JOHN v. WHOLE FOODS MARKET et al, No. 2:2013cv00144 - Document 4 (D. Me. 2013)

Court Description: ORDER VACATING RECOMMENDED DECISION AND ORDER TO COMPLY WITH FEDERAL RULES OF CIVIL PROCEDURE re: 3 Report and Recommendations. By MAGISTRATE JUDGE MARGARET J. KRAVCHUK. (Attachments: # 1 Complaint Sample Form) (dfr)

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IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MAINE PRO SE CIVIL COMPLAINT Case No. (the court will assign a number) I. CASE CAPTION: Parties to this Civil Action: Pursuant to Fed. R. Civ. P. 10(a), the names of all parties must appear in the case caption. The court will not consider a claim against any defendant who is not listed in the caption. 1. Plaintiff(s) Name(s): 2. Address(es): Defendant(s) Name(s): Telephone No. (only if you are NOT a prisoner) Address(es) If known: 1 (Attach extra sheets if necessary.) II. STATEMENT OF CLAIM(S) State briefly the facts of your claim. Describe how each defendant is involved. You do not need to give legal arguments or cite cases or statutes. Use as much space as you need to state the facts. (Attach extra sheets if necessary.) 1. When did the events occur? 2. What happened? 2 II. STATEMENT OF CLAIM(S) (continued) 3 III. STATEMENT OF JURISDICTION Check any of the following that apply to this case (you may check more than one): United States or a federal official or agency is a party Claim arises under the Constitution, laws or treaties of the United States Violation of civil rights Employment discrimination Diversity of Citizenship (a matter between citizens of different states in which the amount in controversy exceeds $75,000) Other basis for jurisdiction in federal court (explain below) IV. STATEMENT OF VENUE State briefly the connection between this case and Maine. For example, does a party reside or do business in Maine? Is a party incorporated in Maine? Did an injury occur in Maine? Did the claim arise in Maine? 4 V. RELIEF State briefly what you want the court to do for you. VI. EXHAUSTION OF ADMINISTRATIVE PROCEDURES Some claims, but not all, require exhaustion of administrative procedures. Answer the questions below to the best of your ability. 1. Have the claims which you make in this civil action been presented through any type of administrative procedure within any state or federal government agency? Yes No 2. If you answered yes, state the date your claims were so presented, how they were presented, and the result of that procedure: 3. If you answered no, give the reasons, if applicable, why the claims made in this action have not been presented through administrative procedures: 5 VII. ARE YOU REQUESTING TRIAL BY A JURY OR BY A JUDGE? (check one): JURY JUDGE VIII. VERIFICATION I (we) declare under penalty of perjury that the foregoing is true and correct. Date(s) Executed: Signature(s) of Plaintiff(s): Note: IF YOU CANNOT AFFORD TO PAY THE COURT S FILING FEE UPON THE FILING OF YOUR COMPLAINT, THERE IS A SEPARATE FORM TO BE USED FOR APPLYING TO PROCEED IN FORMA PAUPERIS. Also, if there is more than one plaintiff in the case who wishes to proceed in forma pauperis, each such plaintiff must submit a separate application to proceed in forma pauperis. 6

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