Case 6:15-cv-01780-TC

Document 2

Filed 09/21/15

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FILED 21 ~ff"1513:13 USDCffi

UNITED STATES DISTRICT COURT

DISTRICT OF OREGON
EUGENE
DIVISION

Civil Case No.

ee~ \Sc."Q>\)~~TC

(to be assigned by Clerk of the Court}

(Enter full name of plaintiff(s))

COMPLAINT
Plaintiff(s),
~-Trial

~ es

Demanded
0No

(Enter full name of ALL defendant(s))

Defendant(s).

I.

PARTIES

List your name, address, and telephone number below, and the same information for each
defendant. Make sure that the defendant(s) listed below are identical to those contained in the
caption of the complaint. Attach additional sheets ofpaper if necessary.

Plaintiff

Name:

JJeL oft:;;.-L (rts~L,

fil JLS 17 511Y

~ c~ ~JI'-.<JI~./lJ /I) I vJ ~
City, State & Zip Code: v<J-<..~ () J<..'/Y 0}
Street Address:

Telephone No.

COMPLAINT
Revised: July 20, 20 I 0

s 'II

6 ?' -(

t ~

Page I

Case 6:15-cv-01780-TC

Defendant No. 1

Name:

Document 2

Filed 09/21/15

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Cdij ..f [ J f}r f'..A-- (c.lrj fl1 "-" "- r J~A (t vrJ

Street Address:

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{i
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__..:;__()_{L_---L..._1_ _Y._ f) J

City, State & Zip Code:

\J

541 6 <j-1.-- 5 () /TJ

Telephone No.

Defendant No. 2

Name:

Street Address:

( OVJ\*1 {{ov'l'1 f1J,,.,Jr%.( lllorrol.1sk1)

LS [

City, State & Zip Code:

Telephone No.

Defendant No. 3

Name:

"/

~v ~re- &-JAG._r -t-..t-" ..,/~ Jr 1 So MJ {

~

Street Address:

-....J cJ

City, State & Zip Code:

Telephone No.

Defendant No.4

~-+l- //v-.
~f'<
1'/D /
8:2- (./~ 0 3

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L/ 1
- -li: : :---=--~=:.:...._____;~-L.....L1_c.f
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c.~ (}c;..\/J Ooyk)

OLs<-Lu-{;_5 {u\J,f'-r"J {?ew:r"-1

Street Address: ! -3u o tv W vJ ()-/1 5""+r--&-j
City, State & Zip Code: J3ey,J () 1't Cf/1 <.) /

(ov r)
II. JURISDICTION

Federal courts are courts of limited jurisdiction. Only two types of cases can be heard in
federal court: cases involving a federal question and cases involving diversity ofcitizenship of the
parties. A case involving the United States Constitution or federal laws or treaties is a federal
question case. A case in which a citizen ofone state sues a citizen ofanother state and the amount
in damages claimed is more than $75,000 is a diversity of citizenship case.
What is the basis for federal court jurisdiction (check all that apply)

COMPLAINT
Revised : July 20, 20 I 0

D Diversity of Citizenship

Page 2

t1

t\...,a.~r

0 D

Name

~deral Question

~)

Telephone No.

A.

)G-r~r6-e )

Case 6:15-cv-01780-TC

Document 2

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Filed 09/21/15

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Page 3 of 12

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Case 6:15-cv-01780-TC

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Plaintiff(s) state of citizenship _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Defendant(s) state(s) of citizenship _ __ _

III. STATEMENT OF CLAIMS

Claim I

Case 6:15-cv-01780-TC

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Case 6:15-cv-01780-TC

5.

Document 2

Filed 09/21/15

Do you have cash or checking or savings accounts ?

(including prison trust accounts)?

Page 6 of 12

rnYes 0No

If "Yes," state the total amount:

6.

Do you own any real estate, stocks, bon~ecurities , other financial instruments, automobiles or
other valuable property?
OY es (L$No
If"Yes," describe the asset(s) and state the value of each asset listed.

7.

Do you have any other assets?

