REQUEST FOR CIVIL COMPLAINT FORMS
THE FOLLOWING INFORMATION WILL BE NEEDED IN ORDER TO SUPPLY ANY
FORMS TO THE REQUESTOR.
THE FORM MUST BE COMPLETED TO ASSURE THE CORRECT NUMBER OF FORMS
TO BE RETURNED TO THE REQUESTOR.
___ I HEREBY REQUEST AN APPLICATION TO FILE WITHOUT PREPAYMENT OF
FEES. IF APPROVED FOR INCARCERATED PLAINTIFFS, A SCHEDULE FOR
PAYMENT OF THE $350.00 FILING FEE WILL BE SET BY THE COURT.
___ THE NUMBER OF DEFENDANTS I WISH TO LIST IN MY COMPLAINT.
PLAINTIFF: PRISONER #: __________________
NAMES: _____________________________________________________________________
ADRESS: ____________________________________________________________________
ADDITIONAL PLAINTIFF(S): (NAME AND ADDRESSES REQUIRED) (USE ADDITIONAL SHEET IF NEEDED)
______________________________________________________________________________
______________________________________________________________________________
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DEFENDANT(S): (USE ADDITIONAL SHEET IF NEEDED)
NAME: ______________________________________________________________________
ADDRESS: ___________________________________________________________________
NAME: ______________________________________________________________________
ADDRESS: ___________________________________________________________________
NAME: ______________________________________________________________________
ADDRESS: ___________________________________________________________________
NAME: ______________________________________________________________________
ADDRESS: ___________________________________________________________________
NAME: ______________________________________________________________________
ADDRESS: ___________________________________________________________________