lJNITED STATES DISTRICT COURT 

DISTRICT OF OREGON 

PORTLAND DIVISION 

I Civil Case No. 

(to be assigned by C erk of the Court) 

(Enter full name of plaintiff(s)) 

Plaintiff(s), 

v. 

Kt.AHAJll t:IJM7Y ANIMAL t!o/1/r££ 

/<LA!-1A17J lltuiM~F U'a&cry 

(Enter full name of ALL defendant(s)) 

CJ7Y of= !<'LAI-1 A-r)l' FALL tP fJdLIM JJ,dr. 

Defendant(s). 

I. PARTIES 

. COMPLAINT 

Jury Trial Demanded 

[ZYes 0No 

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 Name: EE£NAI(Do HoLALGJ> .f£. 

I 

Street Address: .. 5"74.5 c.JLUIII!i£S LA;Jb' 

City, State & Zip Code: ~ k'LAt1Ar;l GLL.S I oe 9'lto.3 j 

Telephone No. (5~1)591-StA58 

COMPLAINT Page I 

Revised: July 20, 20 I 0 

Case 1:16-cv-00013-MC Document 1 Filed 01/05/16 Page 1 of 5
Defendant No. 1 

Defendant No. 2 

Defendant No. 3 

Defendant No. 4 

Name: J't(}A{j G}.L£ M~ HAHz:}f( 

Street Address: J./33() WASH~ W'AY 

City, State & Zip Code: KLA H A1U f't. LL.:!:J 1 0 g q76c:8 

TelephoneNo. {p4Q 8'6~ - Ja.7'1 

Name: f<LAHA111 CiJUti1Y ANI HAL CoN/((f)L 

Street Address: Y l£:lo WA~H 5u..f.N WAY 

City, State & Zip Code: HLA M A:r1d fAL.L.S 1 Df?.. qry(o{J3 

Telephone No. (?iy 8B~- J:J.7'/ . 

Name: KLAMA1'tl t\U!iAN'~ SOCd 0Y 

StreetAddress: 'fJt.j-0 WASt/&LFCN WAY 

City, State & Zip Code: HJA MA171 (,AU6 I ot... q1&D3 

Telephone No. ~{,.-=SZI=--,1).__ _________ _ 

Name: GI1Y c£ J.(l.AHA.IH fALLS POLicE qJ6P/. 

StreetAddress: ~5lJI S'H~A WAY 

City, State & Zip Code: KLAt'l A11.f rALL-s, or< 91~/)j 

Telephone No. (5'-11) 88 cf-73fl7 

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. \Vhat is the basis for federal court jurisdiction (check all that apply) 

~Federal Question 0 Diversity of Citizenship 

COMPLAINT Page 2 

Revised: July 20, 2010 

Case 1:16-cv-00013-MC Document 1 Filed 01/05/16 Page 2 of 5
. : 

B. If the basis for jurisdiciion is F eC.eral Question, \vhat federal Constitutional, statutory, or 

treaty right is at issue') 

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

party? 

Plaimiff(s) state of citizenship -------------------------------------

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

III. STATEMENT OF CLAIMS 

Claim I 

State here as b;·iefZy as possible rhe (acts of your case. Describe hm-v each defendant >vas 

involved, when the conducr occu_:-Fed, and any injuries you have suffered as a result. It is nor 

necessary to give a:1.y Zegc.l arg-1/..ments or eire any cases or statutes. 

M/IHA L. t:tJ/1/rRbL, 11LAHAn-l Ht.J.HAf\1£ .9o&eTY A!-IO J7.IC &·1Y 

k'LAI'-IA1JI FAL.LJ rf>tJt.i t!.G ~-Pr. ~IOBJ t:J/..l£ h4/'t!LY 1-/oH& 

CO::VJ:PLA.I:-:T 

Revised: July 20,20:0 

Page 3 

Case 1:16-cv-00013-MC Document 1 Filed 01/05/16 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 

Revised: July 20, 2010 

Page 4 

Case 1:16-cv-00013-MC Document 1 Filed 01/05/16 Page 4 of 5
_,;6• • \ \_ I 

IV. RELIEF 

( 

State brieflv exactly what you want the court to do for you and the amou'nt, if any, of 

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

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

' . . r'1' 

Signed this. ':-/~day of ~If./() U lfiV 

I 

, 2o_L¢.. 

t:~r&Jo~~~ (Signature of Plaintiff(s)) 

COMPLAINT Page 5 

Revised: July 20, 2010 

Case 1:16-cv-00013-MC Document 1 Filed 01/05/16 Page 5 of 5