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Question:
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Summons and Complaint:
The summons must include the party served, location, and time to respond. The complaint should contain the alleged wrong and claims for relief.
In complaint include the following: Caption, Party Names, Jurisdictional Facts, Elements of the Cause of Action (Allegations), Prayer for Relief (put allegations of negligence here, and Signatures (they can be electronic).
For statement of claim and relief you must put that on a separate document, if there is not enough room on the form.
Use information below to answer the fill in the following forms.
Parties:
- B.K., minor by her Parents and guardians, Janice Knowles and Steven Knowles, 1243 Asbury Ave., Bennington Vermont
- Ronald Clemmons, 24 Logan Street, Albany, NY
- Lower Council School District, 701 Wilkes Rd., Albany, NY
- Bud Smith and Ace Trucking, 2501 Industrial Hwy, Center Bridge, NY
Facts:
Ronald Clemmons, a 69-year-old licensed bus driver was employed by Lower Council School District.
Bud Smith was a licensed dump truck driver working for Ace Trucking.
On Oct. 21, 2017, Mr. Clemmons picked up 44 children for a field trip. B.K. was a minor on that bus.
At approximately 10:30 am, that same day,Defendant Bud Smith failed to stop at a stop sign and entered the intersection at SR-30A and SR-7 when he collided with the school bus.
As a result of the accident, B.K., a minor was injured requiring surgery and hospitalization, and other medical treatment, damages in excess of $75,000.
1.) Type in the information to the form.
2.) The summons must include the party served, location, and time to respond.
3.) The complaint should contain the alleged wrong and claims for relief, names, and addresses of the parties, damages requested, and so on see case facts above.
A0 440 (Rev. 06H 2) Summons in a Civil Action UNITED STATES DISTRICT COURT for the Civil Action No. vvvvvvvvvvvv Defndant(s) SUMMONS IN A CIVIL ACTION To: (Defendant's name and address) A lawsuit has been led against you. Within 21 days after service of this summons on you (not counting the day you received it) or 60 days if you are the United States or a United States agency, or an officer or employee of the United States described in Fed. R. Civ. P. 12 (a)(2) or (3) you must serve on the plaintiff an answer to the attached complaint or a motion under Rule 12 of the Federal Rules of Civil Procedure. The answer or motion must be served on the plaintiff'or plaintiff's attorney, whose name and address are: If you fail to respond, judgment by default will be entered against you for the relief demanded in the complaint. You also must le your answer or motion with the court. CLERK OF COURT Signature of Cierk or Deputy Clerk AO 440 (Rev. 06/12) Summons in a Civil Action (Page 2) Civil Action No. PROOF OF SERVICE (This section should not be filed with the court unless required by Fed. R. Civ. P. 4 (1)) This summons for (name of individual and title, if any) was received by me on (date) I personally served the summons on the individual at (place) on (date) ; or I left the summons at the individual's residence or usual place of abode with (name) , a person of suitable age and discretion who resides there, on (date) , and mailed a copy to the individual's last known address; or I served the summons on (name of individual) , who is designated by law to accept service of process on behalf of (name of organization) on (date) ; or I returned the summons unexecuted because ; or Other (specify): My fees are $ for travel and $ for services, for a total of $ 0.00 I declare under penalty of perjury that this information is true. Date: Server's signature Printed name and title Server's address Additional information regarding attempted service, etc:Pro Se 1 (Rev. 12/16) Complaint for a Civil Case UNITED STATES DISTRICT COURT for the District of Division Case No. (to be filled in by the Clerk's Office) Plaintiff(s) (Write the full name of each plaintiff who is filing this complaint. If the names of all the plaintiffs cannot fit in the space above, Jury Trial: (check one) Yes No please write "see attached" in the space and attach an additional page with the full list of names.) -V- Defendant(s) (Write the full name of each defendant who is being sued. If the names of all the defendants cannot fit in the space above, please write "see attached" in the space and attach an additional page with the full list of names.) COMPLAINT FOR A CIVIL CASE I. The Parties to This Complaint A. The Plaintiff(s) Provide the information below for each plaintiff named in the complaint. Attach additional pages if needed. Name Street Address City and County State and Zip Code Telephone Number E-mail Address B. The Defendant(s) Provide the information below for each defendant named in the complaint, whether the defendant is an individual, a government agency, an organization, or a corporation. For an individual defendant include the person's job or title (if known). Attach additional pages if needed Page 1 of 5Pro Se 1 (Rev. 12/16) Complaint for a Civil Case Pro Se 1 (Rev. 12/16) Complaint for a Civil Case Defendant No. 1 II. Basis for