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UNITED STATES DISTRICT COURT 

DISTRICT OF OREGON 

MEDFORD DIVISION 

(to be assigned by Clerk of the Court) 

(Enter full name of p/aintiff(s)) 

COMPLAINT 

Plain tiff( s ), 

v. 

I. PARTIES 

~Trial Demanded 

[L$..Yes D No 

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 if necessary. 

Plaintiff 

COMPLAINT 

Revised: July 20,2010 

Name: _jQDlE MCEhj . StreetAddress: coS\0 so, GTh5 'S\, ~B reo 

City, State & Zip ._?od~ t"-l:M.AATH . mus I a_, TelephoneNo.~l-e£20-lf\qO ~lCJ05 

Pagel 

Case 1:15-cv-00380-CL Document 1 Filed 03/05/15 Page 1 of 5
' . 

Defendant No.1 

Defendant No.2 

Defendant No.3 

Defendant No.4 

Name: 

A TTOP08(_ u5N~L 

STATE OP~ 

Street Address: · 

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

Telephone No. 

Name: \(.lAMATl-\ (Q\_)0\( 

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 

OF 

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 of citizenship 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 of another 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 court jurisdiction (check all that apply) 

~ederal Question D Diversity of Citizenship 

COMPLAINT Page 2 

Revised: July 20, 20 I 0 

Case 1:15-cv-00380-CL Document 1 Filed 03/05/15 Page 2 of 5
B. If the basis for jurisdiction is Federal Question, what federal Constitutional, statutory, or 

trea~. ~~t ·ssue~? ~h - \ r . , 

~~=== ~~ k 

C. If the basis for jurisdiction is Diversity of Citizenship, what is the state of citizenship of each 

party? 

Plaintiff(s)stateofcitizenship ____________________ _ 

Defendant(s)state(s)ofcitizenship ___________________ _ 

III. STATEMENT OF CLAIMS 

Claim I 

State here as briefly as possible t~e [acts of your 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. 

4 . a:? . F5\ 

COMPLAINT Page 3 

Revised: July 20, 20 I 0 

Case 1:15-cv-00380-CL Document 1 Filed 03/05/15 Page 3 of 5
' ' 

Claim II 

State here as briefly as possible the [acts of your 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 of your 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. 

(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 1:15-cv-00380-CL Document 1 Filed 03/05/15 Page 4 of 5
.. 

IV. RELIEF 

R~ lCQ5 

3, .·<E:L)FQR£6 51ACKl00\ A31ftkJ9 

5 I FZS<'(' K?tet5tbt 5\ CG:S 

co, ec F?~ t\ ve CY-><V l4P\f3:3 ( 

I declare under penalty of perjury that the foregoing is true and correct. 

Signed this L day of ~ , 20 (L_::, 

~ODlS MCEN 

(Signature of Plaintifli ~ 

COMPLAINT 

Revised: July 20, 20 I 0 

Page 5 

Case 1:15-cv-00380-CL Document 1 Filed 03/05/15 Page 5 of 5