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Pro Se (State Prisoner) Complaint Form - South Carolina
| Pro Se (State Prisoner) Complaint Form Form. This is a South Carolina form and can be used in Pro Se District Court Federal . |
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UNITED STATES DISTRICT COURT DISTRICT OF SOUTH CAROLINA FORMS FOR FILING CASES PRO SE (Representing Yourself) State Prisoner Revised August 22, 2006 Complaint - State Prisoner Revised 8/22/2006 American LegalNet, Inc. www.FormsWorkflow.com IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF SOUTH CAROLINA __________________________________________________________ ) ) [Enter the full name of the plaintiff in this action] ) ) v. ) ) __________________________________________________________ ) ) __________________________________________________________ ) ) __________________________________________________________ ) ) __________________________________________________________ ) ) __________________________________________________________ ) Enter above the full name of defendant(s) in this action ) Civil Action No. ___________________________ (to be assigned by Clerk) COMPLAINT State Prisoner I. PREVIOUS LAW SUITS A. Have you begun other lawsuits in state or federal court dealing with the same facts involved in this action or otherwise related to your imprisonment? Yes_______ No_______ B. If your answer to A is Yes, describe the lawsuit in the space below. If there is more than one lawsuit, describe the additional lawsuits on another piece of paper using the same outline. 1. Parties to this previous lawsuit: Plaintiff: __________________________________________________________________________________ Defendant(s):_______________________________________________________________________________ 2. Court: _____________________________________________________________________________________ (If federal court, name the district; if state court, name the county) _____________________________________________________________________________ 3. Docket Number: 4. Name(s) of Judge(s) to whom case was assigned: ___________________________________________________ 5. Disposition: ________________________________________________________________________________ (For example, was the case dismissed? Appealed? Pending?) ______________________________________________________________ ________________________________________________________________ 6. Approximate date of filing lawsuit: 7. Approximate date of disposition: Complaint - State Prisoner Revised 8/22/2006 Page 1 of 12 American LegalNet, Inc. www.FormsWorkflow.com II. PLACE OF PRESENT CONFINEMENT A. Name of Prison/Jail/Institution: ____________________________________________________________________ B. W hat are the issues that you are attempting to litigate in the above-captioned case? ___________________________ _____________________________________________________________________________________________ C. (1) (2) Is there a prisoner grievance procedure in this institution? Yes_______ No_______ Yes_______ No_______ Did you file a grievance concerning the claims you are raising in this matter? W hen____________________________ Grievance Number (if available) ____________________________ D. Have you received a final agency/departmental/institutional answer or determination concerning this matter (i.e., your grievance)? Yes_______ No_______ E. W hen was the final agency/departmental/institutional answer or determination received by you? _________________ If possible, please attach a copy of your grievance and a copy of the highest level decision concerning your grievance that you have received. F. If there is no prison grievance procedures in this institution, did you complain to prison, jail, or institutional authorities? Yes_______ No_______ G. If your answer is YES: 1. 2. W hat steps did you take? ______________________________________________________________________ W hat was the result?_________________________________________________________________________ III. PARTIES In Item A below, place your name, inmate number, and address in the space provided. Do the same for additional plaintiffs, if any. A. Name of Plaintiff:________________________________________________ Inmate No.: ___________________ Address: ______________________________________________________________________________________ In Item B below, place the full name of the defendant, his official position, and place of employment in the space provided. Use Item C for additional defendants, if any. B. Name of Defendant:______________________________________________ Position: _____________________ Place of Employment: ____________________________________________________________________________ C. Additional Defendants (provide the same information for each defendant as listed in Item B above): _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Complaint - State Prisoner Revised 8/22/2006 Page 2 of 12 American LegalNet, Inc. www.FormsWorkflow.com IV. STATEMENT OF CLAIM State here, as briefly as possible, the facts of your case. Describe how each defendant is involved. Include also the names of other persons involved, dates, and places. Do not give any legal arguments or cite any cases or statutes. If you intend to allege a number of related claims, number and set forth each claim in a separate paragraph. Use as much space as you need. Attach an extra sheet if necessary. _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ ________________
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