1:16-cv-10868-TLL-PTM Doc 1 Filed 03/10/16 Pg 1 13 Pg ID 1 · 2016-03-14 · 1:16-cv-10868-TLL-PTM Doc 1 Filed 03/10/16 Pg 2 of 13 Pg ID 2 1 1.3 Defendant's Name, Address & Phone

1:16-cv-10868-TLL-PTM Doc 1 Filed 03/10/16 Pg 1 of 13 Pg ID 1

2

3

Case: 1:16-cv-108684 Judge: Ludington, Thomas L.

MJ: Morris, Patricia T.5 Filed: 03-10-2016 At 10:16AM

CMP Avery v. Henry (krk)6

7

8

9 UNITED STATES DISTRICT COURT

10 EASTERN DISTRICT OF MICHIGAN

11 NORTHERN DIVISION

12

13 CHAD JERAMI AVERY, GBE-GIIZHIG CASE NO.:

14 PLAINTIFF, COMPLAINT FOR

15 vs. DECLARATORY AND

16 TERESA MARIE HENRY, and INJUNCTIVE RELIEF

17 THE SAGINAW CHIPPEWA

18 INDIAN TRIBE OF MICHIGAN

19 DEFENDANTS

20

21 PARTIES TO THIS COMPLAINT

22 1.1 Plaintiffs Name, Address & Phone Number:

23 CHAD JERAMI AVERY, GBE-GIIZHIG

24 1602 Fourth St,

25 Bay City, MI. 48708

26 (989) 546-7442

27 1.2 Defendant's Name, Address & Phone Number:

28 TERESA MARIE HENRY

29 1903 Lynnwood St.

30 Mt. Pleasant, MI. 48858

31 (989) 400-6133


1 1.3 Defendant's Name, Address & Phone Number:

2 SAGINAW CHIPPEWA INDIAN TRIBE OF MICHIGAN

3 7070 E. Broadway

4 Mt. Pleasant, MI 48858

5 (989) 775-4000

6

7 JURISDICTION

8 2.1 Plaintiff resides in the EASTERN DISTRICT OF MICHIGAN.

9 2.2 Defendant, TERESA MARIE HENRY, resides in the EASTERN DISTRICT

10 OF MICHIGAN.

11 2.3 Defendant, SAGINAW CHIPPEWA INDIAN TRIBE OF MICHIGAN, and its

12 reservations, are within the EASTERN DISTRICT OF MICHIGAN.

13 2.4 Plaintiff seeks Declaratory Relief under 28 USC 2201; adjudicating that the

14 SAGINAW CHIPPEWA INDIAN TRIBE OF MICHIGAN does not have Civil

15 Jurisdiction to adjudicate petitions for custody of non-tribal member children

16 born of a non-tribal member and a non-Indian, or to dissolve the marriage of

17 a non-tribal member and a non-Indian.

18 2.5 Plaintiff also seeks Injunctive Relief under 28 USC 2202, to prohibit the

19 Defendants from seeking and granting relief without such jurisdiction.

20 2.6 Whether a tribal court has adjudicative authority over a non-tribal member is

21 a federal question under 28 USC 1331.

22 2.7 Plaintiff seeks Declaratory Relief under 28 USC 2201, adjudicating that the

23 SAGINAW CHIPPEWA INDIAN TRIBE OF MICHIGAN is not the modern-day

24 successor of the treaty-based Saginaw, Swan Creek & Black River Bands of

25 the Chippewa Nation.

26 2.8 Plaintiff seeks Declaratory Relief under 28 USC 2201, adjudicating that the

