IN THE Xth U.S.

DISTRICT COURT

STATE OF STATE

First Middle Last :

:
:
PLAINTIFF :
: CIVIL ACTION
vs. :
: FILE NO.
:
CLERK NAME :
:
:
Defendant :

COMPLAINT FOR DAMAGES

COMES NOW First Middle Last, Plaintiff herein, and files this Complaint showing to this

Court as follows:

1.
Defendant, COURT CLERK NAME, et al., is a public official operating under oath at the

Office of COURT NAME at 1234 ADDRESS ST., CITY, ST 54321, and may be served at that

address, thereby subjecting the Defendant to the jurisdiction of this Court.

2.

On Date of Filing Attempt, Plaintiff attempted to file a Document Name and Power of

Attorney in Fact with said Clerk of Court.

3.

At said time and place alleged herein, the Defendant refused to file or record the Document

Name without just cause for refusal since the Defendant’s occupation is custodial in nature. Further,

Defendant refused to return the funds for filing.

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 4.

Plaintiff attempted to reason with Defendant by phone and otherwise, including a Notice to

the Clerk including citations of multiple Federal statutes, but the Defendant claimed the filing was

fraudulent without the prior ruling of a Magistrate.

5.

During the alleged course of events, Plaintiff alleges that there is proof beyond a reasonable

doubt that Defendant is in violation of several Federal statutes, including 5.(d)(4) of the Federal

Rules of Civil Procedure, 18 USC § 2071, and Statutes at Large Sections 5403, 5407, and 5408. Any

and all violations of these statutes constitute crimes against justice and is punishable by removal from

Office, the loss of one’s bond, fines, and imprisonment.

6.

Plaintiff alleges that the actions of the Defendant was an attempt to administer the Estate of

the Plaintiff and has, thereby, caused the Plaintiff to suffer an Executor De Son Tort without just

cause.

7.

Plaintiff also shows that as a result of said events, he / she is entitled to recover from

Defendants the following:

A) Refund of the filing costs.

B) Damages in the amount of $5,000 denoted in fine silver.

C) For these damages the full sum of $5,000, or such other sum

as a jury may determine reasonable compensation upon hearing the facts in

this case.

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 WHEREFORE, Plaintiff demands judgment of Defendant, in the sum of $5,000.00, or such

other sum as a jury may determine reasonable compensation upon hearing the facts of this case:

(A) That a trial by jury be held as to all issues in this case;

(B) That this Court grant such other and further relief as

may be just and proper.

RESPECTFULLY SUBMITTED this _____ day of Month, 2019.

____________________________________
First Middle Last, Pro Se’

First Middle Last, Attorney in Fact

1234 Your Address St.
City, State Republic
non-domestic, without the UNITED STATES