Cochran v. Wichita, Kansas, City of et al

Filing 7

ORDER. Plaintiff must file an amended complaint no later than October 25, 2017. See Order for details. Signed by Magistrate Judge Gwynne E. Birzer on 8/23/17. (Attachments: # 1 Exhibit Civil Complaint form)(sj)

Reset Form
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF KANSAS
______________________________________ )
)
______________________________________ )
)
______________________________________ )
(Enter above the full name of the Plaintiff(s)
)
)
vs.
)
)
______________________________________ )
Name
)
______________________________________ )
Street and number
)
______________________________________ )
City
State
ZipCode )

Case Number__________________

(Enter above the full name and address of the
Defendant in this action - list the name and
address of any additional defendants on the back
side of this sheet).
CIVIL COMPLAINT
I.

Parties to this civil action:
(In item A below, place your name in the first blank and place your present address in the
second blank. Do the same for additional plaintiffs, if any, on the back side of this sheet).
A.

Name of plaintiff___________________________________________________
Address___________________________________________________________
__________________________________________________________________
__________________________________________________________________

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(In item B below, write the full name of the defendant in the first blank. In the second
blank, write the official position of the defendant. Use item C for the names and positions
of any additional defendants).
B.

Defendant________________________________________________________is
employed at _______________________________________________________
__________________________________________________________________

C.

Additional Defendants_______________________________________________
__________________________________________________________________
__________________________________________________________________

II.

Jurisdiction:
(Complete one or more of the following subparagraphs, A., B.1, B.2., or B.3., whichever is
applicable.)
A. (If Applicable) Diversity of citizenship and amount:
1.

Plaintiff is a citizen of the State of ___________________.

2.

The first-named defendant above is either
a. a citizen of the State of ____________________; or
b. a corporation incorporated under the laws of the State of
__________________ and having its principal place of business
in a State other than the State of which plaintiff is a citizen.

3. The second-named defendant above is either
a.

a citizen of the State of __________________; or

b.

a corporation incorporated under the laws of the State of

______________ and having its principal place of business in a
State other than the State of which plaintiff is a citizen.
(If there are more than two defendants, set forth the foregoing information for each
additional defendant on a separate page and attach it to this complaint.)
Plaintiff states that the matter in controversy exceeds, exclusive of interest and
costs, the sum of seventy-five thousand dollars ($75,000.00).

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B.
(If applicable) Jurisdiction founded on grounds other than diversity
(Check any of the following which apply to this case).

_____ 1.

This case arises under the following section of the Constitution of
the United States or statute of the United States (28 U.S.C. '1331):
Constitution, Article_____, Section_____;
Statute, US Code, Title_____, Section_____.

_____ 2.

This case arises because of violation of the civil or equal rights,
privileges, or immunities accorded to citizens of, or persons within
the jurisdiction of, the United States (28 U.S.C. '1343).

_____ 3.

Other grounds (specify and state any statute which gives rise to such
grounds):
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________

III.

Statement of Claim:

(State here a short and plain statement of the claim showing that plaintiff is entitled to
relief. State what each defendant did that violated the right(s) of the plaintiff, including
dates and places of such conduct by the defendant(s). Do not set forth legal arguments.
If you intend to allege more than one claim, number and set forth each claim in a separate
paragraph. Attach an additional sheet, if necessary, to set forth a short and plain statement
of the claim[s].)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
IV.

Relief:

(State briefly exactly what judgement or relief you want from the Court. Do not make
legal arguments.)
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________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
V.
Do you claim the wrongs alleged in your complaint are continuing to occur at the
present time? Yes [ ] No [ ]
VI.

Do you claim actual damages for the acts alleged in your complaint?
Yes [ ]
No [ ]

VII.

Do you claim punitive monetary damages? Yes [ ]

No [ ]

If you answered yes, state the amounts claimed and the reasons you claim you are entitled
to recover money damages.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

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VIII.

Administrative Procedures:
A.
Have the claims which you make in this civil action been presented through
any type of Administrative Procedure within any government agency?
Yes [ ] No [ ]
B.
If you answered yes, give the date your claims were presented,
how they were presented, and the result of that procedure:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
C.
If you answered no, give the reasons, if any, why the claims made in this
action have not been presented through Administrative Procedures:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

IX.

Related Litigation:
Please mark the statement that pertains to this case:
______

This cause, or a substantially equivalent complaint, was previously filed in
this court as case number _______________ and assigned to the Honorable
Judge ____________________________.

______

Neither this cause, nor a substantially equivalent complaint, previously has
been filed in this court, and therefore this case may be opened as an original
proceeding.
___________________________________
Signature of Plaintiff
___________________________________
Name (Print or Type)
___________________________________
Address

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___________________________________
City
State
Zip Code
___________________________________
Telephone Number

DESIGNATION OF PLACE OF TRIAL
Plaintiff designates { [ ]Wichita, [ ]Kansas City , or [ ]Topeka} , Kansas as the
(Select One)
location for the trial in this matter.
_______________________________
Signature of Plaintiff

REQUEST FOR TRIAL BY JURY
Plaintiff requests trial by jury { [ ]Yes or [ ]No }
(Select One)

________________________________
Signature of Plaintiff
Dated: __________
(Rev. 10/15)

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