UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF ILLINOIS [CHOOSE ONE] ________________________________ ________________________________ ________________________________ (Enter above the full name of the plaintiff or plaintiffs in this action) vs. ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ (Enter above the full name of ALL defendants in this action. Do not use "et al.") CHECK ONE ONLY: _______ AMENDED COMPLAINT Case No:_________________________________ (To be supplied by the Clerk of this Court) COMPLAINT UNDER THE CIVIL RIGHTS ACT, TITLE 42 SECTION 1983 U.S. Code (state, county, or municipal defendants) COMPLAINT UNDER THE CONSTITUTION ("BIVENS" ACTION), TITLE 28 SECTION 1331 U.S. Code (federal defendants) OTHER (cite statute, if known) _______ _______ BEFORE FILLING OUT THIS COMPLAINT, PLEASE REFER TO "INSTRUCTIONS FOR FILING." FOLLOW THESE INSTRUCTIONS CAREFULLY. American LegalNet, Inc. www.FormsWorkflow.com I. Plaintiff(s): A. B. C. D. E. Name: List all aliases: Prisoner identification number: Place of present confinement: Address: (If there is more than one plaintiff, then each plaintiff must list his or her name, aliases, I.D. number, place of confinement, and current address according to the above format on a separate sheet of paper.) II. Defendant(s): (In A below, place the full name of the first defendant in the first blank, his or her official position in the second blank, and his or her place of employment in the third blank. Space for two additional defendants is provided in B and C.) A. Defendant: Title: Place of Employment: B. Defendant: Title: Place of Employment: C. Defendant: Title: Place of Employment: (If you have more than three defendants, then all additional defendants must be listed according to the above format on a separate sheet of paper.) 2 Revised 9/2007 American LegalNet, Inc. www.FormsWorkflow.com III. List ALL lawsuits you (and your co-plaintiffs, if any) have filed in any state or federal court in the United States: A. Name of case and docket number: B. C. Approximate date of filing lawsuit: List all plaintiffs (if you had co-plaintiffs), including any aliases: D. List all defendants: E. Court in which the lawsuit was filed (if federal court, name the district; if state court, name the county): Name of judge to whom case was assigned: F. G. Basic claim made: H. Disposition of this case (for example: Was the case dismissed? Was it appealed? Is it still pending?): I. Approximate date of disposition: IF YOU HAVE FILED MORE THAN ONE LAWSUIT, THEN YOU MUST DESCRIBE THE ADDITIONAL LAWSUITS ON ANOTHER PIECE OF PAPER, USING THIS SAME FORMAT. REGARDLESS OF HOW MANY CASES YOU HAVE PREVIOUSLY FILED, YOU WILL NOT BE EXCUSED FROM FILLING OUT THIS SECTION COMPLETELY, AND FAILURE TO DO SO MAY RESULT IN DISMISSAL OF YOUR CASE. COPLAINTIFFS MUST ALSO LIST ALL CASES THEY HAVE FILED. 3 Revised 9/2007 American LegalNet, Inc. www.FormsWorkflow.com IV. Statement of Claim: State here as briefly as possible the facts of your case. Describe how each defendant is involved, including names, 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.) 4 Revised 9/2007 American LegalNet, Inc. www.FormsWorkflow.com 5 Revised 9/2007 American LegalNet, Inc. www.FormsWorkflow.com V. Relief: State briefly exactly what you want the court to do for you. Make no legal arguments. Cite no cases or statutes. VI. The plaintiff demands that the case be tried by a jury. 9 YES 9 NO CERTIFICATION By signing this Complaint, I certify that the facts stated in this Complaint are true to the best of my knowledge, information and belief. I understand that if this certification is not correct, I may be subject to sanctions by the Court. Signed this _________day of _________, 20_____ (Signature of plaintiff or plaintiffs) (Print name) (I.D. Number) (Address) 6 Revised 9/2007 American LegalNet, Inc. www.FormsWorkflow.com