1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Name: Address: Telephone Phone: Email: UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF CALIFORNIA Case No.: _____________________ (assigned at time of filing) , Plaintiff(s), v. COMPLAINT , Defendant(s). I. RELATED CASES a. b. Do you have other Civil Case(s) in this or any other federal court? Yes No If yes, please list the case numbers here: II. STATEMENT OF CLAIM (Briefly state the facts of your case. Describe how each defendant is involved, and tell what each defendant did to you that caused you to file this suit against them. Include names of any other persons involved, dates, and places.) 1 American LegalNet, Inc. www.FormsWorkFlow.com _____________________ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 2 American LegalNet, Inc. www.FormsWorkFlow.com _____________________ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 III. RELIEF YOU REQUEST (State exactly what you want the court to do for you. Do not use this space to state the facts of your claim.) 3 _____________________ American LegalNet, Inc. www.FormsWorkFlow.com 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 IV. DEMAND FOR JURY TRIAL (Would you like a trial by jury on all claims pursuant to FRCP, Rule 38?) Yes No I declare under penalty of perjury that the foregoing is true and correct. Date Signature Printed Name 4 _____________________ American LegalNet, Inc. www.FormsWorkFlow.com