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Complaint Form. This is a California form and can be use in USDC Eastern Federal.
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Tags: Complaint, California Federal, USDC Eastern
Plaintiff's Name:
CDC No:
Address:
IN THE UNITED STATES DISTRICT COURT
FOR THE EASTERN DISTRICT OF CALIFORNIA AT FRESNO
(Name of Plaintiff)
vs.
(Names of all Defendants)
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(Case Number)
COMPLAINT
Civil Rights Act, 42 U.S.C. 1983
Previous Lawsuits:
A. Have you brought any other lawsuits while a prisoner? Yes
No
B. If your answer to A is yes, how many?:
Describe previous or pending lawsuits in the space below.
(If more than one, use back of paper to continue outlining all lawsuits.)
1. Parties to this previous lawsuit:
Plaintiff
Defendant
s
2. Court (if Federal Court, give name of District; if State Court, give name of County)
3. Docket Number
5. Disposition
4. Assigned Judge
(For example: Was the case dismissed? Was it appealed? Is it still pending?)
6. Filing date (approx.)
7. Disposition date (approx.)
(List all other previous or pending lawsuits on back of this form)
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II.
Exhaustion of Administrative Remedies
A. Is there a grievance procedure available at your institution? Yes
No
B. Have you filed a grievance concerning the facts of this complaint? Yes
No
If your answer is no, explain why not
C. Is the grievance process completed? Yes
Date process completed, and disposition
III.
No
Defendants
(In Item A below, place the full name of the defendant in the first blank, his/her official position
in the second blank, and his/her place of employment in the third blank. Use item B for the
names, positions and places of employment of any additional defendants.)
is employed as
A. Defendant
at
B. Additional defendants
IV. Statement of Claim
(State here as briefly as possible the facts of your case. Describe how each defendant is
involved, including dates and places. Do not give any legal arguments or cite any cases or
statutes. Attach extra sheets if necessary.)
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v.
Relief
(State briefly exactly what you want the court to do for you. Make no legal arguments. Cite no
cases or statutes.)
I declare under penalty of perjury that the foregoing is true and correct.
(Date)
(Signature of Plaintiff)
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2001 © American LegalNet, Inc.
