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Civil Rights Complaint Prisoner Cases - Wisconsin
| Civil Rights Complaint Prisoner Cases Form. This is a Wisconsin form and can be used in USDC Eastern Federal . |
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INSTRUCTIONS FOR FILING A CIVIL RIGHTS COMPLAINT UNDER 42 U.S.C. § 1983: PRISONER CASES Enclosed is a § 1983 complaint form, a Petition and Affidavit to Proceed in forma pauperis, including an Authorization for Release of Institutional Account Information and Payment of the Filing Fee, an information sheet, and a Notice of Lawsuit and Request for W aiver of Service of Summons form. The filing fee is $350.00 which must be paid at the time the action is filed. If you are unable to pay the fee, you may petition the court for leave to proceed in forma pauperis. Instructions: 1. You must file with the Clerk of the United States District Court an original complaint and one copy for each defendant that you sue. You also should keep a copy of the complaint for your own records. All copies of the complaint must be identical to the original. 2. Your complaint must be legibly handwritten or typed. The complaint must be signed by each plaintiff and should include the prisoner identification number of each plaintiff. The complaint need not be notarized. Answer each question to the best of your knowledge and belief. Be concise. 3. Provide facts supporting your claims. You must explain what each defendant did to violate your federal rights. Include the relief you are requesting from the court. 4. Please try to keep your complaint to the space provided. However, if you need additional space to answer a question or state your claim, attach additional pages to the form. Do not use the back of the form. 5. If you are unable to pay the filing fee, you may petition the court for leave to proceed in forma pauperis by completing and signing, under penalty of perjury, the attached petition and affidavit to proceed without prepayment of fees and/or costs. This need not be notarized. Each plaintiff who seeks to file in forma pauperis must complete a petition and affidavit. 6. You must also file a certified copy of your trust fund account statement for the six month period immediately preceding the filing of the complaint. 7. W hen these forms are properly completed, mail them to: Clerk, United States District Court United States Courthouse, Rm. 362 517 E. W isconsin Avenue Milwaukee, W isconsin 53202 i American LegalNet, Inc. www.FormsWorkFlow.com UNITED STATES DISTRICT COURT EASTERN DISTRICT OF WISCONSIN , (Full N ame o f each P laintiff) Plaintiff(s), v. Case No. (S upplied by C lerk) , (Full N ame o f each D efendant) Defendant(s). COM PLAINT UNDER THE CIVIL RIGHTS ACT, 42 U.S.C. § 1983 I. PLACE OF PRESENT CONFINEM ENT (Provide full address) A. B. Is there a grievance procedure in your prison/jail? YES G NO G Have you filed a grievance concerning the facts relating to this complaint? YES G NO G II. PARTIES A. B. C. D. Your name (Plaintiff) Prisoner I.D. Number Social Security Number (Last Four Digits Only) Your Address (City & State) (For additional plaintiffs provide the same information in the same format on a separate page.) American LegalNet, Inc. www.FormsWorkFlow.com E. DEFENDANT (name) is employed as at F. Additional DEFENDANTS (name, position, and place of employment): III. PREVIOUS LAWSUITS A. Have you begun other lawsuits in state or federal court relating to the same facts involved in this action? G YES G NO Have you begun other lawsuits in state or federal court relating to your imprisonment?G YES G NO If your answer is YES to either of the above questions, provide the following requested information. 1. Parties to the previous lawsuit B. C. Plaintiff(s): Defendant(s): 2. 3. 4. 5. Date filed Court where case filed (if federal court, name district: if state court, name the county) Case number and citation Nature of claim -2American LegalNet, Inc. www.FormsWorkFlow.com 6. Current status (for example: W as the case dismissed? W as it appealed? Is it still pending?) 7. 8. If resolved, date of disposition If resolved, state whether for (plaintiff or defendant) (For additional cases, provide the above information in the same format on a separate page.) IV. STATEM ENT OF CLAIM A. State as briefly as possible the facts of your case. Describe how each named defendant is involved. Include the name of other persons involved, dates, and places. Describe specifically the injuries incurred. Do not give legal arguments or cite cases or statutes. You may do that in Item "B" below. If you allege related claims, number and set forth each claim in a separate paragraph. Use as much space as you need to state the facts. Attach extra pages, if necessary. Unrelated separate claims should be raised in a separate civil action. STATEM ENT OF CLAIM continued -3American LegalNet, Inc. www.FormsWorkFlow.com B. State briefly your legal theory or cite appropriate authority. V. RELIEF YOU REQUEST State briefly and exactly what you want the court to do for you. Make no legal arguments. Do not use this space to state the facts of your claim. Use it only to request remedies for the injuries you complain about. -4American LegalNet, Inc. www.FormsWorkFlow.com I declare under penalty of perjury that the foregoing is true and correct. Complaint signed this day of , . Signature of Plaintiff(s) (If there are multiple plaintiffs, each must sign the complaint) Prisoner I.D. Number(s) -5American LegalNet, Inc. www.FormsWorkFlow.com Instructions for Completing the Petition and Affidavit to Proceed Without Prepayment of Fees and/or Costs Before District Court or on Appeal Read Carefully 1. Purpose of Form - This form may be used to establish indigency for the purpose of (1) obtaining a waiver of the applicable filing fee for your action; (2) obtaining a waiver of the applicable fee for filing an appeal; (3) establishing financial eligibility for the appointment of counsel; or (4) waiving of other fees, such as fees for transcripts or subpoenas. 2. Signed Under Penalty Of Perjury - To submit your petition and affidavit, it must be signed. Your signature indicates that the Petition and Affidavit is signed "under penalty of perjury." This means that any false statement of a material fact presented in your petition may serve as a basis for prosecution and conviction for perjury. Your signature does not have to be witnessed by a notary public. 3. If You Are A Non-Prisoner Bringing a Civil Action, You Are Advised - The filing fee for a civil action (other than a petition for habeas corpus relief pursuant to 28 U.S.C. § 2241, § 2254 or a motion pursuant to 28 U.S.C. § 2255) is $350.00. If you are bringing a petition for habeas corpu
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