INSTRUCTIONS FOR FILING CIVIL RIGHTS COMPLAINT UNDER BIVENS IN THE UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF CALIFORNIA (1) This complaint must be legibly handwritten or typewritten, and signed by the plaintiff. All questions must be answered concisely in the proper space on the form. Do NOT write on the back of any page. No citation of case or statutory authority is necessary. (2) Additional pages not to exceed fifteen (15) in number may be included with the court approved form complaint, provided the form is completely filled in to the extent applicable in the particular case. This limitation does not include exhibits. (3) Upon receipt of a fee of $400 ($350 statutory fee and $50 administrative fee) your complaint will be filed if it is in proper order. The $400 fee must be submitted with the complaint, not separately. (4) If you do not have the necessary funds to pay the filing fee or cannot afford to pay for transcripts, counsel, appeal, or other costs connected with this civil action, you may request permission to proceed in forma pauperis, in which event you must execute a separate form provided by the Court, entitled "Motion and Declaration Under Penalty of Perjury in Support of Motion to Proceed In Forma Pauperis" setting forth information establishing your inability to pay fees or costs. IF YOU ARE A PRISONER, you must attach a certified copy of your prison trust account statements for the 6-month period immediately preceding the filing of the complaint per 28 U.S.C. § 1915(a)(2) or your motion to proceed in forma pauperis will be denied. Even if your motion to proceed in forma pauperis is granted, however, the Court may assess an initial partial filing fee at the time your action is filed and the $50 administrative fee will be waived. After the initial partial fee is assessed, YOU WILL STILL OWE THE BALANCE OF THE $350 STATUTORY FILING FEE WHICH THE COURT WILL ORDER GARNISHED FROM YOUR PRISON TRUST ACCOUNT. (5) When the complaint is fully completed, it must be mailed to: Clerk of U.S. District Court 333 West Broadway, Suite 420 San Diego, CA 92101 American LegalNet, Inc. www.FormsWorkFlow.com __________________________ (Name) ______________________________________ (Address) ______________________________________ (City, State, Zip) ______________________________________ (CDCR / Booking / BOP No.) United States District Court Southern District of California ) (Enter full name of plaintiff in this action.) ) ) Plaintiff, ) ) v. ) ) ______________________________, ) ______________________________, ) ) ______________________________, ) ______________________________, ) ______________________________, ) (Enter full name of each defendant in this action.) ) Defendant(s). ) _______________________________________________ ) A. Jurisdiction , Civil Case No. (To be supplied by Court Clerk) Civil Rights Complaint per 28 U.S.C. § 1331 and Bivens v. Six Unknown Named Agents of Federal Bureau of Narcotics, 403 U.S. 388 (1971) Jurisdiction is invoked pursuant to 28 U.S.C. § 1331and Bivens. If you wish to assert jurisdiction under different or additional authority, list them below. _____________________________________________________________________________. B. Parties 1. Plaintiff: This complaint alleges that the civil rights of Plaintiff, ___________________________ (print Plaintiff's name) _____________________, who presently resides at ________________________________________ (mailing address or place of confinement) ______________________________________________________, were violated by the actions of the below named individuals. The actions were directed against Plaintiff at________________________ ________________________________ on (dates) ___________, ___________, and ___________. (institution/place where violation occurred) Bivens SD Form (Rev. 8/15) (Count 1) (Count 2) (Count 3) American LegalNet, Inc. www.FormsWorkFlow.com 2. Defendants: (Attach same information on additional pages if you are naming more than 4 defendants.) Defendant _____________________________ resides in _____________________________, (name) (defendant's position/title (if any)) (County of residence) and is employed as a ____________________________________. This defendant is sued in his/her 9 individual 9 official capacity. (Check one or both.) Explain how this defendant was acting under color of law: ______________________________________________________________ ___________________________________________________________________________________ ________________________________________________________________________. Defendant _____________________________ resides in _____________________________, (name) (defendant's position/title (if any)) (County of residence) and is employed as a ____________________________________. This defendant is sued in his/her 9 individual 9 official capacity. (Check one or both.) Explain how this defendant was acting under color of law: ______________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________. Defendant _____________________________ resides in _____________________________, (name) (defendant's position/title (if any)) (County of residence) and is employed as a ____________________________________. This defendant is sued in his/her 9 individual 9 official capacity. (Check one or both.) Explain how this defendant was acting under color of law: _____________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________. Defendant _____________________________ resides in _____________________________, (name) (defendant's position/title (if any)) (County of residence) and is employed as a ____________________________________. This defendant is sued in his/her 9 individual 9 official capacity. (Check one or both.) Explain how this defendant was acting under color of law: _____________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________. Bivens SD Form (Rev. 8/15) 2 American LegalNet, Inc. www.FormsWorkFlow.com C. Causes of Action (You may attach additional pages alleging other causes of action and the facts supporti