Pro Se Non Prisoner Complaint Form

Rev. 6/03 UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF NORTH CAROLINA Pro se [Non-prisoner] Complaint Form ________________________________, (Your Name) Plaintiff, v. Defendant(s). ) ) ) ) ) ) ) ) ) ) ) ) Civil Action No. (to be assigned by the Clerk) COMPLAINT I. JURISDICTION ______________________________________________________________________ II. A. PARTIES Plaintiff Name of Plaintiff: Address: B. Defendant(s) (Notice: A person must be identified in subsections B and C in order to be considered as a defendant.) Name of Defendant: Current Address: American LegalNet, Inc. www.USCourtForms.com C. Additional Defendants (please provide the same information for each defendant as listed in Item B above): III. STATEMENT OF CLAIM (State here as briefly as possible the FACTS of your case. Do this by identifying the alleged legal wrong and by describing how each defendant named in Section II.B. and C. above is personally responsible for depriving you of your rights. Include relevant times, dates, and places. Also, you must state the basis for federal jurisdiction. In other words, why should the case be in federal court as opposed to state court. DO NOT GIVE LEGAL ARGUMENTS OR CITE ANY CASES. Number and set forth each separate claim in a separate paragraph.) (Attach extra sheets if necessary.) American LegalNet, Inc. www.USCourtForms.com III. STATEMENT OF CLAIM - continued. American LegalNet, Inc. www.USCourtForms.com IV. RELIEF State briefly and exactly what relief you want from this court. Signed this day of , 20 . Signature of plaintiff Address Telephone number American LegalNet, Inc. www.USCourtForms.com