UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA _________________________________ _________________________________ _________________________________ (Enter above the full name of plaintiff in this action) v. : : : : : : : : : : CIVIL CASE NO: _________________ (to be supplied by Clerk of the District Court) _________________________________ _________________________________ _________________________________ _________________________________ (Enter above the full name of the defendant(s) in this action) : : : : : : : : : COMPLAINT 1. The plaintiff ___________________________________________ a citizen of the County of ___________________________________________ State of Pennsylvania, residing at __________________________________________________ wishes to file a complaint under ____________________________________________ (give Title No. etc.) ______________________________________________________________________ 2. The defendant is ______________________________________________________ ______________________________________________________________________ 3. STATEMENT OF CLAIM: (State below the facts of your case. If you have paper exhibits that give further information of your case, attach them to this completed form. Use as much space as you need. Attach extra sheet(s) if necessary) ___________________________ American LegalNet, Inc. www.FormsWorkflow.com 3. (CONTINUED) _______________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 4. WHEREFORE, plaintiff prays that _________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________ (Signature of Plaintiff) American LegalNet, Inc. www.FormsWorkflow.com