Free PDF - Indiana

Full name(s)

Street address or postal box number

City, State and zip code ________________________________________ Phone Number

IN THE UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF INDIANA
Civil Action No. (To be supplied by the Court)

Plaintiff(s) Full name(s) (Do not use et al.) v.

Defendant(s). Full name(s) (Do not use et al.)

CIVIL RIGHTS COMPLAINT
A. PARTIES 1. I, ________________________________________________, am a citizen of ______________ (Plaintiff name(s)) (State) and presently reside 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 complete address and title.) B. JURISDICTION 1. This cause of action is brought pursuant to _____________________________________________ ______________________________________________________________________________________ 2. Jurisdiction also invoked pursuant to 28 U.S.C. § 1331. (If you wish to assert jurisdiction under different or additional statutes, you may list them below.)

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 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.)

Claim II:

Supporting Facts:

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Claim III:

Supporting Facts:

E. PREVIOUS LAWSUITS Have you been or are you now a party to any other lawsuit(s) in state or federal court dealing with the same facts involved in this action? ____Yes ____No. If your answer is "Yes," describe each lawsuit. (If there is more than one lawsuit, describe the additional 4

lawsuits using this same format on a blank sheet which you should label "E. PREVIOUS LAWSUITS.") a. Parties to previous lawsuit: Plaintiff(s):__________________________________________________________________________

Defendant(s):________________________________________________________________________ b. Name and location of court and docket number ____________________________________ c. Disposition of lawsuit. (For example, was the case dismissed? Was it appealed? Is it still pending?) _____________________________________________________________________________________ d. Issues raised: __________________________________________________________________ e. Approximate date of filing lawsuit:____________________________ f. Approximate date of disposition: ______________________________

F. REQUEST FOR RELIEF I request the following relief:

_______________________________________ Original signature of attorney (if any)

___________________________________

Plaintiff's Original Signature

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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. Executed at _________________________ on ________________________. (location) (date)

___________________________________

Plaintiff's Original Signature
I request the Court's assistance in serving process on the defendant(s). _________Yes ___________ No

Plaintiff demands a trial by jury. ___________ Yes ____________No

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