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Case 1:12-cv-20790-MGC Document 1 Entered on FLSD Docket 02/27/2012 Page 1 of 24

U N IT E D ST A T E S D IST R IC T C O U R T

SO U T H E R N D IST R IC T O F F L O R FD A

C ase N o.

12-CV-20790-COOKE/WHITE

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SU P P L E M E N T A L

P A P E R F IL E

Case 1:12-cv-20790-MGC Document 1 Entered on FLSD Docket 02/27/2012 Page 2 of 24

(Rov. 09/2007 Com laint Under T

he Civil Ri hts Act, 42 U.S.C. li 1 983

FILED by

D.c.

FEB 2 7 2212

U NITED

STATES D ISTRICT C OURT

southern District of Florida

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Case Number:

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Above, emerthe s1l name oftiw deorzantts) in uus action) y;- lA j #,f J. tygf-sf-w7k// pg
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A COMPLAINT UNDER THE CIW L RIGHTS ACT, 42 U.S.C. j 1983

lnstructions for Filing:

r'i J ,' J /zk fo .f f.

This packet includes four copies of the complaint form and tw o copies of the Application to
Proceed without Prepaym ent of Fees and A ffidavit. To start an action you m ust file an original and
one copy of your complaint for the coul't and one copy for each defendant you nam e. For example,
if you name two defendants, you must file the original and three copies of the complaint (a total of
four) with the court. You should also keep an additional copy of the complaint for your own records.
A11 copies of the complaint m ust be identical to the oriainal.

Y our complaint m ust be legibiy handwritten or typewritten. Please do not use pencil to
com plete these form s. The plaintiff m ust sign and swear to the com plaint. lf you need additional

Fpaçe to answer a question, use an additional blank paRe.

Your complaint can be brought in this court only if oneor m ore of the nam ed defendantsIS
district. Further,it is necessaryforyou to file a separate com plaint for each claim

located w ithin this
that you

have unless they areall relatedto the sam eincident or issue.

Page l of 5

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Case 1:12-cv-20790-MGC Document 1 Entered on FLSD Docket 02/27/2012 Page 3 of 24

(Rev. 09/2007) Complaint Under Tbe Civil Rights Act, 42 U.S.C, # 1 983

There is a filing fee of $350.00 for this complaint to be filed. lf you are unabie to pay the
fiiing fee and service costs for this action, you m ay petition the court to proceed in form a pauperis.

Two blank Applications to Proceed without Prepaym ent of Fees and A ffidavit for this

purpose are included in this packet. Both should be com pleted and filed with your com plaint.

You will note that you are required to give facts. THIS COM PLAW T SHOULD N OT

CON TA m LBGAL ARGUM EN TS OR CITATION S.

W hen these forms are completed, m ail the original and the copies to the Clerk's O ffice of
the United States District Court, Southern District of Florida, 301 N ortb M iam i Avenue, M iam i,

Florida 33128-7788.

Parties

ln ltem A below , place yournam e in the first blank and place yourpresent address in the third

blank.

A. Name of plaintiff: pz/'/f-? < 3* y//A/ VW 4!#

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In ltem B below, place the full nam e of the defendant in the first blanlt, his/her official
position in the second biank, and his/herplace of employm ent in the third blank. U se ltem C for the
nam es, positions, and places of employm ent for any additional defendants.

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