG6WDWHV'LVWULFW&RXUWIRU
    WKH 1RUWKHUQ 'LVWULFW RI 0LVVLVVLSSL LQIRUPDWLRQ IURP P\ SULVRQ LQPDWH LQVWLWXWLRQDO DFFRXQW LQFOXGLQJ DOO
    EDODQFHVGHSRVLWVDQGZLWKGUDZDOV7KHFXVWRGLDQRIP\LQPDWHDFFRXQWPD\DOVRSURYLGHWKH&OHUNRI&RXUW
    LQIRUPDWLRQIURPWKHSDVWPRQWKVDQGLQWKHIXWXUHXQWLOWKHIXOOILOLQJIHHLVSDLG,DOVRDXWKRUL]HFXVWRGLDQ
    RIP\LQPDWHDFFRXQWWRZLWKGUDZIXQGVIURPP\DFFRXQWDQGWRVHQGWKHSD\PHQWVWRWKH&OHUNRI&RXUWLQ
    DFFRUGDQFHZLWK8QLWHG6WDWHV&RGHDVDPHQGHG
         'DWH
                                                                                                            0RYD QW¶V6LJQDWX UH
                                                             &(57,),&$7(
                                                            3ULVRQHU$FFRXQWV2QO\
                      7 + , 6 ) 2 5 0 , 6 7 2 % ( & 2 0 3 / ( 7 ( ' % < $ 1 $ 8 7 + 2 5 , = (' ,167,787,21$/2 ) ) , & ( 5
         ,FHUWLI\WKDW
                                                         0RYDQW¶V1DPHDQG3ULVRQ5HJLVWHURU,GHQWLILFDWLRQ1XPEHU
         LVDSULVRQHUFRQILQHGDWWKHIROORZLQJLQVWLWXWLRQ
         ,FHUWLI\WKDW,DPWKHLQVWLWXWLRQ¶VRIILFHUUHVSRQVLEOHIRUPDNLQJFHUWLILFDWLRQVUHJDUGLQJ
         SULVRQHUV¶LQPDWHDFFRXQWV,FHUWLI\WKDWDVRIWKHGDWHDSSHDULQJQH[WWRP\VLJQDWXUH
         DWWKHERWWRPRIWKLV&HUWLILFDWHWKHSULVRQHUQDPHGDERYHKDVWKHIROORZLQJVXPRI
         PRQH\RQGHSRVLWLQWKHLQPDWHDFFRXQWUHFRUGVDWWKLVLQVWLWXWLRQ                                                 
         ,IXUWKHUFHUWLI\WKDWGXULQJWKHODVWPRQWKVWKLVSULVRQHU¶VDYHUDJHPRQWKO\EDODQFH
         LQWKHLQPDWHDFFRXQWUHFRUGVZDV                                                                                  
         ,IXUWKHUFHUWLI\WKDWGXULQJWKHODVWPRQWKVWKLVSULVRQHU¶VDYHUDJHPRQWKO\GHSRVLWLQ
         WKHLQPDWHDFFRXQWUHFRUGVZDV                                                                                     
         , IXUWKHU FHUWLI\ WKDW WKH SULVRQHU
         KDVWKHIROORZLQJVHFXULWLHVWRKLV
         FUHGLW
         'DWH
                                                                                                3ULVRQ,QP DWH$FFR XQW2IILFHU¶V6 LJQDWXUH
          0DLOWKLVIRUPWR3UR6H/DZ&OHUN86'LVWULFW&RXUW3RVW2IILFH%R[$EHUGHHQ0LVVLVVLSSL