Free ) - Wisconsin

Pro Se/Non-Prisoner Complaint Package Instructions - Read Carefully 1. In order for the United States District Court to consider this complaint, you must fill it out in legible handwriting or on a typewriter. Also, you must answer each question or fill in each blank clearly and simply. If you cannot finish an answer in the available space on the front of the page, you may continue the answer on another sheet of paper. If you continue an answer this way, make sure you identify clearly which question the continuation applies to. Before submitting your proposed complaint to the court, you must do several things: a. Prepare an original and an identical copy of your proposed complaint and all attachments or exhibits to your proposed complaint for (1) (2) (3) THE COURT EACH DEFENDANT YOU NAME YOURSELF

2.

For example, if you name two persons as defendants, you should prepare and return the original and two copies to the court (the original for the court and a copy for each named defendant), and retain one copy for your own reference. DO NOT MAIL A COPY OF YOUR COMPLAINT DIRECTLY TO ANY DEFENDANT(S). b. If you sue an officer or agency of the United States, you must send the court two additional copies of the complaint and any attachments. Submit a check or money order in the amount of $350.00. Make the check or money order payable to the CLERK, U.S. DISTRICT COURT. If you cannot afford to prepay the fee, you must complete the affidavit of indigency (attached), declare it to be true and submit the affidavit with your proposed complaint.

c.

3.

Again, you are reminded that if you attach any documents to your complaint, you must provide copies of each attachment with each copy of the complaint. It is not the court's function to make or provide copies for litigants. IT IS YOUR RESPONSIBILITY TO KEEP A COPY FOR YOUR OWN FILE OF EVERY DOCUMENT OR LETTER THAT YOU SEND TO THE COURT. Mail your proposed complaint with the necessary copies, your check or money order or affidavit of indigency to: Clerk, U.S. District Court Western District of Wisconsin P.O. Box 432 Madison, WI 53701-0432

4.

IN THE UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF WISCONSIN

(Full name of plaintiff(s))

Case Number:

vs
(Supplied by clerk)

(Full name of defendant(s))

COMPLAINT
A. JURISDICTION 1._________________________________________________________, resides at
(Plaintiff)

_______________________________________, at __________________________________
(Address) (City, State)

2. Defendant ___________________________________________ is employed as
(Name of First Defendant)

______________________________________ at ___________________________________
(Position and Title, if any) (Address)

3. Defendant ____________________________________________ is employed as
(Name of Second Defendant)

_____________________________________ at ___________________________________
(Position and Title, if any) (Address)

(WDWI rev. 4/07

)

(Non-Prisoner Complaint)

B. CAUSE OF ACTION On the space provided on the following pages, tell what specific incidents or conversations occurred which led you to believe your constitutional or federal rights have been or are presently being violated. IT IS IMPORTANT THAT THE ALLEGATIONS BE BRIEF, BUT SPECIFIC. Do not cite legal authorities, such as earlier court decisions or laws enacted by the legislature or Congress, to support your lawsuit at this early stage of your case.

______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

(WDWI rev. 4/07

)

(Non-Prisoner Complaint)

______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ________________________________________________________________________________

(WDWI rev. 4/07

)

(Non-Prisoner Complaint)

C. REQUEST FOR RELIEF 1. I ________________ request that I be allowed to commence this action without
(do, do not)

prepayment of fees and costs, or security therefor, pursuant to 28 U.S.C. §1915. The attached affidavit of indigency has been completed and is submitted in support of this request for leave to proceed in forma pauperis. 2. In the following space, please indicate exactly what it is you wish this court to do. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ __________________________________________ Dated this ________ day of _____________________, 20_____. _____________________________________________
(Signature)

_____________________________________________
(Street or PO Box)

_____________________________________________
(City, State Zip Code)

(WDWI rev. 4/07

)

(Non-Prisoner Complaint)