Jurisdiction Name Federal courts are courts of limited jurisdiction (limited power). Generally, only two types of cases can be Job or Title (if known) heard in federal court: cases involving a federal question and cases involving diversity of citizenship of the parties. Under 28 U.S.C. $ 1331, a case arising under the United States Constitution or federal laws or treaties Street Address is a federal question case. Under 28 U.S.C. $ 1332, a case in which a citizen of one State sues a citizen of City and County another State or nation and the amount at stake is more than $75,000 is a diversity of citizenship case. In a diversity of citizenship case, no defendant may be a citizen of the same State as any plaintiff. State and Zip Code Telephone Number What is the basis for federal court jurisdiction? (check all that apply) E-mail Address (if known) Federal question Diversity of citizenship Defendant No. 2 Fill out the paragraphs in this section that apply to this case. Name A. If the Basis for Jurisdiction Is a Federal Question Job or Title (if known) Street Address List the specific federal statutes, federal treaties, and/or provisions of the United States Constitution that are at issue in this case. City and County State and Zip Code Telephone Number E-mail Address (if known) B. If the Basis for Jurisdiction Is Diversity of Citizenship Defendant No. 3 1. The Plaintiff(s) Name a. If the plaintiff is an individual Job or Title (if known) The plaintiff, (name) is a citizen of the Street Address State of (name) City and County State and Zip Code b. If the plaintiff is a corporation Telephone Number The plaintiff, (name) , is incorporated E-mail Address (if known) under the laws of the State of (name) and has its principal place of business in the State of (name) Defendant No. 4 Name Job or Title (if known) If more than one plaintiff is named in the complaint, attach an additional page providing the same information for each additional plaintiff.) Street Address City and County 2. The Defendant(s) State and Zip Code a If the defendant is an individual Telephone Number The defendant, (name) , is a citizen of E-mail Address (if known) the State of (name) Or is a citizen of foreign nation) Page 2 of 5 Page 3 of 5Pro Se I 93cm 12/16) Complailitfor a Civil Cue III. b If the defeth is a corporation The defendant, (name) the laws of the State of (name) , and has its , is incorporated under principal place of business in the State of (name) Or is incorporated under the laws of (foreign nation) , and has its principal place of business in (name) (Ifmore than one defendant is named in the complaint. attach an additional page providing the some information for each additional defendant.) 3. The Amount in Controversy The amount in controversythe amount the plaintiff claims the defendant owes or the amount at stakeis more than $75,000, not counting interest and costs of court, because (explain): Statement of Claim Write a short and plain statement of the claim Do not make legal arguments State as briey as possible the facts showing that each plaintiff is entitled to the damages or other relief sought. State how each defendant was involved and what each defendant did that caused the plaintiff harm or violated the plaintiffs rights, including the dates and places of that involvement or conduct. If more than one claim is asserted, number each claim and write a short and plain statement of each claim in a separate paragraph. Attach additional pages if needed. Relief Stale briey and precisely what damages or other relief the plaintiff asks the court to order. Do not make legal arguments. Include any basis for claiming that the wrongs alleged are continuing at the present time, Include the amounts of any actual damages claimed for the acts alleged and the basis for these amounts. Include any punitive or exemplary damages claimed, the amounts, and the reasons you claim you are entitled to actual or punitive money damages Page 4 of 5 Pro Se I gem 11/161Cmnplaintfor ICivil Cue Certication and Closing Under Federal Rule of Civil Procedure 11, by signing below, I certify to the best of my lmowledge, information, and belief that this complaint: (1) is not being presented for an improper purpose, such as to harass, cause unnecessary delay, or needlessly increase the cost of litigation; (2) is supported by existing law or by a nonfrivolous argument for extending, modifying, or reversing existing law; (3) the factual contentions have evidentiary support or, if specically so identied, will likely have evidentiary support alter a reasonable opportunity for further investigation or discovery; and (4) the complaint otherwise complies with the requirements of Rule 11. A. For Parties Without an Attorney I agree to provide the Clerk's Ofce with any changes to my address where caserelated papers may be served. I understand that my failure to keep a current address on le with the Clerk's Ofce may result in the dismissal of my case. Date of signing: Signature of Plaintiff Printed Name of Plaintiff B. For Attorneys Date of siyiing: Signature of Attorney Printed Name of Attorney Bar Number Name of Law Firm Street Address State and Zip Code Telephone Number Email Address Page 5 of s