Complaint Pursuant To The Americans With Disabilities Act
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Complaint Pursuant To The Americans With Disabilities Act Form. This is a New York form and can be use in District Court Federal.
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Tags: Complaint Pursuant To The Americans With Disabilities Act, New York Federal, District Court
UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF NEW YORK
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Plaintiff(s)
vs.
Defendant(s)
Plaintiff(s) demand(s) a trial by: ____ JURY
Civil Case No.:
COMPLAINT PURSUANT
TO THE AMERICANS
WITH DISABILITIES ACT
_____ COURT
(Select only one).
Plaintiff(s) in the above-captioned action, allege(s) as follows:
JURISDICTION
1.
This is a civil action seeking judgment, relief and/or damages brought pursuant to the
Americans with Disabilities Act, 42 U.S.C. § 12101 et seq., as amended, for
discrimination based upon a disability and the failure to accommodate same. This Court
has jurisdiction of this action pursuant to 28 U.S.C. §§ 1331 and 1343(4).
PARTIES
2. a.
Plaintiff:
Address:
b. Plaintiff:
Address:
Additional Plaintiffs may be added on a separate sheet of paper.
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3.
a.
Defendant:
Official Position:
Address:
b.
Defendant:
Official Position:
Address:
Additional Defendants may be added on a separate sheet of paper.
4.
My disability is as follows:
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5.
The conduct complained of in this action involves:
(Check all that apply)
(A)
(B)
Termination of employment.
(C)
Denial of participation in public service or program.
(D)
Failure to make alterations to accommodate disability.
(E)
Retaliation.
(G)
6.
Failure to employ.
Other acts as specified below:
FACTS
On the following page, set forth the facts of your case which substantiate your claim of
discrimination. List the events in the order they happened, naming defendants involved, dates and
places.
Note: Each fact should be stated in a separate paragraph; paragraphs should be
numbered sequentially.
You must include allegations of wrongful conduct as to EACH and EVERY
defendant in your complaint.
You may use additional sheets as necessary.
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7.
PRAYER FOR RELIEF
WHEREFORE, plaintiff(s) request(s) that this Court grant the following relief:
I declare under penalty of perjury that the foregoing is true and correct.
DATED:
Signature of Plaintiff(s)
(all Plaintiffs must sign)
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