27 SAGINAW CHIPPEWA INDIAN TRIBE OF MICHIGAN is an "Indian

28 Community" first recognized under the Wheeler-Howard Act or Indian

29 Reorganization Act on May 6, 1937.


31 SAGINAW CHIPPEWA INDIAN TRIBE OF MICHIGAN from further


1 misrepresenting the federal status of said tribe to obtain advantages, rights

2 and/or privileges, not pertaining to the establishment of the Isabella Indian

3 Reservation, Isabella County, Michigan or the Saganing Indian Reservation,

4 Arenac County, Michigan, that are exclusive to the treaty-based Saginaw,

5 Swan Creek & Black River Bands of the Chippewa Nation.


7 SAGINAW CHIPPEWA INDIAN TRIBE OF MICHIGAN from further using the

8 words: "Saginaw, Swan Creek, and/or Black River" in its name; Plaintiff

9 respectfully suggests the SAGINAW CHIPPEWA INDIAN TRIBE OF

10 MICHIGAN henceforth be called the Isabella Indian Community.

11 3.1 Plaintiff also seeks Injunctive Relief under 28 USC 2202, to prohibit thel12 SAGINAW CHIPPEWA INDIAN TRIBE OF MICHIGAN from further claiming

13 to be the modern-day successor of the treaty-based Saginaw, Swan Creek &

14 Black River Bands of the Chippewa Nation.

15

16 STATEMENT OF CLAIM

17 14.1 Plaintiff is an unmarried man. He is Native American; and is a descendant of

18 the treaty-based Saginaw, Swan Creek & Black River Bands of the

19 Chippewa Nation. At all times material hereto, he was not a member of the

20 SAGINAW CHIPPEWA INDIAN TRIBE OF MICHIGAN. Prior to September

21 18, 1998, Plaintiff did not reside on the Isabella Indian Reservation, Isabella

22 County, Michigan or on the Saganing Indian Reservation, Arenac County,

23 Michigan, with his wife, TERESA MARIE HENRY, and their two children; nor

24 do they now.

25 4.2 Defendant, TERESA MARIE HENRY, is an unmarried woman. She is non-

26 Indian. Prior to September 18, 1998, Defendant did not reside on the Isabella

27 Indian Reservation, Isabella County, Michigan or on the Saganing Indian

28 Reservation, Arenac County, Michigan, with her husband, CHAD JERAMI

29 AVERY, and their two children; nor do they now.

30 4.3 Plaintiff and Defendant were married on October 27, 1990 in the Village of

31 Maple Rapids, Clinton County, Michigan. They have two children: SLA


1 (D.O.B. 04/27/1991) and SLA (D.O.B. 06/28/1992). At all times material

2 hereto, neither of the parties' children were members of the SAGINAW

3 CHIPPEWA INDIAN TRIBE OF MICHIGAN.

4 4.4 The Saginaw Chippewa Community Court is created and exists by virtue of

5 Article VI, Section 1 (t) of the Constitution and Bylaws of the SAGINAW

6 CHIPPEWA INDIAN TRIBE OF MICHIGAN; and is established pursuant to

7 Chapter 1.501 of the SAGINAW CHIPPEWA INDIAN TRIBE OF MICHIGAN

8 Codes and Ordinances. Said Code provides:

9 "JURISDICTION AND AUTHORITY OF THE COURT

10 1.501 COMMUNITY COURT.

11 The Saginaw Chippewa Community Court is hereby created pursuant to

12 Article VI Section 1(t), of the Amended Tribal Constitution and pursuant to

13 the inherent and sovereign powers of the Saginaw Chippewa Indian Tribe of

14 Michigan.

15 1.501.1 SAGINAW CHIPPEWA INDIAN TRIBE OF MICHIGAN,

16 JURISDICTION DEFINITION.

17 For the purpose of enforcement of this Code, the Community Court's

18 jurisdiction shall be deemed to extend to all land within the exterior

19 boundaries of the Isabella Reservation and all land within the control of the

20 Tribe at the Saganing Indian Reservation pursuant to Article II of the

21 Amended Tribal Constitution. The jurisdiction of the Saginaw Chippewa

22 Indian Tribe of Michigan shall extend to all crimes committed within the

23 Isabella or the Saganing Indian Reservations including those crimes set forth

24 under the Major Crimes Act in 18 USC 1153, which by their very nature must

25 be transferred to U.S. District Court, Eastern District of Michigan for

26 1 disposition.

27 1.502 PERSON TO WHOM JURISDICTION EXTENDS.

28 Any Indian, who is found within the territorial jurisdiction of this Court as

29 defined in Section 1.501, or who has allegedly committed an offence defined

30 in this Code, shall be subject to the jurisdiction of this Court.

