INSTRUCTIONS FOR FILING A COMPLAINT BY PRISONERS PURSUANT TO THE CIVIL RIGHTS ACT 42, U.S.C. § 1983 This packet includes four copies of a complaint form and two copies of a pauper’ s affidavit. To start an action you must submit an original and one copy of your complaint for the Court, plus one additional copy of the complaint for each defendant you name. For example, if you name two defendants you must file the original and three copies of the complaint. You should also keep an additional copy of the complaint for your own records. All copies of the complaint must be identical to the original, including any attachments or exhibits. The Clerk will NOT file your complaint if it does not conform to these instructions and to these forms. Your complaint must be typed or legibly HAND PRINTED with no less than 1 ½ spaces between lines; no single spacing is allowed. If you need additional space to answer a question you may use additional blank paper, provided you use standard letter-size paper. Local Court Rules require that all pleadings, including attachments, must be on paper no larger than 8½ x 11 inches. Any pleadings submitted on paper exceeding this size will be returned. Extra copies of pleadings submitted to the Court that you wish to have marked “ filed”and returned must be accompanied by a self-addressed stamped envelope. Each plaintiff must also sign and swear to the complaint. Your complaint can be brought in this court only if one or more of the named defendants is located within this district. Further, it is necessary for you to file a separate complaint for each claim that you have unless they are all related to the same incident or issue. In order for this complaint to be filed, it must be accompanied by the filing fee of $150.00. If you are unable to pay the required filing fee, you may request the Court to allow you to proceed in forma pauperis. Two blank affidavits are included in this packet for this purpose. One copy should be filed with the complaint and the other kept for your own records. If more than one plaintiff is filing suit and each plaintiff requests to proceed in forma pauperis, then each plaintiff must complete and submit a separate pauper’ affidavit. Additional affidavit forms are available s from this office. THE COMPLAINT SHOULD NOT CONTAIN LEGAL ARGUMENTS OR CITATIONS; YOU ARE REQUIRED TO GIVE ONLY THE FACTS. When these forms are completed, mail the original and copies to: Clerk, U.S. District Court Northern District of Georgia 2211 U.S. Courthouse 75 Spring Street, S.W. Atlanta, GA 30303-3361 You are not required to provide completed Marshal’ Service forms. (USM 285) at the s initial stage of filing your complaint. You will be notified by the Court to provide them at a later date. American LegalNet, Inc. www.FormsWorkFlow.com CIVIL RIGHTS COMPLAINT PURSUANT TO 42 U.S.C. § 1983 IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF GEORGIA ___________________________________ (Enter above the full name and prisoner identification number of the plaintiff.) vs. ___________________________________ ___________________________________ ___________________________________ (Enter above the full name of the defendant(s).) I. Previous Lawsuits A. Have you begun other lawsuits in state or federal court dealing with (1) the same facts involved in this action, or (2) otherwise relating to your imprisonment? Yes ( B. ) No( ) If you anser to A(1) or (2) is yes, describe each lawsuit in the space below and tell us whether the “ old”case involves the same facts or other issues. (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): ________________________________________________________________ ________________________________________________________________ 3. Docket Number: __________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com III. Previous Lawsuits (Cont’ d) 4. Name of judge to whom case was assigned: ____________________________ 5. Did the previous case involve the same facts: Yes ( 6. ) No( ) Disposition (Was the case dismissed? Was it appealed? Is it still pending?): ________________________________________________________________ ________________________________________________________________ 7. 8. II. Approximate date of filing lawsuit: ____________________________________ Approximate date of disposition:______________________________________ Exhaustion of Administrative Remedies A. Place of Present Confinement: ____________________________________________ B. Is there a prisoner grievance procedure in this institution? Yes ( C. ) No ( ) Did you present the facts relating to your complaint in the state prisoner grievance procedure? Yes ( D. No ( ) If your answer is YES: 1. What steps did yo take and what were the results? _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ 2. III. ) If you answer is NO, explain why not: _________________________________ _______________________________________________________________ Parties (In item A below, place you name in the first blank and place your present address in the second blank. Do the same for additional plaintiffs, if any.) A. Name of Plaintiff(s): _____________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com III. Parties (Cont’ d) Address(es): ___________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ (In item B 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. Do the same for each additional defendant, if any.) B. Defendant(s): ________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Employed as: __________________________________________________________ _____________________________________________________________________ at ___________________________________________________________________ _____________________________________________________________________ IV. Statement of Claim State here as briefly as possible the facts of your case. Describe how each defendant is involved. Include also the names of other persons involved, dates, and places. Do not give any legal arguments or cite any cases or statutes. If you intend to allege a number of related claims, number and set forth each claim in a separate paragraph. (Use as much space as you need. Attach extra sheets if necessary.) ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com IV. Statement of Claim (Cont’ d) ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ V. Relief State briefly exactly what you want the Court to do for you. Make no legal arguments. Cite no cases or statutes. ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com V. Relief (Cont’ d) ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Signed this _______________ day of _______________________________, 19 _________. _____________________________ Signature of Plaintiff STATE OF _____________________________ COUNTY (CITY) OF ______________________ I declare under penalty of perjury that the foregoing is true and correct. EXECUTED ON _________________________ (Date) ______________________________________ Signature of Plaintiff American LegalNet, Inc. www.FormsWorkFlow.com