IN THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF ALABAMA INSTRUCTIONS FOR COMPLETING CIVIL RIGHTS COMPLAINT FORM STATEMENT OF PROCEDURES PRISONER READ CAREFULLY I. General Instructions Your complaint must be legibly handwritten or typewritten on this form. If your complaint is handwritten, please write legibly. You must sign the complaint at the place indicated for your signature. Under Rule 11, Federal Rules of Civil Procedure, your signature means that you have read the complaint and that to the best of your knowledge, information and belief, the complaint is well grounded in fact and is warranted by existing law. If a complaint is filed in violation of Rule 11, the court may impose appropriate sanctions against you. These sanctions may include a requirement to pay to the defendants the amount of reasonable expenses, including attorney fees, created by the filing of the complaint. While it is no longer reguired, you may swear to the truth of the facts which are stated in the complaint by executing a declaration under penalty of perjury that the facts alleged in it are true and correct. If you declare that the facts in your complaint are correct, under penalty or perjury, any false statement of any material fact may serve as the basis for prosecution and conviction. Therefore, you should exercise care to ensure that all statements you make in your complaint are true and correct. Your complaint may be brought in this court only if one or more of the named defendants are located in the geographical area covered by the United States District Court for the Middle District Court for the Middle District of Alabama. The Middle District of Alabama contains the following counties: Autauga, Barbour, Bullock, Butler, Chambers, Chilton, Coffee, Coosa, Covington, Crenshaw, Dale, Elmore, Geneva, Henry, Houston, Lee, Lowndes, Macon, Montgomery, Pike, Randolph, Russell, and Tallapoosa. A plaintiff must file a separate complaint for each claim unless the claims are related to the same incident or issue. The complaint should name the defendants against whom relief is sought and briefly state the facts upon which the claim is based. It is not necessary that a plaintiff state each and every fact upon which he may rely. Rule 8(a) of the Federal Rules of Civil Procedure require only a short and plain statement of claim. No authorities or citations should be set out in the complaint. Ifbriefs and arguments are submitted, they should be submitted in a separate memorandum for which no form is necessary. You must include in the complaint all grounds for relief and facts supporting such grounds for relief. It is permissible to include no more than two (2) additional pages if more space is needed to answer a question. All pleadings and other papers in cases filed must be on 8 Yz x 11 inch paper. Otherwise, this office cannot accept them for filing. Additionally, all pleadings filed must be an original document. Copies of a pleading will not be accepted. In order for this complaint to be filed, it must be accompanied by the filing fee of$350. In addition, you will be required to pay the cost of serving the complaint on each of the defendants. If you are unable to pay the filing fee and service costs for this action, you may petition the court for leave to proceed without payment of fees. A blank application for this purpose is included and it should be filed with your complaint. It must b e notarized by a notary public or other official authorized to administer oaths or must contain your statement that it is true and correct. If more than one plaintiff is named on the complaint, a separate application will be required for each. If you wish to proceed without payment of fees, you must h ave an authorized officer at the penal institution complete the certificate as to the amount of money and securities on deposit to your credit in any account in the institution. What amount, if any, of the filing fee and the cost of serving the complaint you will be required to pay will be determined from the information supplied to the court by you and the penal institution. American LegalNet, Inc. www.FormsWorkFlow.com MIDI IN THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF ALABAMA Full name and prison name of Plaintiff(s) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) v. CNIL ACTION NO. ,----,-c-----,-----c------c--- (T o be supplied by Clerk of U.S. District Court) Name of person(s) who violated your constitutional rights. (List the names of all the person.) I. PREVIOUS LAWSUITS A. Have you begun other lawsuits in state or federal court dealing with the same or 267 similar facts involved in this action? YES D No D B. Have you begun other lawsuits in state or federal court relating to your imprisonment? YES D NOD C. If your answer to A or Bis yes, describe each lawsuit in the space below. (If there is more than one lawsuit, describe the additional lawsuits on another piece of paper, using the same outline.) 1. Parties to this previous lawsuit: Plaintiff (s) Defendant( s) 2. Court (if federal court, name the district; if state court, name the county) American LegalNet, Inc. www.FormsWorkFlow.com 4. Name of judge to whom case was assigned 5. Disposition (for example: was the case dismissed? Was it appealed? Is it still pending?) 6. Approximate date of filing lawsuit 7. Approximate date of disposition IT. PLACE OF PRESENT CONFINEMENT PLACE OR INSTITUTION WHERE INCIDENT OCCURRED Ill. NAME AND ADDRESS OF INDIVIDUAL(S) YOU ALLEGE VIOLATED YOUR CONSTITUTIONAL RIGHTS. 1. 2. 3. 4. 5. 6. NAME IV. THE DATE UPON WHICH SAID VIOLATION OCCURRED V. STATE BRIEFLY THE GROUNDS ON WHICH YOU BASE YOUR ALLEGATION THAT YOUR CONSTITUTIONAL RIGHTS ARE BEING VIOLATED: GROUND ONE: American LegalNet, Inc. www.FormsWorkFlow.com STATE BRIEFLY THE FACTS WHICH SUPPORT THIS GROUND. (State as best you can the time, place and manner and person involved.) American LegalNet, Inc. www.FormsWorkFlow.com VI. STATE BRIEFLY EXACTLY WHAT YOU WANT THE COURT TO DO FOR YOU. MAKE NO LEGAL ARGUMENT. CITE NO CASES OR STATUTES. Signature of plaintiff(s) I declare under penalty of perjury that the foregoing is true and correct. (Date) Signature of plaintiff(s) American LegalNet, Inc. www.FormsWorkFlow.com AO 240 (Rev. 07/10) Application to Proceed in District Court Without Prepaying Fees or Costs (Short Form)UNITEDSTATESDISTRICTCOURT for the ))))Plaintiff/Petitionerv.Civil Action No. Defendant/RespondentAPPLICATION TO PROCEED IN DISTRICT COURT WITHOUT PREPAYING FEES OR COSTS(Short Form)I am a plaintiff or petitioner in this case and declare that I am unable to pay the costs of these proceedings andthat I am entitled to the relief requested.In support of this application, I answer the following questions under penalty of perjury:1.If incarcerated. I am being held at:.If employed there, or have an account in the institution, I have attached to this document a statement certified by theappropriate institutional officer showing all receipts, expenditures, and balances during the last six months for anyinstitutional account in my name. I am also submitting a similar statement from any other institution where I wasincarcerated during the last six months.2.If not incarcerated.If I am employed, my employer222s name and address are:My gross pay or wages are: $, and my take-home pay or wages are: $per(specify pay period).3.Other Income. In the past 12 months, I have received income from the following sources (check all that apply):(a) Business, profession, or other self-employmentYesNo(b) Rent payments, interest, or dividendsYesNo(c) Pension, annuity, or life insurance paymentsYesNo(d) Disability, or worker222s compensation paymentsYesNo(e) Gifts, or inheritancesYesNo(f) Any other sourcesYesNoIf you answered 223Yes224 to any question above, describe below or on separate pages each source of money andstate the amount that you received and what you expect to receive in the future. American LegalNet, Inc. www.FormsWorkFlow.com AO 240 (Rev. 07/10) Application to Proceed in District Court Without Prepaying Fees or Costs (Short Form)4. Amount of money that I have in cash or in a checking or savings account: $.5. Any automobile, real est