DYes

If "Yes," list the asset(s) and state the value of each asset listed.

8.

Do you have
expenses?

an..4,housi~

transportation, utilities, or loan payments, or other regular monthly

ti::! Yes UNo

If"Yes," describe and provide the amount of the monthly expense.

c a.r

9.

/;'1. 1vra,.,_u__

y so

List the persons (or, if under 18, initials only) who are dependent on you for support, state your
relationship to each person and indicate how much you contribute to their support.

Revised August 6, 2010

Page3

USDC - Oregon

Case 6:15-cv-01780-TC

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Claim II

State here as briefly as possible the [acts ofyour case. Describe how each defendant was
involved, when the conduct occurred, and any injuries you have suffered as a result. It is not
necessary to give any legal arguments or cite any cases or statutes.

Claim III

State here as briefly as possible the {acts ofyour case. Describe how each defendant
was involved, when the conduct occurred, and any injuries you have suffered as a result. It is not
necessary to give any legal arguments or cite any cases or statutes.

(Ifyou have additional claims, describe them on another piece ofpaper, using the same outline.)
COMPLAINT
Revised : July 20, 20 I 0

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Case 6:15-cv-01780-TC

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IV.

Filed 09/21/15

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RELIEF

I declare under penalty of perjury that the foregoing is true and cmrect.
Signed this/ 1 _ day of

/""'

b.c. r

20

If

(Signature of Plaintiff(s))

COMPLAINT
Revised : July 20, 20 I 0

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Case 6:15-cv-01780-TC

10.

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Do you have any debts or financial obligations?

If"Yes," describe the amounts owed and to whom they are payable.

If I am incarcerated, I hereby authorize the agency having custody of me to collect from my

trust account and forward to the Clerk of the United States District Court payments toward the full
filing fee of $350.00 for a prisoner civil rights complaint in accordance with 28 U.S.C. 191S(b).

PRINTED NAME OF APPLICANT

Revised August 6, 2010

Page4

USDC - Oregon

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JS 44 (Rev. 12/ 12)

The JS 44 civil cover sheet and the information contained herein neither replace nor supplement the filing and service of pleadings or other papers as required by law, except as
provided by local rules of court. This form, approved by the Judicial Conference of the United States in September 1974, is reqUired for the use of the Clerk of Court for the
purpose of initiating the civil docket sheet. (SEE INSTRUCTIONS ON NEXT PAGE OF THIS FORM)

I. (a) PLAINTIFFS

DEFENDANTS

County of Residence of First Listed Defendant

(b) County of Residence of First Listed Plaintiff

(IN U.S. PLAIN11FF CASES ONLY)

IN LAND CONDEMNATION CASES, USE THE LOCATION OF
THE TRACT OF LAND INVOLVED.

(EXCEPT IN U.S. PLAINTIFF CASES)

NOTE:

Attorneys (If Known)

(C) Attorneys (Firm Name, Address, and Telephone Number)

II. BASIS OF JURISDICTION (Piacean "X"inOneBoxOnty)

r..,4

0 1 U.S. Government
Plaintiff

0 2

0 4

U.S. Government
Defendant

Ill. CITIZENSHIP OF PRINCIPAL PARTIES (Place an "X" in one Box for Plaintiff
and One Box for Defendant)
PTF
DEF
Incorporated or Principal Place
0 4
0 4
of Business In This State

(For Diversity Cases Only)

Federal Question
(U.S. Government Not a Party)

~ ~1

Citizen ofTI1is State

Diversity
(Indicate Citizenship of Parties in Item Ill)

Citizen of Another State

0 2

Incorporated and Principal Place

of Business In Another State

0 5

0 5

Citizen or Subject of a

0 3

Foreign Nation

0 6

Forei n Country

IV. NATURE OF SUIT (Place an

CONTRA

0
0
0
0
0

0
0
0
0

110 Insurance
120 Marine
130 Miller Act
140 Negotiable Instrument
150 Recovery of Overpayment
& Enforcement of Judgment
15 I Medicare Act
152 Recovery of Defaulted
Student Loans
(Excludes Veterans)
153 Recovery of Overpayment
of Veteran' s Benefits
160 Stockholders ' Suits
190 Other Contract
I95 Contract Product Liability
196 Franchise