31 1.503 TRIBAL COURT JURISDICTION.


1 The Court shall have criminal jurisdiction over all offenses enumerated in

2 this Code, when committed by a person within the jurisdiction of the Saginaw

3 Chippewa Indian Tribe of Michigan.

4 3.102 JURISDICTION.

5 (a) The Community Court shall have jurisdiction over all civil

6 causes of action arising within the territorial jurisdiction of the Court as

7 described in Chapter 1.5 of Title 1 of this Code;

8 (b) The Community Court, except as it may be limited by the

9 Tribal laws or laws of the United States, shall have all inherent powers of any

10 court including, but not limited to:

11 (1) The power to make rules for the conduct of its business;

12 (2) The power to issue orders, decrees, subpoenas or writs

13 necessary to implement its decisions;

14 (3) The power to punish for contempt;

15 (4) The power to administer oaths or affirmations;

16 (5) The power to issue separation agreements;

17 (6) The power to enforce its decision by either a personal

18 command to the party or parties or by a declaration that relief is

19 granted regardless of the nature of the matter before the Court.

20 3.1709 JURISDICTION; DIVORCE; ANNULMENT

21 The Tribal Court Shall have jurisdiction over annulment, divorce, and any

22 paternity, child custody, child support, division of property, or alimony issue

23 where at least one (1) party to the marriage is a Native American, and at

24 least one (1) party has been a bona fide resident of the Isabella or Saganing

25 Indian Reservations for a period of at least 180 days prior to the filing of the

26 action.

27 3.406 SERVICE OF PROCESS UPON PERSONS OUTSIDE THE

28 TERRITORIAL JURISDICTION OF THE SAGINAW CHIPPEWA INDIAN

29 TRIBE OF MICHIGAN.

30 Any person subject to the jurisdiction of the Saginaw Chippewa

31 Community Court and doing any of the following acts:


1 (a) The transaction of any business within Tribal jurisdiction;

2 (b) The commission of any act or failure to act when required,

3 which results in a cause of action for tort arising within Tribal jurisdiction;

4 (c) The ownership, use, or possession of any property, or any

5 interest therein, situated within Tribal jurisdiction;

6 (d) Contracting to insure any person, property, or risk located within

7 this reservation at the time of contracting; or

8 (e) Entering into a contract for services to be rendered or for

9 materials to be furnished in Tribal jurisdiction' shall, in a civil action arising

10 out of or as a result of any of the above enumerated acts, be subject to

11 service of process outside the reservation with the same force and effect as

12 though service had been made within the jurisdiction of the Saginaw

13 Chippewa Indian Tribe of Michigan.

14 14.5 On or about September 18, 1998, Defendant, TERESA MARIE HENRY, filed

15 with the Saginaw Chippewa Community Court a Summons and Petition forl

16 Dissolution of her marriage to Plaintiff; based entirely upon the false

17 assertions of the Defendant, SAGINAW CHIPPEWA INDIAN TRIBE OF

18 MICHIGAN, that it is the modern-day successor of the treaty-based Saginaw,

19 Swan Creek & Black River Bands of the Chippewa Nation. At all times

20 material hereto, the Defendant, TERESA MARIE HENRY, had no knowledge

21 that would contradict said false assertions of the Defendant, SAGINAW


23 4.6 On or about September 18, 1998, the Plaintiff, acquiesced to the jurisdictional

24 authority of the Saginaw Chippewa Community Court based entirely upon

25 the false assertions of the Defendant, SAGINAW CHIPPEWA INDIAN TRIBE

26 OF MICHIGAN, that it is the modern-day successor of the treaty-based

27 Saginaw, Swan Creek & Black River Bands of the Chippewa Nation; the

28 Plaintiff being a descendant thereof, and having no knowledge at the time

29 that would contradict said false assertions, blindly believed and therefore felt

30 compelled to submit to the jurisdictional authority of the Saginaw Chippewa

31 Community Court without question. No waivers of express consent were


1 written, signed or granted by the Plaintiff and Defendant, TERESA MARIE

2 HENRY, regarding this or any other matter that would otherwise confer such

3 authority to the Defendant, SAGINAW CHIPPEWA INDIAN TRIBE OF

4 MICHIGAN.

5 4.7 At all times material hereto, neither the Defendant, TERESA MARIE HENRY,

6 nor the Plaintiff, had legal representation.

