FORM TO BE USED BY A PRISONER IN FILING A COMPLAINT UNDER THE CIVIL RIGHTS ACT, 42 U.S.C. § 1983 Instructions for Filing a Complaint by a Prisoner Under the Civil Rights Act, 42 U.S.C. § 1983 The clerk of the court will not file your complaint unless it conforms to the following instructions. IF YOU ARE IN THE CUSTODY OF THE MICHIGAN DEPARTMENT OF CORRECTIONS: To start an action, you m file an original complaint and one copy for the court. All copies of the com ust plaint must be identical to the original. If youare providing exhibits, you must file two copies with your complaint. You also should keep a copy of the complaint and exhibits for your own records. If the court determines that the complaint should be served on one or more defendant, the court will specifically order you to provide further copies for this purpose. Until ordered to do so, do not subm it to the court copies of the complaint or exhibits for purposes of service on the defendants. IF YOU ARE NOT IN THE CUSTODY OF THE MICHIGAN DEPARTMENT OF CORRECTIONS: To start an action, you must file an original complaint, one copy for the court and an additional copy for each defendant. All copies of the complaint must be identical to the original. If you are pr viding exhibits, you must file a copy for o each of the defendants. You also should keep a copy of the complaint and exhibits for your own records. INSTRUCTIONS FOR ALL FILERS: In order for this com plaint to be filed, it must be accompanied by the civil action filing fee of $400.00. In addition, the United States Marshal will require you to pay the cost of serving the complaint on each of the defendants. If you are unable to prepay the filing fee and service co for this action, you m petition the court to proceed in forma sts ust pauperis by completing and signing the attached af fidavit. You must also have an authorized officer at the penal institution complete a certificate as to the amount of money and securities on deposit to your credit in your institutional account for the six months immediately preceding the filing of thecomplaint. If the court grants you leave to proceed in forma pauperis, the civil action filing fee is reduced from $400.00 to $350.00, and you will be required to pay the $350.00 fee through an initial partial filing fee and through monthly installments. Your complaint must be legibly handwritten or typewritten. You, the plaintiff(s), must sign and date the complaint on the last page. If you need additional space to completely answer a question, you must attach additional pages. Your complaint can be brought in this court only if one or more of the named defendants is located within this district. Further, you must file a separate complaint for each claim that you have unless they are all related to the same incident or issue. You are required to furnish, so that the United States Marshal can complete service, the correct name and address of each person you have named as a defendant. A PLAINTIFF IS REQUIRED TO GIVE INFORMATION TO THE UNITED STATES MARSHAL TO ENABLE THE MARSHAL TO COMPLETE SERVICE OF THE COMPLAINT UPON ALL PERSONS NAMED AS DEFENDANTS. You will note that you are required to give f acts. THIS C OMPLAINT SHOULD NOT C ONTAIN LEGAL ARGUMENTS OR CITATIONS. When these forms are completed, mail the original and copies to the Clerk of the United States District Court for the Western District of Michigan at any of the addresses below: U.S. District Court 399 Federal Building 110 Michigan St., NW Grand Rapids, MI 49503 U.S. District Court 314 Federal Building P.O. Box 698 Marquette, MI 49855 U.S. District Court 107 Federal Building 410 W. Michigan Ave. Kalamazoo, MI 49007 U.S. District Court 113 Federal Building 315 W. Allegan Lansing, MI 48933 (Last Revised: July 2015) American LegalNet, Inc. www.FormsWorkFlow.com UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF MICHIGAN (Enter above the full names of all plaintiffs, including prisoner number, in this action.) v. (Enter above the full name of the defendant or defendants in this action.) COMPLAINT I. Previous Lawsuits CAUTION: The Prison Litigation Reform Act has resulted in substantial changes in the ability of incarcerated individuals to initiate lawsuits in this and other federal courts without prepayment of the civil action filing fee. Accurate and complete responses are required concerning your litigation history. Generally, a plaintiff's failure to accurately and completely answer the questions set forth below will result in denial of the privilege of proceeding in forma pauperis and require you to pay the entire $400.00 filing fee regardless of whether your complaint is dismissed. A. B. Have you ever filed a lawsuit while incarcerated or detained in any prison or jail facility? Yes G No G If your answer to question A was yes, for each lawsuit you have filed you must answer questions 1 through 5 below. Attach additional sheets as necessary to answer questions 1 through 5 below with regard to each lawsuit. 1. Identify the court in which the lawsuit was filed. If it was a state court, identify the county in which the suit was filed. If the lawsuit was filed in federal court, identify the district within which the lawsuit was filed. 2. Is the action still pending? a. Yes G No G If your answer was no, state precisely how the action was resolved: 3. Did you appeal the decision? Yes Q Yes Q No Q No Q 4 . Is the appeal still pending? a. If not pending, what was the decision on appeal? 5. Was the previous lawsuit based upon the same or similar facts asserted in this lawsuit? Yes Q If so, explain: No Q II. Place of Present Confinement If the place of present confinement is not the place you were confined when the occurrence that is subject of instant lawsuit arose, also list the place you were confined: -1- American LegalNet, Inc. www.FormsWorkFlow.com III. Parties A. Plaintiff(s) Place your name in the first blank and your present address in th e second blank. Provide the sam e information for any additional plaintiffs. Attach extra sheets as necessary. Name of Plaintiff _________________________________________________________ Address _______________________________________________________________________________________________ B. Defendant(s) Complete the information requested below for each defendant in this action, including whether you are suing each defendant in a n official and/or personal capacity. If there are m than four defendants, provide the same information fo