Civil Rights Complaint Form (To Be Used By Federal Prisoners) | Pdf Fpdf Doc Docx | Florida

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Civil Rights Complaint Form (To Be Used By Federal Prisoners) | Pdf Fpdf Doc Docx | Florida

Civil Rights Complaint Form (To Be Used By Federal Prisoners)

This is a Florida form that can be used for USDC Northern within Federal.

Alternate TextLast updated: 5/2/2006

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UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF FLORIDA INSTRUCTIONS FOR PRISONERS FILING COMPLAINTS IN CIVIL RIGHTS ACTIONS UNDER 28 U.S.C. 1331 OR 1346 Civil rights actions commenced by pro se litigants will not be considered by the Court unless this form has been completed by the litigant as explained below. Explanation and Instructions - Read Carefully 1. This packet includes a complaint form which should be completed as instructed below. Alsoincluded is an in forma pauperis application which you must complete if you cannot pay the filing fee. 2. Your complaint must be legibly handwritten or typewritten. Answer all questions on thecomplaint form. You must furnish your full and correct name as Plaintiff. When listing Defendants,provide name and either job title or position; i.e., Officer R. Smith. You must furnish an address for eachDefendant. If you need additional space to answer a question, you may use additional blank pages, butdo not write on the reverse side of any page. You must sign the complaint on the last page of thecomplaint form. ANY FALSE STATEMENT MADE ON THIS FORM MAY RESULT IN SANCTIONSAND MAY ALSO SERVE AS THE BASIS FOR PROSE CUTION FOR PERJURY. You must keep acopy of the complaint for your records, but the complaint that is sent to the Court for filing must containyour original signature. Do not send service copies until directed to do so by the Court. 3. State the facts which support your claims in Section V of the complaint form. The claimsraised in this action must relate to the same basic incident or issue. Any other claims must beaddressed in a separate civil rights complaint. When presenting the facts, do not make legal argumentsor provide case citations. If you desire to make a legal argument, you should do so by filing a separatememorandum of law. However, such argument is unnecessary at the initiation of a case. You will beadvised when the submission of evidence or argument in support of your claim(s) is appropriate. Withone exception, do not attach evidence or exhibits to the complaint form. THE ONLY EXCEPTION ISTHAT PRISONERS ARE REQUIRED TO SU BMIT COPIES OF ALL GRIEVANCES WHICHDEMONSTRATE EXHAUSTION OF ADMINISTRATIVE REMEDIES ON EACH CLAIM RAISED IN THECOMPLAINT. 4. For the complaint to be filed, you must submit a filing fee of $150.00 at the same time yousubmit your complaint. If you can pay the fee, you are also responsible for the costs of service of thecomplaint upon Defendants, although you may seek assi stance from the Court. If you are unable to paythe filing fee and service costs for this action, you may petition the Court to proceed in forma pauperisusing the forms included in this packet. The forms must be submitted with your complaint. You mustalso have an authorized official at your institution complete the certificate section of the forms whichprovides information about your inmate bank account. 5. Those who are allowed to proceed in forma pauperis are entitled to service of the complaintupon Defendants by the United States Marshal. If you ar e granted leave to proceed in forma pauperis,you should not attempt to effect service of the complaint by yourself, nor should you mail to anyDefendant a request for waiver of formal service pursuant to Rule 4 of the Federal Rules of CivilProcedure. The Court will order the Marshal to serve the complaint on the Defendants at the appropriatetime. <<<<<<<<<********>>>>>>>>>>>>> 2 INSTRUCTIONS FOR CIVIL RIGHTS ACTIONS COMMENCED BY PRISONERS UNDER 28 U.S.C. 1331 OR 1346 - PAGE 2 6. After receiving notice from the Clerk of your case number, you must include the case number onall documents you file with the Court. You must keep a copy of every document you send to the Court(including a copy of this complaint) as you are not entitled to free copies from the Clerk even if you areproceeding in forma pauperis. You must immediately advise the Court of any change of address by filing a"Notice to the Court of Change of Address." This notice should contain the address change and the effectivedate and must be signed. FAILURE TO NOTIFY THE COURT OF ANY CHANGE OF ADDRESS COULDRESULT IN THE DISMISSAL OF YOUR CASE! 7. The complaint will be prosecuted in either the Gainesville, Panama City, Pensacola, or TallahasseeDivision of the Court, depending on the county of residence of one or more of the Defendants or the placewhere the events forming the basis of the complaint occurred. You should name the appropriate division ofthe Court in the space provided at the top of the complaint form. The following counties comprise the Gainesville Division: Alachua, Dixie, Gilchrist, Lafayette, andLevy. The following counties comprise the Panama City Division: Bay, Calhoun, Gulf, Holmes, Jackson,and Washington. The following counties comprise the Pensacola Division: Escambia, Okaloosa, Santa Rosa, andWalton. The following counties comprise the Tallahassee Division: Franklin, Gadsden, Jefferson, Leon,Liberty, Madison, Taylor, and Wakulla. Cases to be filed in the Tallahassee Division Cases to be filed in the Gainesville should be mailed to: Division should be mailed to:CLERK, U.S. DISTRICT COURT CLERK, U.S. DISTRICT COURT111 N. ADAMS STREET 401 S.E. FIRST AVENUESUITE 322 ROOM 243TALLAHASSEE, FLORIDA 32301-7717 GAINESVILLE, FLORIDA 32601 Cases to be filed in either the Pensacola or Panama City Divisions should be mailed to: CLERK, U.S. DISTRICT COURT 1 N. PALAFOX STREET ROOM 226 PENSACOLA, FLORIDA 32502-5658 Revised 08/03 <<<<<<<<<********>>>>>>>>>>>>> 3 UNITED STA TES DISTRICT COURT FOR THE NORTHERN DISTRICT OF FLORIDA DIVISION CIVIL RIGHTS COMPLAINT FORM TO BE USED BY PRISO NERS IN ACTIONS UNDER 28 U.S.C . 1331 or 1346 , Inmate # . (Enter full name of Plaintiff) vs. CASE NO: (To be assigned by Clerk) , , , , . (Enter name and title of each Defendant. If additional space is required, use the blank area below and directly to the right.) ANSWER A LL QUESTION S ON THE FOLLOWING PAGES: <<<<<<<<<********>>>>>>>>>>>>> 4I. PLA INTIFF: State your full name, inmate number (if applicable), and full mailing address in the lines below. Name of Plaintiff: Inmate Number Prison or Jail: Mailing address: II. DEFEN DANT(S): State the name of the Defendant in the first line, official position in the second line, place ofemployment in the third line, and mailing address. Do the same for every Defendant:(1) Defendants name: Official position: Employed at: Mailing address: (2) Defendants name: Official position: Employed at: Mailing addr

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