7 4.8 On or about May 5, 1998, the Saginaw Chippewa Community Court entered

8 a Final Judgment of Divorce between the Plaintiff and Defendant. Both

9 parties have subsequently married and divorced.

10 4.9 On or about January 26, 2005, Plaintiff began conducting historical research

11 at the direction of the Defendant, SAGINAW CHIPPEWA INDIAN TRIBE OF

12 MICHIGAN; this research was specific to the Saginaw, Swan Creek & Black

13 River Bands of the Chippewa Nation and the Defendant, SAGINAW


15 5.0 Plaintiff met with the Defendant, SAGINAW CHIPPEWA INDIAN TRIBE OF

16 MICHIGAN, formally on June 3, 2006, November 25, 2008, March 17, 2010,

17 and July 26, 2012, to discuss the result of research; which contradicted the

18 aforementioned false assertions made by the Defendant, SAGINAW

19 CHIPPEWA INDIAN TRIBE OF MICHIGAN regarding its political history.

20 Plaintiff had also met innumerable times with individual members of the

21 Tribal Council for the Defendant, SAGINAW CHIPPEWA INDIAN TRIBE OF

22 MICHIGAN, during that time to discuss the same issue.

23 5.1 No action was taken on the part of the Defendant, SAGINAW CHIPPEWA

24 INDIAN TRIBE OF MICHIGAN, to correct the aforementioned false

25 assertions pertaining to its political history following these meetings.

26 5.2 Beginning on September 7, 2006, Plaintiff began working professionally to

27 assist descendants of the Saginaw, Swan Creek & Black River Bands of the

28 Chippewa Nation, who were involved in enrollment and disenrollment

29 actions, in opposition to the Defendant, SAGINAW CHIPPEWA INDIAN

30 TRIBE OF MICHIGAN.

31


1 5.3 Between March 9, 2010 and July 26, 2012, Plaintiff became increasingly

2 more involved in disproving the aforementioned false assertions made by the

3 Defendant, SAGINAW CHIPPEWA INDIAN TRIBE OF MICHIGAN,

4 concerning its political history; meeting with various officials of Isabella

5 County in the hopes preventing any further unlawful fee-to-trust acquisitions.

6 5.4 Between September 7, 2006 and May 1, 2015, Plaintiff and Defendant,

7 SAGINAW CHIPPEWA INDIAN TRIBE OF MICHIGAN, became increasingly

8 more adversarial in position.

9 5.5 Plaintiff moved to Bay City, Bay County, Michigan on or about May 1, 2015

10 due to a recent escalation of harassment by Defendant, SAGINAW

11 CHIPPEWA INDIAN TRIBE OF MICHIGAN, and its membership.

12 5.6 On or about August 8, 2015, the Saginaw Chippewa Community Court issued

13 the Plaintiff a Notice To Appear for a Show Cause Hearing scheduled for

14 Friday, September 11, 2015; which was subsequently rescheduled for

15 Friday, October 9, 2015. No order was entered that day.

16 5.7 On or about October 21, 2015, the Saginaw Chippewa Community Court

17 found, "Mt the time of filing this case the Tribal Court had jurisdiction over

18 the matter" and then ordered, "plat the Saginaw Chippewa Tribal Court is

19 the correct jurisdiction for this matter and it is a valid court order."

20 5.8 For all the aforementioned reasons, the Plaintiff must object to the

21 jurisdictional authority of the Saginaw Chippewa Community Court, based on

22 knowledge of the Defendant's, SAGINAW CHIPPEWA INDIAN TRIBE OF

23 MICHIGAN, true status as a Wheeler-Howard or Indian Reorganization Act

24 created tribal entity, which was first recognized on May 6, 1937 as "a group

25 of Indians residing on a reservation" and not as the treaty-based Saginaw,

26 Swan Creek & Black River Bands of the Chippewa Nation.

27

28 CAUSES OF ACTION

29

30 COUNT 1

31 DECLARATORY RELIEF


1 6.1 Plaintiff realleges paragraphs 1.1 through 5.8 herein.

