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CASE 0:13-cv-02280-PAM-SER Document 1 Filed 08/20/13 Page 1 of 5

TINITED STATES DISTRICT COURT

DISTRICT OF MINNESOTA

vs.

Plaintiff(s),

Do a'-;u ftnr&zy case No. 11 cva+vo 04ru/5E"L-

(To be assigned by Clerk of District Court)

DEMAND FOR ruRY TRIAL
YESf] Nol-l

7Mwn\"WW^-Jlr/y'; (oe
,/

(Enter the full name(s) ofALL defendants in
this lawsuit. Please attach additional sheets
ifnecessary).

PARTIES

COMPLAINT

1. List your name, address and telephone number. Do the same for any additional plaintiffs.

a. plaintiff pet,rat;q Pa_7 ftudfr_-g

Name

Street Address SlA ( fla l'[/-o at D tf 't<- ,4 SO I
County, City fltd/-y
state & zip code m N ft VZ(
rerephoneNumber f t Z- 72 S- fr6 | Cq/ 4An4- Of 2-fr6-fr2 I

SCANNED
AUG 2'0 2013

u.s. prsrRqr cllqBJ/lqlg

CASE 0:13-cv-02280-PAM-SER Document 1 Filed 08/20/13 Page 2 of 5

2. List all defendants. You should state the full name of the defendant, even if that defendant is

a government agency, an organization, a corporation, or an individual. Include the address
where each defendant may be served. Make sure that the defendant(s) listed below are
identical to those contained in the above caption.

a. DefendantNo. 1
'' Name 7 re9.
Street Address L50 5 e n7-"1 r\la'rLa'eft' <- ptroarue--
County, Ciry 7L&-A/nrL-P | 4'r
State & Zip Code /nt\.a

b.

Defendant No. 2

Name

Street Address

County, City

State & Zip Code

Defendant No. 3

Name

Street Address

County, City

State & Zip Code

NOTE: IF TIIERE ARE ADDITIONAL PLAINTIFFS OR DEFENDANTS, PLEASE
PROVIDE THEIR NAMES AND ADDRXSSES ON A SEPARATE SHEET OF PAPER.
Check here if additional sheets of paper are attached:l-l
Please label the attached sheets of paper to correspond to the appropriate numbered
paragraph above (e.g. Additional Defendants 2.d.,2.e., etc.)

CASE 0:13-cv-02280-PAM-SER Document 1 Filed 08/20/13 Page 3 of 5

JURISDICTION

Federal courts are courts of limited jurisdiction. Generally, two types of cases can be heard in
federal court: cases involving a federal question and cases involving diversity of citizenship of
the parties. Under 28 U.S.C. $ 1331, a case involving the United States Constitution or federal
laws or treaties is a federal question case. Under 28 U.S.C. $ 1332, a case in which a citizen of
one state sues a citizen of another state and the amount of damages is more than $75,000 is a
diversity of citizenship case.

3. What is the basis for federal court jurisdiction? (check all that apply)

l-lFederal Question

nDiversity of Citizenship

4. If the basis for jurisdiction is Federal Question, which Federal Constitutional, statutory or

treaty right is at issue? List all that apply.

5. If the basis for jurisdiction is Diversity of Citizenship, what is the state of

party? Each Piaintiff must be diverse from each Defendant for diversity jurisdiction.

ip of each

"itir"ort

Plaintiff Name:

Defendant No. 1:

Defendant No. 2:

State of Citizenship:

State of Citizenship:

State of Citizenship:

Attach additional sheets of paper as necessary and label this information as paragraph
:.
Check here if additional sheets of paper are attached. ll

6. What is the basis for venue in the District of Minnesota? (check all that apply)

IO"f"naant(s) reside in Minnesota n Facts alleged below primarily occurred in
nother: explain

Minnesota

STATEMENT OF THE CLAIM

Describe in the space provided below the basic facts of your claim. The description of facts
should include a specific explanatign of how, where, and when each of the defendants named in
the caption violated the law, and how you were harmed. Each paragraph must be numbered

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CASE 0:13-cv-02280-PAM-SER Document 1 Filed 08/20/13 Page 4 of 5

separately, beginning with number 7. Please write each single set of circumstances in a
s ep arately numb bred p aragraph.

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q1/27q-
+,A nf {4 Z ,!r-o-l ^,ro-y t 6 ^sU, Zo Cot I Kcrca-,
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hna.L Luc.z- fro.t^,- Ur'4. F c/tr)d-.lrrc=_ n-o11 1O
J "ts4 f y re- *o f4",'4 e-*4 T a-n, L9 L; ry Fa f' p"N)tin _
gorn*-gQ- aaud- Aa,rq-sSw2^'t Pf mat{ ftom '9'< Fn *?.

Attach additional sheets of paper as necessary.
Check here if additional sheets of paper are attachea,I
Please label the attached sheets of paper to as Additional Facts and continue to number the
paragraphs consecufively.

REQUEST FOR RELIEF

State what you want the Court to do for you and the amount of monetary compensation, if any,
you are seeking.

A

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t,*^H A+tl e-rt- J-aa-* */t7 f an<- Ao4agsr{ n <-
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CASE 0:13-cv-02280-PAM-SER Document 1 Filed 08/20/13 Page 5 of 5

Signed this

aay otT\trr fu

Signature "rr^ ,
MailingAddress U/gl ftAf:LoN DCIh*
{F;dJ e7 4 ,.-^ Tfyzy

rerephoneNumber Frz- 7Z 3-- re6 Y -6ff//<-

7--trT&rry

Note: All plaintiffs named in the caption of the complaint must date and sign the complaint and
provide his/her mailing address and telephone number. Attach additional shiets of paper as
necessary.