Jacobs v. Robeson County Public Library, et al

Filing 1

MOTION for Leave to Proceed in forma pauperis filed by Sherryl Lynn Jacobs. (Attachments: # 1 Proposed Complaint, # 2 Equal Employment Opportunity Commission Forms, # 3 Proposed Summonses, # 4 Proposed Waivers, # 5 Civil Cover Sheet) (Grady, B.)

CIVIL COVER SHEET

JS 44 (Rev. 09/J I)

The JS 44 civil cover sheet and the information contained herein neither replace nor supplement the filing and service ofpleadings or other papers as required by law, except as provided
by local rules of court. This form, approved by the Judicial Conference ofthe United States in September 1974, is requtred for the use of the Clerk ofCourt for the purpose of mitiating
the civil docket sheet. (SEE INSTRUCTIONS ON NEXT PAGE OF THIS FORM)

I. (a) PLAINTIFFS

DEFENDANTS

SHERRYLLYNNJACOBS

(b)

ROBERT FISHER, ROBESON COUNTY, ROBESON COUNTY
PUBLIC LIBRARY, AND THE BOARD OF DIRECTORS FOR THE
ROBESON COUNTY PUBLIC L1BRARY-2007 thru 2009
County of Residence of First Listed Defendant
R06ESQJl/J;.OUNI'L_

BOBESONCQUNlY_

County of Residence of First Listed Plaintiff

(EXCEPT IN U.s. PLAINTIFF CASES)

(IN U.S. PLAINTIFF CASES ONLY)

IN LAND CONDEMNAnON CASES, USE 1lffi LOCAnON Of
THE TRAer Of LAND INVOLVED.

NOTE:

(c)

Attorneys (IfKnown)

Attorneys (Firm Name, Address. and Telephone Number)

SHERRYL LYNN JACOBS (PROSE)

II. BASIS OF JURISDICTION

o

IX 1 U.S. Government

III. CITIZENSmp OF PRINCIPAL PARTIES (place an ..X" in One HOIfor Plaintiff)

(place an "X" in One Box Only)

and One HOI for Defendant)

(For Diversity Cases Only)

o

o

2 U.S. Government
Defendant

IV NATURE OF SUIT
r-oONTtUCT

I

4

Slander
& Enforcement of Judgment
o 151 Medicare Act
CJ 330 federal Employers'
o 152 Recovery of Defaulted

Liability
Student Loans

o 340 Marine
o 345 Marine Product
(Exc\. Veterans)

o 153 Recovery of Overpayment

Liability
of Veteran's Benefits

0350 Motor Vehicle
o 160 Stockholders' Suits
CI 355 Motor Vehicle
o 190 Other Contract
Product Liability
o 195 Contract Product Liability
o 360 Other Personal
Ol96Franchise

Injury
(] 362 Personal Injury Med. Ma\oractice
REAL PROPERTY
CIVIL RIGHTS
I
a 210 Land Condemnation
o 440 Other Civil Rights
o 220 Foreclosure
044\ Voting
o 230 Rent Lease & Ejectment o 442 Employment
o 240 Torts to Land
CJ 443 Housing!
o 245 Tort Product Liability
Accommodations
o 290 All Other Real Property 111445 Amer. wlDisabilities ­
Employment
CJ 446 Amer. wlDisabilities •
Other
o 448 Education

~I

Original

Q!I:

1

Q( I

Incorporated or Principal Place
of Business In This State

0

4

0 4

Citizen of Another State

o

2

0

2

Incorporated and Principal Place
of Business In Another State

o

5

0

5

o

3

0

3

Foreign Nation

o

6

0

6

(pIace an ..X" in 0 ne HOI Onl
'Iy)
TORTS

o 110 Insurance
PERSONAL INJURY
o 310 Airplane
o 120Marine
o 130 Miller Act
o 315 Airplane Product
Liability
o J40 Negotiable Instrument
o 150 Recovery of Ovetpayment o 320 Assault, Libel &

v. ORIGIN

Citizen of This State

Diversity
(Indicate Citizenship ofParties in Item 1lI)

