Kansas > Federal > District Court
Civil Complaint - Kansas
| Civil Complaint Form. This is a Kansas form and can be used in District Court Federal . |
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IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF KANSAS ) ) ) ) ) (Enter above the full name of the Plaintiff(s) ) ) vs. ) ) (1) ) Name ) ) Case Number: ) Street and number ) ) ) City State Zip Code ) ) (Enter above the full name and address of the Defendant in this action - list the name and address of any additional defendants on the back side of this sheet). CIVIL COMPLA INT I. Parties to this civil action: (In item A below, place your name in the first blank and place your present address in the second blank. Do the same for additional plaintiffs, if any, on the backside of this sheet). A. Name of plaintiff_________________ _________________ _________________ ____ Address_________________ _________________ _________________ _____________________________ _________________ _________________ _________________ ___________________ _________________ _________________ _________________ __ 1 <<<<<<<<<********>>>>>>>>>>>>> 2(In item B below, write the full name of the defendant in the first blank. In the second blank, writethe official position of the defendant. Use item C for the names and positions of any additionaldefendants). B. Defendant________________________________________________________is employed at _________________ _________________ _________________ ____ _________________ _________________ _________________ _______________ C. Additional Defendants_________________ _________________ __________________________________ _________________ _________________ _________________ ___________________ _________________ _________________ _________________ __II. Jurisdiction: (Complete one or more of the following subparagraphs, A., B.1, B.2., or B.3., whichever is applicable.) A. (If Applicable) Diversity of citizenship and amount: 1. Plaintiff is a citizen of the State of __________. 2. The first-named defendant above is either a. a citizen of the State of _____________; or b. a corporation incorporated under the laws of the State of _____________ and having its principal place of business in a State other than the State of which plaintiff is a citizen. 3. The second-named defendant above is either a. a citizen of the State of ______________; or b. a corporation incorporated under the laws of the State of ______________ and having its principal place of business in a State other than the State of which plaintiff is a citizen. 2<<<<<<<<<********>>>>>>>>>>>>> 3 (If there are more than two defendants, set forth the foregoing information for each additional defendant on a separate page and attach it to this complaint.) Plaintiff states that the matter in controversy exceeds, exclusive of interest and costs, the sum of seventy-five thousand dollars ($75,000.00). B. (If applicable) Jurisdiction founded on grounds other than diversity(Check any of the following which apply to this case). _____ 1. This case arises under the following section of the Constitution of the United States or statute of the United States (28 U.S.C. 1331): Constitution, Article_____, Section_____; Statute, US Code, Title_____, Section_____. _____ 2. This case arises because of violation of the civil or equal rights, privileges, or immunities accorded to citizens of, or persons within the jurisdiction of, the United States (28 U.S.C. 1343). _____ 3. Other grounds (specify and state any statute which gives rise to such grounds): _________________ _________________ ___________ _________________ _________________ ___________ _________________ _________________ ___________ _________________ _________________ ___________ III. Statement of Claim: (State here a short and plain statement of the claim showing that plaintiffis entitled to relief. State what each defendant did that violated the right(s) of the plaintiff, including dates and places of such conduct by the defendant(s). Do not set forth legal arguments. If you intend to allege more than one claim, number and set forth each claim in a separate paragraph. Attach an additional sheet, if necessary, to set forth a short and plain statement of the claim[s].) _________________ _________________ _________________ _________________ ____ _________________ _________________ _________________ _________________ ____ _________________ _________________ _________________ _________________ ____ 3 <<<<<<<<<********>>>>>>>>>>>>> 4_________________ _________________ _________________ _________________ ____ _________________ _________________ _________________ _________________ ____ _________________ _________________ _________________ _________________ ____ _________________ _________________ _________________ _________________ ___. IV. Relief: (State briefly exactly what judgement or relief you want from the Court. Do not make legal arguments.) _________________ _________________ _________________ _________________ ____ _________________ _________________ _________________ _________________ ____ _________________ _________________ _________________ _________________ ___. V. Do you claim the wrongs alleged in your complaint are continuing to occur at the present time? Yes [ ] No [ ] VI. Do you claim actual damages for the acts alleged in your complaint? Yes [ ] No [ ]VII. Do you claim punitive monetary damages? Yes [ ] No [ ] If you answered yes, state the amounts claimed and the reasons you claim you are entitled to recover money damages. _________________ _________________ _________________ _________________ ____ _________________ _________________ _________________ _________________ ____ _________________ _________________ _________________ _________________ ____ _________________ _________________ _________________ _____________________ _________________ _________________ _________________ _____________________ 4 <<<<<<<<<********>>>>>>>>>>>>> 5 _________________ _________________ _________________ _________________ ____VIII. Administrative Procedures: A. Have the claims which you make in this civil action been presented through any type of Administrative Procedure within any government agency? Yes [ ]No [ ] B. If you answered yes, give the date your claims were presented, how they were presented, and the result of that procedure: _________________ _________________ _________________ ____________ ___ _________________ _________________ _________________ ____________ ___ _________________ _________________ _________________ ____________ ___ C. If you answered no, give the reasons, if any, why the claims made in this action have not been presented through Administrative
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