2 6.2 The Saginaw Chippewa Community Court lacks jurisdiction to adjudicate

3 custody of non-tribal member children born of a non-tribal member and a

4 non-Indian, who were not residing on the Isabella Indian Reservation,

5 Isabella County, Michigan or on the Saganing Indian Reservation, Arenac

6 County, Michigan and were not "bona fide resident[s] of the Isabella or

7 Saganing Indian Reservations for a period of at least 180 days prior to the

8 filing of the action."

9 6.3 The Saginaw Chippewa Community Court lacks jurisdiction to Dissolve the

10 marriage of a non-tribal member and a non-Indian, who were not married on

11 the Isabella Indian Reservation, Isabella County, Michigan or on the

12 Saganing Indian Reservation, Arenac County, Michigan and were not "bona

13 fide resident[s] of the Isabella or Saganing Indian Reservations for a period

14 of at least 180 days prior to the filing of the action."

15 6.4 Plaintiff is entitled to Declaratory Relief, pursuant to 28 USC 2201, that the

16 Saginaw Chippewa Community Court lacks jurisdiction to adjudicate the

17 Petitions filed in said court by Defendant, TERESA MARIE HENRY, and that

18 orders issued by the Saginaw Chippewa Tribal Court pursuant to said

19 petitions are null and void.


21 SAGINAW CHIPPEWA INDIAN TRIBE OF MICHIGAN is not the modern-day

22 successor of the treaty-based Saginaw, Swan Creek & Black River Bands of

23 the Chippewa Nation.


25 SAGINAW CHIPPEWA INDIAN TRIBE OF MICHIGAN is an "Indian

26 Community" first recognized under the Wheeler-Howard Act or Indian


28

29 COUNT 2

30 INJUNCTIVE RELIEF

31 7.1 Plaintiff realleges paragraphs 1.1 through 6.6 herein.


1 7.2 Plaintiff is entitled to Injunctive Relief, pursuant to 28 USC 2202, prohibiting

2 the Saginaw Chippewa Community Court from issuing, and TERESA MARIE

3 HENRY, and SAGINAW CHIPPEWA INDIAN TRIBE OF MICHIGAN, from

4 enforcing orders issued by the Saginaw Chippewa Community Court against

5 the Plaintiff without the jurisdiction to do so.


7 the SAGINAW CHIPPEWA INDIAN TRIBE OF MICHIGAN from further

8 misrepresenting the federal status of said tribe to obtain advantages or

9 rights, not pertaining to the establishment of the Isabella Indian Reservation,

10 Isabella County, Michigan or the Saganing Indian Reservation, Arenac

11 County, Michigan, that are exclusive to the Saginaw, Swan Creek & Black

12 River Bands of the Chippewa Nation.


14 the SAGINAW CHIPPEWA INDIAN TRIBE OF MICHIGAN from further using

15 the words "Saginaw, Swan Creek, and/or Black River" in its name.


17 the SAGINAW CHIPPEWA INDIAN TRIBE OF MICHIGAN from further

18 claiming to be the modern-day successor of the treaty-based Saginaw, Swan

19 Creek & Black River Bands of the Chippewa Nation.

20

21 RELIEF

22 Plaintiff prays the court grant the following relief:

23 8.1 Declare the Saginaw Chippewa Community Court lacks jurisdiction to grant

24 the petitions filed therein by Defendant, TERESA MARIE HENRY, against

25 the Plaintiff and that orders issued by the Saginaw Chippewa Tribal Court

26 pursuant to said petitions are null and void.

27 8.2 Enjoin the Saginaw Chippewa Community Court from issuing orders against

28 the Plaintiff based on said petitions.

29 18.3 Enjoin the SAGINAW CHIPPEWA INDIAIN TRIBE OF MICHIGAN and

30 TERESA MARIE HENRY from enforcing orders issued by the Saginaw

31I

Chippewa Community Court against the Plaintiff without jurisdiction.