0
0
0
0
0
0

REAL PROPERTY
210 Land Condemnation
220 forec losure
230 Rent Lease & Ejectment
240 Torts to Land
245 Tort Product Liability
290 All Other Real Property

0
0
0

"X"inOneBoxOnly)
rcJRrs

PERSONAL INJURY
0 310 Airplane
0 315 Airplane Product
Liability
0 320 Assault, Libel &
Slander
0 330 Federal Employers'
Liability
0 340 Marine
0 345 Marine Product
Liability
0 350 Motor Vehicle
0 355 Motor Veh icle
Product Liability
0 360 Other Personal
Injury
0 362 Personal InjuryMedical Malpractice
CIVIL RIGHTS
~~440 Other Civil Rights
0 441 Voting
0 442 Employment
0 443 Housing!
Accommodations
0 445 Amer. w/DisabilitiesEmployment
0 446 An1er. w/Disabilities Other
0 448 Education

FORFEITURE/PENA

PERSONAL INJU RY
0 365 Personal Injury Product Liability
0 367 Health Care/
Pharmaceutical
Personal Injury
Product Liability
0 368 Asbestos Personal
Injury Product
Liability
PERSONAL PROPERTY
0 370 Other Fraud
0 371 Truth in Lending
0 380 Other Personal
Property Damage
0 385 Property Damage
Product Liability
PRISONER PETITIONS
Habeas Corpus:
0 463 Alien Detainee
0 5 tO Motions to Vacate
Sentence
0 530 General
0 535 Death Penalty
Other:
0 540 Mandamus & Other
0 550 Civil Rights
0 555 Prison Condition
0 560 Civil DetaineeConditi ons of

"'Y

0 625 Drug Related Seizure

of Property 21 USC 881

BANKRUPTCY

0 422 Appeal28 USC 158

0 423 Withdrawal

0 690 Other

28

usc 157
' RIGHTS

0 820 Copyrights
0 830 Patent
0 840 Trademark
. ARO~

0 710 Fair Labor Standards

Act

0 720 Labor/Management
0
0
0
0

Relations
740 Railway Labor Act
75 I family and Medical
Leave Act
790 Other Labor Litigation
791 Employee Retirement
Income Security Act

0
0
0
0
0

SOC' !A
861 HIA (1395fl)
862 Black Lung (923)
863 DIWC/DIWW (405(g))
864 SS!D Title XVI
865 RSI (405(g))

FEDERAL TAX SUITS

0 870 Taxes (U.S. Plaintiff
or Defendant)
0 871IRS-Tilird Parry
26 usc 7609

OTHER STATUTES

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

IMMIGRATION

0 462 Naturalization Application

0 465 Other Inmugration
Actions

Confinement

Jf.

0 RIG IN

(Place an "X" in One Box Only)

Original
Proceeding

0 2 Removed from
State Court

Remanded from
Appellate Court

0 4 Reinstated or
Reopened

5 Transferred from
Another District

0 6 Multidistrict
Litigation

(specify)

Cite the U.S.

VII. REQUESTED IN
COMPLAINT:
VIII. RELATED CASE(S)
IF ANY
DATE

(See ins/ructions):

DOCKET NUMBER

7 /7 /)

FOR OFFICE USE ONLY

RECEIPT #

AMOUNT

APPLYING lfP

JUDGE

MAG. JUDGE

375 False Claims Act

400 State Reapportionment
410 Antitrust
430 Banks and Banking
450 Conunerce
460 Deportation
4 70 Racketeer Influenced and
Corrupt Organizations
480 Consumer Credit
490 Cable/Sat TV
850 Securities/Commodities/
Exchange
890 Other Statutory Actions
891 Agricultural Acts
893 Environmental Matters
895 freedom of Information
Act
896 Arbitration
899 Administrative Procedure
Act/Review or Appeal of
Agency Decision
950 Constitutionality of
State Statutes