In the District Court of ______________________ County State of Oklahoma ____________________________ ) ) ) vs. ) ) ____________________________ ) ____________________________ ) ____________________________ ) ____________________________ ) Plaintiff Defendant(s) ) Case No. ____________________ (To be entered by Court Clerk) Petition Comes now the Plaintiff, _______________________________________, and alleges to the Court as follows: 1. The Plaintiff, (full name) _______________________________________, is an inmate confined in the penal facility located at (mailing address) _____________________________________________ ____________________________________________________________________________. 2. 3. The Plaintiff is a resident of the State of Oklahoma and has been for ________ years. (a) The Defendant, (name of first defendant) ________________________ is employed as (position and title, if any) _____________________________________________________. The Defendant's employment address is (mailing address) _________________________________ _______________________________________________________________________. At the time the claim(s) alleged in this complaint arose, was this Defendant acting under Color of state law? _____ Yes, or, _____ No. If answer is `yes', briefly explain: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 3. (b) The Defendant, (name of second defendant) ________________________ is employed as (position and title, if any) _____________________________________________________. The Defendant's employment address is (mailing address) _________________________________ _______________________________________________________________________. At the time the claim(s) alleged in this complaint arose, was this Defendant acting under color of state law? _____ Yes, or, _____ No. If your answer is `yes', briefly explain: _______________________________________________________________________ _______________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Note: Attach additional pages to furnish the information above on each defendant. 4. Jurisdiction: ______________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 5. Venue: ____________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 6. Briefly state the facts of the case: _____________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 7. (a) The Plaintiff alleges that the following constitutional rights, privileges or immunities have been violated: (List and designate each count separately). _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ The following facts support the allegation above: (List and designate each count separately). _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ (b) American LegalNet, Inc. www.FormsWorkFlow.com 8. I have filed other lawsuits in state or federal court dealing with the same facts involved in this action. _____ Yes, or, _____ No. If the answer is `yes', describe each lawsuit. (Please attach additional copies of the petition(s) and/or requests) for administrative relief). (a) Parties to the previous lawsuit: Plaintiff(s): ________________________________________________________ Defendant(s): ________________________________________________________ (b) Name of court and case number: ______________________________________ _______________________________________________________________________ (c) Case status: ____ ____ ____ ____ ____ Pending Relief granted Action dismissed On appeal Other, please specify: ______________________________________________________________________ ______________________________________________________________________ (d) Issues presented: _______________________________________________________ ______________________________________________________________________ ______________________________________________________________________ (e) Date of filing: _______________________________________________________ (f) Date of Disposition: _________________________________________________ 9. I have sought informal or formal relief from the appropriate administration officials regarding the acts stated in allegation 8 of this Petition. _____ Yes, or, _____ No. If your answer is `yes', briefly describe how relief was sought and the outcome of the proceedings. If your answer is `no', briefly explain why administrative relief was not sought. ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ _______________________________________