1 8.4 Declare the SAGINAW CHIPPEWA INDIAN TRIBE OF MICHIGAN is not the

2 modern-day successor of the treaty-based Saginaw, Swan Creek & Black

3 River Bands of the Chippewa Nation.

4 8.5 Declare the SAGINAW CHIPPEWA INDIAN TRIBE OF MICHIGAN is an

5 "Indian Community" first recognized under the Wheeler-Howard or Indian


7 8.6 Enjoin the SAGINAW CHIPPEWA INDIAN TRIBE OF MICHIGAN from

8 further misrepresenting the federal status of said tribe to obtain advantages,

9 rights and/or privileges, not pertaining to the establishment of the Isabella

10 Indian Reservation, Isabella County, Michigan or the Saganing Indian

11 1 Reservation, Arenac County, Michigan, that are exclusive to the treaty-based

12 Saginaw, Swan Creek & Black River Bands of the Chippewa Nation.


14 further using the words "Saginaw, Swan Creek & Black River" in its name.


16 further claiming to be the modern-day successor of the treaty-based

17 Saginaw, Swan Creek & Black River Bands of the Chippewa Nation.

18 8.9 Grant other such relief as the court deems just.

19

20 Dated this dayof,2016

21

22

23

24 CHAD JERAMI AVERY, GBE-GIIZHIG

25

26

27

28

29

30

31

UUN KAt, I

FOR OFFICE USE ONLY

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JS 44 (Rev. 12/12) CIVIL COVER SHEET County in which action arose

The JS 44 civil cover sheet and the information contained herein neither replace nor supplement the filing and service of pleadings or other papers as required by law, except as

provided by local rules of court. This form, approved by the Judicial Conference of the United States in September 1974, is required for the use of the Clerk ofCourt for thepurpose of initiating the civil docket sheet. (SEE INSTRUCTIONS ON NEXT PAGE OF THIS FORM)

I. (a) PLAINTIFFS chAd^r„/iv/ DEFENDANTS --ce.r.E., PV:t.lit-i-V-44_4 c2,4%, 0--tos 1-4. rte... I t--m 47.8Sq(b) County of Residence of First Listed Plaintiff FiCfl County of Residence of First Listed Defendant

(EXCEPT IN US. PLAINTIFF CASES) (IN US. PLAINTIFF CASES ONLY)NOTE: IN LAND CONDEMNATION CASES, USE THE LOCATION OF

THE TRACT OF LAND INVOLVED.

(C) Attorneys (Firm Name, Address, and Telephone Number) Attorneys (IfKnown)

II. BASIS OF JURISDICTION (Place an "X" in One Box Only) III. CITIZENSHIP OF PRINCIPAL PARTIES (Place an "X" in One Boxfor Plaintiff(For Diversity Cases Only) and One Boxfor Defendant)

O I U.S. Government .71. Federal Question PTF DEF PTF DEF

Plaintiff (US. Government Not a Party) Citizen of This State 0 1 CI 1 Incorporated or Principal Place 0 4 0 4

of Business In This State

O 2 U.S. Government Cl 4 Diversity Citizen ofAnother State GI 2 GI 2 Incorporated and Principal Place CI 5 0 5

Defendant (Indicate Citizenship ofParties in Item of Business In Another State

Citizen or Subject ofa GI 3 GI 3 Foreign Nation CI 6 CI 6

IV. NATURE OF SUIT (Place an "X" in One Box Only)2. fmnrs. fITIIIC

GMA ore rrve

O 110 Insurance PERSONAL INJURY PERSONAL INJURY 0 625 Drug Related Seizure CI 422 Appeal 28 USC 158 CI 375 False Claims Act

GI 120 Marine CI 310 Airplane CI 365 Personal Injury of Property 21 USC 881 CI 423 Withdrawal 0 400 State ReapportionmentCI 130 Miller Act CI 315 Airplane Product Product Liability CI 690 Other 28 USC 157 GI 410 Antitrust