DEF

Citizen or Subject of a
Foreil!D Country

Plaintiff

PTF

3 Federal Question
(US. Government Not a Party)

PRISONER PETITIONS
o 510 Motions to Vacate
Sentence

o
o
o
o
o
o

o
o

o
o

625 Drug Related Seizure
of Property 21 USC 881
690 Other

KlbHTS

CJ 820 Copyrights
o 830 Patent
o 840 Trademark
.4ROR
o 710 Fair Labor StandanIs
Act
o 720 LaborlMgmt. Relations
o 740 Railway Labor Act
o 751 Family and Medical
Leave Act
o 790 Other Labor Litigation
(] 791 Empl. ReL Inc.
Security Act

o
o
o
o
o

o
o
o
o
o
o
o
o
o

86) IDA ( 1395ff)
862 Black Lung (923)
863 DIWCIDIWW (405(g))
864 ssm Title XVI
865 RSI (405(g))

FEDERAL TAX SUITS
CJ 870 Taxes (U.S. Plaintiff
or Defendant)
o 871 lRS-Third Party
26 USC 7609

Habeas COrpU8:
530 General
535 Death Penalty
540 MandamllS & Other
550 Civil Rigbts
555 Prison Condition
560 Civil Detainee ­
Conditions of
Confinement

422 Appeal 28 USC 158
423 Withdrawal
28 USC 157

DEF

OTJfF.R ST4 TIlTIi'_'l

BANKRUPTC'V

EN4! TV

PERSONAL INJURY
o 365 Personal Injury ­
Product Liability
0 367 Health Carel
Pbarmaceutical
Persona.l Injury
Product Liability
o 368 Asbestos Personal
Injury Product
Liability
PERSONALPROPERTV
o 370 Other Fraud
o 371 Trutb in Lending
CJ 380 Other Personal
Property Damage
0 385 Property Damage
Product Liability

PTF

CJ
CJ

o

CJ

o
o
o
0

375 false Claims Act
400 State Reapportionment
410Antitrust
430 Banks and Banking
450 Commerce
460 Deportation
470 Racketeer Influenced and
Corrupt Organizations
480 Consumer Credit
490 Cable/Sat TV
850 Securities/Commodities/
Exchange
890 Other Statutory Actions
891 Agricultural Acts
893 Environmental Matters
895 freedom ofInfonnation
Act
896 Arbitration
899 Administrative Procedure
ActlReview or Appeal of
Agency Decision
950 Constitutionality of
State Statutes

IMMIGRATION

o 462 Naturalization Application
o 463 Habeas COrpllS ­
o

Alien Detainee
(Prisoner Petition)
465 Other Immigration
Actions

(Place an ..x .. in One BOI Only)

O 2 D
ncemoved fr om

Proceeding

State Court

0

3

n
n.emanded from
Appellate Court

0

4 R etnstate d or 0
.
Reopened

5 another district
Transferred from
s

0 6 M u I'di strict
.
tt

i

Litigation

Cite the U.S. Civil Statute under which you are filing (Do ROt cite jarisdidiolUli_ates anIus tliver:rity):

VI. CAUSE OF ACTION

I-:B:-n:-'e~fd~e-sc~ri:-pt1~'o-n-o~f-ca-u-se-: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ­
-

WORKPLACE DISCRIMINATION AND RETALIATORY DISCRIMINATION

o CHECK IF THIS IS A CLASS ACTION
VII. REQUESTED IN
UNDERF.R.C.P.23
COMPLAINT:
VIII. RELATED CASE(S)
(See instructions):
JUDGE
IF ANY

DEMAND S

CHECK YES only if demanded in complaint:

JURY DEMAND:

DOCKET NUMBER

DATE

0111712012
FOR OFFICE USE ONLY

RECEIPT #

AMOUNT

APPLYING IPP

JlJJXIl!

0 Yes

0 No

I