(Del. Rev.12/98) IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF DELAWARE (Name of Plaintiff or Plaintiffs) v. CIVIL ACTION NO. (Name of Defendant or Defendants) COMPLAINT 1. This action is brought pursuant to (Federal statute on which action is based) for discrimination related to jurisdiction exists by virtue of (In what area did discrimination occur? e.g. race, sex, religion) .0. (Federal statute on which jurisdiction is based) 2. Plaintiff resides at (Street Address) (City) (County) (State) (Zip Code) . (Area Code) (Phone Number) 3. Defendant resides at, or its business is located at (Street Address) . (City) 4. (County) (State) (Zip Code) The alleged discriminatory acts occurred on , (Day) 5. The alleged discriminatory practice Q is , (Month) . (Year) Q is not continuing. American LegalNet, Inc. www.USCourtForms.com 6. Plaintiff(s) filed charges with the (Agency) (Street Address) (City) (County) (State) (Zip) regarding defendant(s) alleged discriminatory conduct on: (Date) 7. Attach decision of the agency which investigated the charges referred in paragraph 6 above. 8. Was an appeal taken from the agency's decision? Yes Q No Q If yes, to whom was the appeal taken? 9. The discriminatory acts alleged in this suit concern: (Describe facts on additional sheets if necessary) 10. Defendant’s conduct is discriminatory with respect to the following: A. Q Plaintiff’s race B. Q Plaintiff’s color C. Q Plaintiff’s sex D. Q Plaintiff’s religion E. Q Plaintiff’s national origin American LegalNet, Inc. www.USCourtForms.com 11. Plaintiff prays for the following relief: (Indicate the exact relief requested) I declare under penalty of perjury that the foregoing is true and correct. Dated: (Signature of Plaintiff) American LegalNet, Inc. www.USCourtForms.com