CI 140 Negotiable Instrument Liability CI 367 Health Care/ CI 430 Banks and BankingCI 150 Recovery of Overpayment CI 320 Assault, Libel & Pharmaceutical r: PROPERTY RIGHTS "(450 Commerce

& Enforcement ofJudgment Slander Personal Injury CI 820 Coppights 0 460 DeportationO 151 Medicare Act GI 330 Federal Employers' Product Liability CI 830 Patent 0 470 Racketeer Influenced and

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(Excludes Veterans) GI 345 Marine Product Liability Li4,130R•. SOCIAL sEetnun, CI 490 Cable/Sat TV

CI 153 Recovery of Overpayment Liability PERSONAL PROPERTY CI 710 Fair Labor Standards II 861 HIA (1395ff) GI 850 Securities/Commodities/

of Veteran's Benefits GI 350 Motor Vehicle 0 370 Other Fraud Act CI 862 Black Lung (923) ExchangeCI 160 Stockholders' Suits CI 355 Motor Vehicle CI 371 Truth in Lending CI 720 Labor/Management 0 863 DIWC/DIWW (405(g)) CI 890 Other Statutory Actions

GI 190 Other Contract Product Liability GI 380 Other Personal Relations GI 864 SSID Title XVI CI 891 Agricultural Acts

CI 195 Contract Product Liability GI 360 Other Personal Property Damage GI 740 Railway Labor Act GI 865 RSI (405(g)) GI 893 Environmental Matters

GI 196 Franchise Injury GI 385 Property Damage GI 751 Family and Medical GI 895 Freedom ofInformation0 362 Personal Injury Product Liability Leave Act Act

Medical Malpractice GI 790 Other Labor Litigation CI 896 Arbitration

REAL PROPERTY .1CIVTL RIGHTS PRISONERPETITIONS CI 791 Employee Retirement FEDERALTAX SUITS: CI 899 Administrative Procedure

CI 210 Land Condemnation CI 440 Other Civil Rights Habeas Corpus: Income Security Act GI 870 Taxes (U.S. Plaintiff Act/Review or Appeal of

CI 220 Foreclosure GI 441 Voting GI 463 Alien Detainee or Defendant) Agency Decision

CI 230 Rent Lease & Ejectment 0 442 Employment GI 510 Motions to Vacate CI 871 IRS—Third Party CI 950 Constitutionality of

GI 240 Torts to Land GI 443 Housing/ Sentence 26 USC 7609 State Statutes

0 245 Tort Product Liability Accommodations CI 530 GeneralCI 290 All Other Real Property CI 445 Amer. w/Disabilities GI 535 Death Penalty IMMIGRATION

Employment Other: CI 462 Naturalization ApplicationGI 446 Amer. w/Disabilities CI 540 Mandamus & Other CI 465 Other Immigration

Other CI 550 Civil Rights Actions

CI 448 Education GI 555 Prison Condition0 560 Civil Detainee

Conditions ofConfinement

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Proceeding State Court Appellate Court Reopened Another District Litigation(specify)

Cite the U.S. Civil Statute under which you are filing (Do not citejurisdictional statutes unless diversity):

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DATE

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RECEIPT 4 AMOUNT APPLYING IFP JUDGE MAG. JUDGE


PURSUANT TO LOCAL RULE 83.11

1. Is this a case that has been previously dismissed? 1=1 Yes

1=1 NoIf yes, give the following information:

Court:

Case No.:

Judge:

2. Other than stated above, are there any pending or previouslydiscontinued or dismissed companion cases in this or any other Li Yes

court, including state court? (Companion cases are matters in which Noit appears substantially similar evidence will be offered or the same

or related parties are present and the cases arise out of the same

transaction or occurrence.)

If yes, give the following information:

Court:

Case No.:

Judge:

Notes:

Documents

1:16-cv-10868-TLL-PTM Doc 1 Filed 03/10/16 Pg 1 13 Pg ID 1 · 2016-03-14 · 1:16-cv-10868-TLL-PTM Doc 1 Filed 03/10/16 Pg 2 of 13 Pg ID 2 1 1.3 Defendant's Name, Address & Phone