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

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

Civil Rights Complaint Form (To Be Used By State 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 42 U.S.C. 1983 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 must be completed as instructed below. Also includedis an in forma pauperis application which you must complete if you cannot pay the $150.00 filing fee. 2. Your complaint must be legibly handwritten or typewritten and all questions on the complaint formmust be answered. Use your full, correct name as Plaintiff. When listing Defendants, provide name and title;i.e., Officer R. Smith. You must furnish an address for each Defendant. If you need additional space toanswer a question, you may use additional blank pages, but do not write on the reverse side of any page. Youmust sign the last page of the complaint form. ANY FALSE STATEMENT MADE ON THIS FORM MAYRESULT IN THE DISMISSAL OF YOUR COMPLAINT AND MAY ALSO SERVE AS THE BASIS FORPROSECUTION FOR PERJURY. Keep a copy of the complaint for your records, but the complaint that issent to the Court for filing must contain your original signature. Do not provide service copies until instructedto do so. 3. State the facts which support your claims in Section V of the complaint form. The claims raised in thisaction must relate to the same basic incident or issue. Any other claims must be addressed in a separate civilrights complaint. When presenting the facts, do not make legal arguments or provide case citations. If youdesire to make a legal argument, you should do so by filing a separate memorandum of law. However, suchargument is unnecessary at the initiation of a case. You will be advised when it is appropriate to submitevidence or legal argument in support of your claim(s). With one exception, do not attach evidence or exhibitsto the complaint form. The only exception is that prisoners are required to submit copies of all grievanceswhich demonstrate exhaustion of administrative remedies on each claim raised in the complaint. 4. For the complaint to be filed, you must submit a filing fee of $150.00 at the same time you submit yourcomplaint if you are financially able to do so. If you can pay the fee, you are also responsible for the costsof service of the complaint upon Defendants, although you may seek assistance from the Court. If you areunable to pay the filing fee, you may petition the Court to proceed in forma pauperis using the forms includedin this packet. The forms must be submitted with your complaint. You must also have an authorized officialat your institution complete the certificate section of the form which provides information about your inmatebank account. 5. Those who are allowed to proceed in forma pauperis are entitled to service of the complaint uponDefendants by the United States Marshal. If you are granted leave to proceed in forma pauperis, you shouldnot attempt to effect service of the complaint by yourself, nor should you mail to any Defendant a request forwaiver of formal service pursuant to Rule 4 of the Federal Rules of Civil Procedure. The Court will order theMarshal to serve the complaint on the Defendants at the appropriate time. 6. After receiving notice from the Clerk of your case number, you must include the case number on alldocuments you file with the Court. You must keep a copy of every document you send to the Court, includinga copy of this complaint. Litigants are not entitled to free copies from the Clerk even if proceeding in formapauperis. You must immediately advise the Court of any change of address by filing a "Notice to the Courtof Change of Address." This notice must contain the address change and must be signed. FAILURE TONOTIFY THE COURT OF ANY CHANGE OF ADDRESS COULD RESULT IN THE DISMISSAL OF YOURCASE. <<<<<<<<<********>>>>>>>>>>>>> 2 INSTRUCTIONS FOR PRISONERS FILING COMPLAINTS UNDER 42 U.S.C. 1983 - PAGE 2 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, and Levy. The following counties comprise the Panama City Division: Bay, Calhoun, Gulf, Holmes, Jackson, andWashington. The following counties comprise the Pensacola Division: Escambia, Okaloosa, Santa Rosa, and Walton. 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 2 <<<<<<<<<********>>>>>>>>>>>>> 3 UNITED STA TES DISTRICT COURT FOR THE NORTHERN DISTRICT OF FLORIDA DIVISION CIVIL RIGHTS COMPLAINT FORM TO BE USED BY PRISONERS IN ACTIONS UNDER 42 U.S.C . 1983 , 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 address: (3) Defendants name: Official position: Employed at: Mailing address: ATTACH ADDITIONAL PAGE

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