Pro Se 6

Complaint for a Civil Case Alleging that the Defendant Owes the Plaintiff a Sum of Money

Agency
U.S. Courts
Revision
Rev. 12/16
Fillable fields
95
Pages
6
Official source
U.S. Courts form page
Checked
October 20, 2026
Fill Pro Se 6 online
Page 1 of form Pro Se 6

Pro Se 6: Complaint Alleging that the Defendant Owes the Plaintiff a Sum of Money

Pro Se 6, Complaint for a Civil Case Alleging that the Defendant Owes the Plaintiff a Sum of Money, 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 6-page form asks for the parties, how the diversity of citizenship requirements are met, the amount the defendant owes and why, using one or more of six grounds such as a promissory note, an account between the parties or money loaned, 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.

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.

Top of page 1 of Pro Se 6: Complaint Alleging that the Defendant Owes the Plaintiff a Sum of Money, as printed by COURTS

What's on Pro Se 6

Caption and I. The Parties

The district and division, the full names of the parties, a yes or no choice for a jury trial and a case number left for the Clerk's Office. Section I asks for name, address, phone and email for each plaintiff and up to four defendants.

II. Basis for Jurisdiction

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.

III.A and III.B: Note or account

The amount the defendant owes, then a promissory note with its dates, amount, interest rate and unpaid principal and interest, or an account between the parties with the statement of account sent to the defendant. Copies are attached as exhibits or summarized.

III.C to III.F: Other grounds

Goods sold and delivered between two dates, money loaned on a date, money paid by mistake, and money had and received, where the form asks why it is unjust for the defendant not to pay the plaintiff the money received.

IV. Relief

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.

V. Certification and Closing

A certification under Federal Rule of Civil Procedure 11, then the date, signature and printed name of the plaintiff, or the attorney's details.

How to fill out Pro Se 6

  1. 1

    Read the notes on the form page

    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.

  2. 2

    Fill in the caption and parties

    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. Names that do not fit go on an attached page.

  3. 3

    Explain the basis for jurisdiction

    Section II asks how the diversity of citizenship requirements have been met, with an extra page for each additional plaintiff or defendant.

  4. 4

    State the amount and the grounds

    Section III asks for the amount owed and one or more of grounds A to F, as appropriate. The form asks to attach the note or the bills or account statements, or to summarize what they say.

  5. 5

    Leave out private details

    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.

  6. 6

    Sign and date

    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.

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Court, timing and help

Court

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.

Fees

The form and its page do not print a filing fee.

Timing

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.

A lawyer

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.

Formats

The U.S. Courts page offers Pro Se 6 as a PDF and as a Word document.

Who uses Pro Se 6?

  • People representing themselves

    Section V.A is for parties without an attorney. They agree to tell the Clerk's Office about any address change, and the form says a missing current address may result in dismissal of the case.

  • Individual plaintiffs

    Section II.A.1 asks for the State of which an individual plaintiff is a citizen. The form says that in a diversity of citizenship case, no defendant may be a citizen of the same State as any plaintiff.

  • Corporate plaintiffs

    Section II.A.2 asks for the State under whose laws a corporate plaintiff is incorporated and the State of its principal place of business. Section III.B gives the example of an agreement between a credit-card company and a credit-card holder.

  • Attorneys

    Section V.B has a signature block for an attorney, with bar number, law firm, address, phone and email.

The plaintiff, or the plaintiff's attorney, fills out and signs Pro Se 6, 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.

Official sources and the blank

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Questions about Form Pro Se 6

Is Pro Se 6 legal advice?

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.

Which grounds does Pro Se 6 list for the money owed?

Section III lists six: on a promissory note, on an account between the parties, for goods sold and delivered, for money loaned, for money paid by mistake, and for money had and received. The form says to use one or more of them, as appropriate.

Are the note or account statements attached?

The form says a copy of the note is attached as an exhibit or summarized, and that copies of the bills or account statements are attached as exhibits or summarized.

What does the $75,000 on the form refer to?

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. Section II.C asks the plaintiff to explain the amount in controversy, not counting interest and costs of court.

Who fills in the case number?

The form says the case number is filled in by the Clerk's Office.

What personal details does a complaint leave out?

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.

Does Pro Se 6 say when to file?

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.