FILED22 JU.. '1514:20J3DC-i~p 

UNITED STATES DISTRICT COURT 

DISTRICT OF OREGON 

~ PORTLAND DIVISION 

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I ~.~ 1 &;as f\\1.- 1 3 6 '.:; r~ '] '"t:: ~H:: eQl1 ---~.,;-~'-'~ J\ 

(Enter full name of plaintiff(s)) I 

(to be assigned by Clerk of the Court) 

COMPLAINT 

HJ 111 P~tiff(•)'Cz ?--LJftR j) ~!;•I Demo~~ 

(Enter fall name of ALL defendant(s)) 

Defendant(s). 

Plaintiff 

COMPLAINT 

Revised: July 20, 20 I 0 

I. PARTIES 

Page 1 

Case 3:15-cv-01365-BR Document 2 Filed 07/22/15 Page 1 of 5
Defendant No. 1 

Defendant No. 2 

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

Telephone No. 

Defendant No. 3 

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

Telephone No. 

Defendant No. 4 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 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) 

D Federal Question D Diversity of Citizenship 

COMPLAINT Page 2 

Revised: July 20, 2010 

Case 3:15-cv-01365-BR Document 2 Filed 07/22/15 Page 2 of 5
B. 

c. 

If the basis for jurisdiction is Federal Question, wh t federal Constitutional, statutory, or 

treaty right is at issue? 

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

party? l k._ - Plaintiff(s) state of citizenship lfi e # ) ~ e '}jj 

Defendant(s) state(s) ofcitizenship~ (: =-! Y lM 

III. STATEMENT OF CLAIMS 

Claim I 

State here as briefly as possible the facts 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 

necT to give any legal ar;en~ or ~any ~es r ~d er! 

-75rj~~~~~~~T-t-7J~f6WJM~l--

---------f"=1-~~~~~f 

Case 3:15-cv-01365-BR Document 2 Filed 07/22/15 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. 

' r 

Claim III 

State here as briefly as possible the facts 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 

Revised: July 20, 20 l 0 

Page 4 

Case 3:15-cv-01365-BR Document 2 Filed 07/22/15 Page 4 of 5
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IV. RELIEF 

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

COMPLAINT 

Revised: July 20, 20 l 0 

Page 5 

Case 3:15-cv-01365-BR Document 2 Filed 07/22/15 Page 5 of 5