UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF NEW YORK ) ) ) ) ) ) )
Plaintiff(s) vs.
Civil Case No.: BIVENS ACTION
Defendant(s)
Plaintiff(s) in the above-captioned action, allege(s) as follows: JURISDICTION 1. This is a civil action brought pursuant to Bivens v. Six Unknown Named Agents of the Federal Bureau of Narcotics, 403 U.S. 388 (1971). The Court has jurisdiction over this action pursuant to 28 U.S.C. ยงยง 1331 and 2201.
PARTIES 2. a. Plaintiff: Address:
Additional Plaintiffs may be added on a separate sheet of paper.
3.
a.
Defendant: Official Position: Address:
FORM E(1)(e).1
5/2005
b.
Defendant: Official Position: Address:
c.
Defendant: Official Position: Address:
Additional Defendants may be added on a separate sheet of paper.
4.
FACTS
Set forth the facts of your case which substantiate your claim of violation of your civil and/or Constitutional rights. List the events in the order they happened, naming defendants involved, dates and places. Note: You must include allegations of wrongful conduct as to EACH and EVERY defendant in your complaint. (You may use additional sheets as necessary).
FORM E(1)(e).2
5.
CAUSES OF ACTION
Note: You must clearly state each cause of action you assert in this lawsuit.
FIRST CAUSE OF ACTION
SECOND CAUSE OF ACTION
THIRD CAUSE OF ACTION
6. Plaintiff(s) demand(s) a trial by Jury - or - Court (Circle only one).
FORM E(1)(e).3 7. PRAYER FOR RELIEF
WHEREFORE, plaintiff(s) request(s) that this Court grant the following relief:
I declare under penalty of perjury that the foregoing is true and correct. DATED:
Signature of Plaintiff(s) (all Plaintiffs must sign)
FORM E(1)(e).4