Pro Se 5
Complaint for a Civil Case Alleging Negligence
Pro Se 5, Complaint for a Civil Case Alleging Negligence, is a pleading form from the U.S. Courts for a civil case in a United States district court. Its heading cites 28 U.S.C. § 1332 and diversity of citizenship. It is one of the Civil Pro Se Forms, which the U.S. Courts page says are limited to types of cases often filed in federal courts by people who represent themselves or who may not have much experience in federal courts.
The 5-page form asks for the parties, how the diversity of citizenship requirements are met, a statement of the date, place and acts or failures to act alleged to be negligent and how they caused the plaintiff's injuries, the relief requested, and a signed certification under Federal Rule of Civil Procedure 11. The page notes that no form provides legal advice or substitutes for having or consulting a lawyer, and that a court may require more or less information than a form asks for.
The U.S. Courts offers it as a PDF and a Word file, effective on December 1, 2016. This page explains the form in plain words and is not legal advice. You can fill it out free in your browser on this page and download the result without an account.
The district and division, the full name of each plaintiff and defendant, a yes or no choice for a jury trial, and a case number left for the Clerk's Office. Names that do not fit go on an attached page, with "see attached" written in the space.
Name, address, phone and email for each plaintiff, and for each defendant, whether an individual, government agency, organization or corporation, with an individual's job or title if known. There is room for four defendants.
Diversity of citizenship under 28 U.S.C. § 1332: each plaintiff's and defendant's State or nation of citizenship, or place of incorporation and principal place of business, and an explanation of why the amount in controversy is more than $75,000.
The date and place, and the acts the defendants performed that a person of ordinary prudence would not have done, or failed to perform that such a person would have done, and why they were negligent. It then asks how the acts or omissions caused or contributed to the plaintiff's injuries.
The damages or other relief asked for, any basis for saying the wrongs are continuing, the amounts of actual damages and their basis, and any punitive or exemplary damages with amounts and reasons.
A certification under Federal Rule of Civil Procedure 11, then the date, signature and printed name of the plaintiff, or the attorney's details.
The U.S. Courts page says no form provides legal advice, a court may require more or less than a form asks, and to consult the rules and caselaw that govern in the court where you file.
Enter the district, division and the full names of the parties, choose yes or no for a jury trial, and leave the case number for the Clerk's Office.
Section II asks how the diversity of citizenship requirements have been met, with an extra page for each additional plaintiff or defendant.
The form asks for short and plain statements, without legal arguments, in sections III and IV, including the date and place of the events. Attach pages if needed.
The page cites Federal Rule of Civil Procedure 5.2: a filing may show only the last four digits of a Social Security, taxpayer or financial account number, the year of birth, and a minor's initials.
Sign under the Rule 11 certification and print your name. Parties without an attorney also agree to keep their address current with the Clerk's Office.
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
The form is captioned for a United States District Court, district and division. The page says to consult the rules and caselaw that govern in the court where the pleading is filed.
The form and its page do not print a filing fee.
The page says the forms give no guidance on when pleadings, claims or defenses have to be raised or who has to be sued, and that some have to be raised within a certain period of time.
The page says that if you are not a lawyer and are suing or have been sued, it is best to have or consult a lawyer if possible.
The U.S. Courts page offers Pro Se 5 as a PDF and as a Word document.
Pro Se 1
76 fields, 5 pages
Pro Se 4
77 fields, 5 pages
Pro Se 6
95 fields, 6 pages
Pro Se 2
77 fields, 6 pages
Pro Se 3
65 fields, 7 pages
AO 440
34 fields, 2 pages
The plaintiff, or the plaintiff's attorney, fills out and signs Pro Se 5, and the Clerk's Office fills in the case number. The page describes the Civil Pro Se Forms as examples for people who represent themselves or have little experience in federal courts.
No tool matches that search.
No. The U.S. Courts page says no form provides legal advice or substitutes for having or consulting a lawyer, and that following a form does not guarantee a pleading is legally or factually correct or sufficient.
Its heading cites 28 U.S.C. § 1332 and diversity of citizenship. Section II says federal courts may hear cases in which a citizen of one State sues a citizen of another State or nation and the amount at stake is more than $75,000, and asks how these requirements have been met.
Section III states that the defendants performed acts that a person of ordinary prudence in the same or similar circumstances would not have done, or failed to perform acts that a person of ordinary prudence would have done, and asks for a description of those acts and why they were negligent.
The form says the case number is filled in by the Clerk's Office.
The page cites Federal Rule of Civil Procedure 5.2: filings should not contain anyone's full Social Security number or full birth date, the name of a person known to be a minor, or a complete financial account number.
No. The page says the forms give no guidance on timing, that some pleadings, claims or defenses have to be raised within a certain period of time, and that the Federal Rules of Civil Procedure are available free at www.uscourts.gov.
