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IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLORADO Civil Action No. (To be supplied by the court) , Plaintiff v. , , , , Defendant(s). (List each named defendant on a separate line. If you cannot fit the names of all defendants in the space provided, please write 223see attached224 in the space above and attach an additional sheet of paper with the full list of names. The names of the defendants listed in the above caption must be identical to those contained in Section B. Do not include addresses here.) COMPLAINT NOTICE Federal Rule of Civil Procedure 5.2 addresses the privacy and security concerns resulting from public access to electronic court files. Under this rule, papers filed with the court should not contain: an individual222s full social security number or full birth date; the full name of a person known to be a minor; or a complete financial account number. A filing may include only: the last four digits of a social security number; the year of an individual222s birth; a minor222s initials; and the last four digits of a financial account number. Plaintiff need not send exhibits, affidavits, grievances, witness statements, or any other materials to the Clerk222s Office with this complaint. American LegalNet, Inc. www.FormsWorkFlow.com A.PLAINTIFF INFORMATIONYou must notify the court of any changes to your address where case-related papers may beserved by filing a notice of change of address. Failure to keep a current address on file with thecourt may result in dismissal of your case. (Name and complete mailing address) (Telephone number and e-mail address) B.DEFENDANT(S) INFORMATIONPlease list the following information for each defendant listed in the caption of the complaint. Ifmore space is needed, use extra paper to provide the information requested. The additionalpages regarding defendants should be labeled 223B. DEFENDANT(S) INFORMATION.224 Defendant 1: (Name and complete mailing address) (Telephone number and e-mail address if known) Defendant 2: (Name and complete mailing address) (Telephone number and e-mail address if known) Defendant 3: (Name and complete mailing address) (Telephone number and e-mail address if known) Defendant 4: (Name and complete mailing address) (Telephone number and e-mail address if known) 2 American LegalNet, Inc. www.FormsWorkFlow.com C.JURISDICTIONIdentify the statutory authority that allows the court to consider your claim(s): (check one) Federal question pursuant to 28 U.S.C. 247 1331 (claims arising under the Constitution, laws, or treaties of the United States) List the specific federal statute, treaty, and/or provision(s) of the United States Constitution that are at issue in this case. Diversity of citizenship pursuant to 28 U.S.C. 247 1332 (a matter between individual or corporate citizens of different states and the amount in controversy exceeds $75,000) Plaintiff is a citizen of the State of . If Defendant 1 is an individual, Defendant 1 is a citizen of . If Defendant 1 is a corporation, Defendant 1 is incorporated under the laws of (name of state or foreign nation). Defendant 1 has its principal place of business in (name of state or foreign nation). (If more than one defendant is named in the complaint, attach an additional page providing the same information for each additional defendant.) 3 American LegalNet, Inc. www.FormsWorkFlow.com D.STATEMENT OF CLAIM(S)State clearly and concisely every claim that you are asserting in this action. For each claim,specify the right that allegedly has been violated and state all facts that support your claim,including the date(s) on which the incident(s) occurred, the name(s) of the specific person(s)involved in each claim, and the specific facts that show how each person was involved in eachclaim. You do not need to cite specific legal cases to support your claim(s). If additional spaceis needed to describe any claim or to assert additional claims, use extra paper to continue thatclaim or to assert the additional claim(s). Please indicate that additional paper is attached andlabel the additional pages regarding the statement of claims as 223D. STATEMENT OF CLAIMS.224 CLAIM ONE: Supporting facts: 4 American LegalNet, Inc. www.FormsWorkFlow.com CLAIM TWO: Supporting facts: 5 American LegalNet, Inc. www.FormsWorkFlow.com E.REQUEST FOR RELIEFState the relief you are requesting or what you want the court to do. If additional space is neededto identify the relief you are requesting, use extra paper to request relief. Please indicate thatadditional paper is attached and label the additional pages regarding relief as 223E. REQUESTFOR RELIEF.224 F.PLAINTIFF222S SIGNATURE I declare under penalty of perjury that I am the plaintiff in this action, that I have read this complaint, and that the information in this complaint is true and correct. See 28 U.S.C. 247 1746; 18 U.S.C. 247 1621. Under Federal Rule of Civil Procedure 11, by signing below, I also certify to the best of my knowledge, information, and belief that this complaint: (1) is not being presented for an improper purpose, such as to harass, cause unnecessary delay, or needlessly increase the cost of litigation; (2)is supported by existing law or by a nonfrivolous argument for extending or modifyingexisting law; (3) the factual contentions have evidentiary support or, if specifically so identified,will likely have evidentiary support after a reasonable opportunity for further investigation ordiscovery; and (4) the complaint otherwise complies with the requirements of Rule 11. (Plaintiff222s signature) (Date) (Revised 6 American LegalNet, Inc. www.FormsWorkFlow.com