Bivens Complaint Form

COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : (Form to be used by federal prisoners filing a civil action under 28 U.S.C. § 1331, civil action under 28 U.S.C. § 1346, or a Bivens action) Calendar No. : IN THE UNITED STATES DISTRICT COURT JUDICIAL SUBPOENA Plaintiff(s) FOR THE DISTRICT OF SOUTH CAROLINA : -against- ...................................................... (Enter above the full name of each plaintiff in this action) ______________________________________ ) : ) ______________________________________ ) Civil Action No. _________ : ) Defendant(s) ______________________________________ ) : ) ) Complaint vs. ) THE PEOPLE OF THE STATE OF NEW YORK ) TO ______________________________________ ) ) ______________________________________ ) ) GREETINGS: ______________________________________ ) ) WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before ______________________________________ the , the Honorable at ) Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed orI. PREVIOUS LAWSUITS: evidence as a witness in this action on the part of the adjourned date, to testify and give (Enter above the full name of each defendant in this action. Do not use "et al.") A. Have you begun other lawsuits in state or federal court dealing with the same facts involved in this action or otherwise relating to your imprisonment? G Yes G No Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party onIf your answerthis"A" is "yes," describe each lawsuit in the space$50 and all damages more B. whose behalf to subpoena was issued for a maximum penalty of below. (If there is sustained as a result of your failure to comply. Witness, Honorable , one of the Justices of the Court in 1. Approximate date dayfiling lawsuit: , 20 County, of of ______________________________________ than one lawsuit, describe the additional lawsuits on another piece of paper the same size as this one, and give the same information about the additional case of cases.) 2. Parties to previous lawsuit: (Attorney must sign above and type name below) Plaintiff(s) __________________________________________________________ Defendant(s) ________________________________________________________ Attorney(s) for 3. Court: (If federal, name the district; if state, name the county.) __________________________________________________________________ Office and P.O. Address 4. 5. Docket Number: _____________________________________________________ Name of Judge to whom case was assigned: _______________________________ Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com Telephone No.: COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. 6. : Calendar Disposition: (Was the case dismissed? appealed? still pending?) No. JUDICIAL SUBPOENA Plaintiff(s) ___________________________________________________________________ ___________________________________________________________________ 7. Approximate date of disposition: ________________________________________ : Defendant(s) : . .II.. . .PLACE. OF .PRESENT . . . . . . . . . . . . . . . . . ________________________________________ . . . . . . . . . . . . . . . . . . . CONFINEMENT: . . . . . . . . . . . : -against: : __________________________________________________________________________ THE PEOPLE OF THE STATE facts relating to your present complaint in the internal prison grievance A. Did you present the OF NEW YORK TO procedure? G Yes 1. G No If your answer to "A" above is "Yes," what was the result? GREETINGS: ___________________________________________________________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before ___________________________________________________________________ , the Honorable at the Court located at County of ___________________________________________________________________ in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a"No," explain.action on the part of the witness in this 2. If your answer to "A" above is ___________________________________________________________________ Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to ___________________________________________________________________ the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. ___________________________________________________________________ Witness, Honorable , one of the Justices of the B. Court in Did you present your claim to the Federal20 County, day of , Bureau of Prisons or other federal agency for administrative action? G Yes G No 1. If your answer is "yes," state the date such (Attorney mustsubmitted and what action, if claim was sign above and type name below) any, has been taken. ___________________________________________________________________ Attorney(s) for ___________________________________________________________________ ___________________________________________________________________ Office and P.O. Address ___________________________________________________________________ Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com 2 COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. 2. : If your claim has been acted on, attach copies ofCalendar No. any correspondence you have received from the Bureau of Prisons or other federal agency concerning your claim. Plaintiff(s) : JUDICIAL SUBPOENA G No C. Are you suing -againstfor a work-related injury? G Yes : If your answer is "Yes," state the nature of your duties you were performing when the : injury occurred. : Defendant(s) : ...................................................... ______________________________________________________________________ ______________________________________________________________________ THE PEOPLE OF THE STATE OF NEW YORK TO III. PARTIES TO THIS SUIT: A. Name and address of each plaintiff (please include prison number): ____________________________________