UNITED STATES DISTRICT COURT 

DISTRICT OF OREGON 

PORTLAND DIVISION 

Civil Case No. lo'.\t.\-c.,v- 61400 - M.C.. 

(to be assigned by Clerk of the Court) 

(Enter jid/ name of plaint!ff(s)) 

Plain tiff( s ), 

v. 

COMPLAINT 

Jury Trial Demanded 

[{I Yes D No 

(Enter jill/ name ufALL defendant(!>)) 

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 of paper ifnecessary. 

Plaintiff 

COMPLAfNT 

Revised: July 20, 2010 

Name: Jose.yb l"\6..±-\--bew Wo.i+e 

Street Address: 3l\-Ol KiDS cow hve. 

City, State & Zip Code: tlAqeae, Ore.j o o 0 • 

Telephone No. 11 b - 8 b 4- - 4-4- b ;( 

?\e&-Se... <S<!..n~ ~ dlApLc.a.te. of O..V\'1 Vvi'"\J C\.1\ (oud hot;~ic"J;on) to: 

R ic.h o.r J o-.n l f'l\ o..rj o rl e \tJ a.. i +e. ( .ro~ e..r h's p(l.,rer,t~ 

J Page I 12~ Woodwo..r AV€... 

Butto..\o I Nt.w Yor\( ll\-a\tt 

Case 6:14-cv-01400-MC Document 1 Filed 08/29/14 Page 1 of 5
Defendant No.1 

Defendant No.2 

Defendant No. 3 

Defendant No. 4 

Name: Uni\fersi±'/ o£ Oce-job 

Street Address: 15 R 5" Eo. S + 13 +h A-ye__ 

City, State & Zip Code: ClAjeoe 1 Ore-JDII Cf7~o3 

Telephone No. 5"Y.I - 3 LJ-lo - I 0 0 0 

Name: -------------------------------------- Street Address: --------------------------------

City, State & Zip Code: _____________ _ 

Telephone No. 

Name: 

Street Address: --------------------------------

City, State & Zip Code: --------------

Telephone No. 

Name: 

Street Address: --------------------------------

City, State & Zip Code: --------------

Telephone No. 

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 of one state sues a citizen ofanother state and the amount 

in damages claimed is more than $75,000 is a diversity of citizenship case. 

A. What is the basis for federal cou1ijurisdiction (check all that apply) 

0 Federal Question D Diversity of Citizenship 

COMPLAINT Page 2 

Revised: July 20, 2010 

Case 6:14-cv-01400-MC Document 1 Filed 08/29/14 Page 2 of 5
Plaintiff(s) state of citizenship--------------------

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

III. STATEMENT OF CLAIMS 

Claim I 

State here as briefly as possible the (acts a_{ your case. Describe how each defendant was 

involved, when the conduct occurred, and any injuries you have suffered as a result. It is not 

necessal)' to give any legal arguments or cite any cases or statutes. 

COMPLAINT Page 3 

Revised: July 20, 2010 

Case 6:14-cv-01400-MC Document 1 Filed 08/29/14 Page 3 of 5
Claim II 

State here as briefly as possible the facts o.fyour 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 thefacts o.fyour case. Describe hmv 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. 

* for ±he.. cle.sLrip+ion of bow ea-.cb po..r±d Wo.f involved r \e..o... s e te fe.r +-o ±n e. "tt"" c..h~A c.\ oJ" rn en± s. 

(If you have additional claims, describe them on another piece of paper, using the same outline.) 

COMPLAINT Page 4 

Revised: July 20, 20 I 0 

Case 6:14-cv-01400-MC Document 1 Filed 08/29/14 Page 4 of 5
IV. RELIEF 

State brieflv exactly >vhat you >vwzt the court to do for you and the amount, if any, of 

monetwy compensation you are seeking. Make no legal arguments. Cite no cases or statutes. 

;rbseph 'vJ~i±p_ is Se.e.\(i¥\j resJ;t. .... tioa fcom +h~ Un\y~t'ii+yof Or~~~n 

m ±b4!. a..mov.n-4- of one. mil\ion JoiiQ,rS for ±he Ii+r~\X 

yiolo..hon, wh;c,\ . ., ho.s res-ulted in d~faMa..·hon .. f h~·s cb"-Y"o.deG 

Sv.bse.ov.e.nt \oS5 of job opforh,.~,y'l\.±ies o.nd.. inconte.. 1 dired·ly re..S\.1.\-ti'j 

fr:oML ~btL Slo..I\A~rov. s o.."A \d~e lov..s o.lleso-.F ol'\ S £CA.br1 c..o..te. ~ by Uni'J~Cs ibf of Ore.j6h emp Ioyce 5-

fv.~'"'\'he..rf'I\O('~ O..f\'1 £u,~e,n~ Po\ic..t.. Re.c..or~~ of J'osc.r\.- \IJ~a~·.s st.noo~\ l"e.LOl'd) 

·\\wJ no-."e... 'b~e." l1-~e.(..J~ ~'I thiS c..o..s~ Suc.h o..S "r"'bi~L if'ld.e.C-Il.t1c.'/' or ''r\)b, .. t +h t"' 

o.re +a be. ~)(pv.n.9e.J. 1'e.D( 

I declare under peJ\alty of perjury that the foregoing is true and conect. 

Signed this a. ~+h day of AU j U S t , 20 l!t_. 

(Signature of Plaintiff(s)) 

COMPLAINT Page 5 

Revised: July 20, 2010 

Case 6:14-cv-01400-MC Document 1 Filed 08/29/14 Page 5 of 5