Free General Form Complaint - Connecticut


File Size: 106.2 kB
Pages: 5
Date: April 23, 2009
File Format: PDF
State: Connecticut
Category: Court Forms - Federal
Word Count: 418 Words, 4,103 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.ctd.uscourts.gov/PDF%20Documents/Compl-gen%20-%20Fillable.pdf

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Preview General Form Complaint
UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT
GENERAL COMPLAINT FORM

Full name(s) of Plaintiff(s) (Do not use et al.) Case No. ______________________ (To be supplied by the Court)

v.

Full names of Defendant(s) (Do not use et al.)

A. PARTIES 1. ____________________________ is a citizen of _______________________ who (Plaintiff) (State) presently resides at _____________________________________________________. (mailing address)

2. Defendant ___________________________ is a citizen of ___________________ (name of first defendant) (State) whose address is_______________________________________________________.

3. Defendant ____________________________ is a citizen of __________________ (name of second defendant) (State) whose address is ______________________________________________________.

(If more space is needed to furnish the above information for additional defendants, continue on a blank sheet which you should label "A. PARTIES." Be sure to include each defendant's identity and complete address.)

B. JURISDICTION The jurisdiction of this court is invoked pursuant to: (list statute(s)) _____________________________________________________________________ _____________________________________________________________________

C. NATURE OF THE CASE BRIEFLY state the background of your case.

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D. CAUSE OF ACTION I allege that the following of my constitutional rights, privileges, or immunities or my rights under a federal statute have been violated and that the following facts form the basis of my allegations: (If more space is needed to explain any allegation or to list additional supporting facts, continue on a blank sheet which you should label "D. CAUSE OF ACTION.") Claim I: __________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 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 legal authority or argument.)

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Claim II: _____________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Supporting Facts:

E. OTHER LAWSUITS If you have filed other lawsuits in this court in the last ten (10) years that are not related to the acts complained of in Part D, please list them. (If more space is needed, continue on a blank sheet which you should label "E. OTHER LAWSUITS.") _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________

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F. REQUEST FOR RELIEF WHEREFORE, plaintiff demands: (state the relief you seek)

G. JURY DEMAND

Do you wish to have a jury trial? Yes_____ _____________________________ Original signature of attorney (if any) ______________________________ Printed Name and address

No______ ______________________________ Plaintiff's Original Signature

Printed Name and address

( ) Attorney's telephone

( ) Plaintiff's telephone

Email address if available

Email address if available

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 in the complaint is true and correct. 28 U.S.C. § 1746; 18 U.S.C. § 1621. Executed at _________________________ on ________________________. (location) (date) ________________________________ Plaintiff's Original Signature

(R ev. 12/15/08)

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