cuERx'

sOFFIEp.s.DIsT.cour
ATuyxcFsuRq vA
FILED
SEP 18 2217
INTHEUNITEDSTATESDISTRICTCOURT
FOR THE W ESTERN DISTRICT OF VIRGINIA
BY:C.
JULIAD
!EP-UT
C. YCEXLER
UDL CLE
n4 lvr DIVISION
X gova Y arn gaf:m an

Plaintiffts),
civilActionNo.:& -
.17 0.MUOO Y S
(To beassignedbyClerkofDistrictCourt)
'bedrcl Tcuo:
GeH.K m :x teG ,

Defendantts).
(Enterthefullnamets)ofALLpartiesinthisIawsuit.
Pleaseattachadditionalsheetsifnecessary).

COM PLAINT

PARTIES

1. List allPlaintiffs. State the fullnam e ofthe Plaintiff,address and telephone num ber.
Do the sam e forany additionalPlaintiffs.

PlaintiffNo.1

Name: Y asora hzafn lpcgloan

-

Address: *% m Gooc b*. Focesj-rVA aAss l

Telephone Num ber: 939.t/zp.F ool -

b, PlaintiffNo.2

Nam e:

Address:

Telephone Num ber:

Case 6:17-cv-00065-NKM Document 1 Filed 09/18/17 Page 1 of 9 Pageid#: 1

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2. List allDefendants. State the fullnam e ofthe Defendant,even if that Defendant is a

governm ent agency, an organization, a corporation, or an individual. Include the
addresswhereeach Defendantmaybeserved.Makesurethatthe Defendantls)Iisted
below are identicalto those contained in the above caption ofthe com plaint.

DefendantNo.1

Name: eg c ooo4
Address: %E' q'
wna-sf.x , P&-! 1 . e 2 V'q a*&+ l
b. DefendantNo.2

Name: G.z.
+ G M ex ies
Address: II%S -wnnlu , ?o)fW k . Yecvr; V6 19&13
NOTE: IF THERE ARE ADDITIONAL PLAINTIFFS OR DEFENDANTS, PLEASE PROVIDE THEIR
NAM ES AND ADDRESSES ON A SEPARATE SHEET OF PAPER.
Checkhereifadditionalsheetsofpaperareattached: IZ
Please Iabel the attached sheets of paper to correspond to the appropriate num bered
paragraphabove (e.g.AdditionalDefendants2.c.,2.d.,etc-).
JURISDICTION

Federalcourtsare courtsofIimited jurisdiction. Generally,two typesofcasescan be heard in

federalcourt: cases involving a federalquestion and cases involving diversity ofcitizenship of
the parties. Under28 U.S.C.j 1331,a case involving the United StatesConstitution orfederal
lawsortreatiesisafederalquestion case. Under28 U.S.C.j 1332,a case in which a citizen of
onestatesuesacitizenofanotherstateandtheamountofdamagesismorethan$75,000isa
diversity ofcitizenship case. Federalcourtsalso have jursdiction overcaseswhere the United
States isa Defendant.

3. W hatisthe basisforfederalcourtjurisdiction?
FederalQuestion I
--lDiversityofcitzenship U GovernmentDefendant
4. Ifthe basisforjurisdiction is FederalQuestion,which FederalConstitution,statutory or
treaty rightisatissue? ListalIthatapply.

& - Q m-
i an4 Y,4*.cM belvq A.%

Case 6:17-cv-00065-NKM Document 1 Filed 09/18/17 Page 2 of 9 Pageid#: 2

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5. lfthe basisforjurisdiction is Di
versity ofCitizenship?whatisthe state ofcitizenship of
each party? Each Plaintiff m ust be diverse from each Defendant for di
versity
jurisdiction.
plaintiffNo 1:'
. X a- u U.bllf +u StateofCitizenship:% l-f'Y N
lnl
' plaintiffNo.2: State ofCitizenship: - -

DefendantNo,1: A r..
x nt stateofcitizenship:V iV-k4SR-
h, %. e.
DefendantNo.2: M ovuh'
e: stateofcitizenship:& 'T- kn IG
Attach additionalsheetsofpaperas necessary and Iabelthis inform ation as paragraph
.
5.Checkhereifadditionalsheetsofpaperareattached.I--I
STATEM ENT OFTHE CLAIM

Describe in the space provided below the basic facts of your claim . The description of facts
should include a specific explanation ofhow,where,and w hen each ofthe defendants nam ed
in'the caption violated the Iaw,and how you were harm ed. Do notgive any Iegalargum ents or
cite casesorstatutes. Each paragraph m ustbe num bered separately,beginning with num ber6.
Please w rite each single setofcircum stances in a separately num bered paragraph.

6. G e. wvhack-x z ooorw.NArxA.
)qu

Case 6:17-cv-00065-NKM Document 1 Filed 09/18/17 Page 3 of 9 Pageid#: 3

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5 << wcr/e.c/-..e .=c,....zJz-ez'

Case 6:17-cv-00065-NKM Document 1 Filed 09/18/17 Page 4 of 9 Pageid#: 4

Attach additional sheets of paper as necessary and Iabel them as Additional Facts and
continue to num berthe paragraphs consecutively. Check here if additionalsheets of paper
areattached.I
--I
REQ UEST FOR RELIEF

State w hatyou wantthe Courtto do foryou and the am ountofm onetary com pensaton,ifany,
you are seeking.
'
eek.
'vn lso ooo G.< Twlvr.e w h
ssefk-'srx Ah
se.
G c-.x
f-h .
-
Q$eu-hhtvx.

Tfokcqloo o. ccgcc.n'f. osL-hhqocx

Case 6:17-cv-00065-NKM Document 1 Filed 09/18/17 Page 5 of 9 Pageid#: 5

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DEM AND FORJURYTRIAL: L so

signedthis /x dayof6- # , /7 .

Signature ofPlaintiffNo.1 - ..<.

Signature ofPlaintiffNo.2

NOTE: AIIPlaintiffs nam ed in the caption ofthe com plaintm ustdate and sign the com plaint.
Attach additionalsheetsofpaperas necessary.

Case 6:17-cv-00065-NKM Document 1 Filed 09/18/17 Page 6 of 9 Pageid#: 6

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Case 6:17-cv-00065-NKM Document 1 Filed 09/18/17

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