I am asking for assistance in filling out this form since I have been researching for days and cannot find a way to fill it out without leaving any blanks as per the instructions... This is what I need to do...

Go to the https://www.uscourts.gov/forms/pro-se-forms/complaint-civil-case section of the https://www.uscourts.gov/ and do the following:

• Note at the top of the page it gives you the ability to Download Form in either a .PDF or .DOCX format. Select the .DOCX link and download it.
• Complete the form using the information and the directions provided in the Case Data Document Section.
• Once completed, save the Complaint for a Civil Case form using the naming convention described below.
• Upload the completed form.

Abe Chevy, a resident of South Florida, drove onto I-95, heading north to visit his mother in Atlanta. After crossing over to I75N heading toward Atlanta around 7:45 PM, he passed a sign that read, "Macon 25 miles" and realize he had been driving seven hours. At that very instant, he started to think about breakfast for some reason and thought, "maybe I am getting a little tired." Dismissing the thought, he looked down the road and was happy to see that traffic was very light. Unexpectedly, looking up, he saw a blinding bright light shining in his rearview mirror. Before he could react, a fourteen wheeler slammed into the back of his Lincoln SUV, causing property damage and personal injuries. The driver of the truck worked for a company registered in Georgia at 1010 Trucking Lane, Atlanta, GA. Abe was placed in an ambulance and taken to the hospital, sustaining what looked like a life-threatening injury. He underwent five hours of surgery to remove his spleen. He also suffered a broken arm and leg and dislocated his C1 C2 vertebra. The bill for Abe's injuries amounted to more than $350,000, and property damage was an additional $80,000. After spending two weeks in the hospital, Abe returned to his house at Zero landlock, Boca Raton, Florida. Abe consulted his attorney to determine what he should do. Abe told his attorney that he wants to file a lawsuit against the Georgia State Trucking Company, the driver Speedy Gonesailing, and owner, Gotdem Bigbucks, in the Florida District Court rather than in the District Court in Georgia. Abe's attorney Dowe Cheathim stated that he would first have to gather some information and research the law to see if that was possible. Dowe asked Abe to provide the following details to preserve evidence for trial and preparation of making a legal claim, or insurance demand: