Third Party Complaint

Extracted Text for Proper Search

Pro Se 11 (Rev. 12/16) Third–Party Complaint	
U	NITED 	S	TATES 	D	ISTRICT 	C	OURT	
for the
__________ District of __________
__________ Division
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)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,
please write “see attached” in the space and attach an additional
page with the full list of names.)	
-v-Jury Trial:  	
(check one)	’Yes’No	
Defendant, Third–party plaintiff(s)
(Write the full name of each defendant/third–party plaintiff.  If the
names of all the defendants/third–party plaintiffs cannot fit in the
space above, please write “see attached” in the space and attach
an additional page with the full list of names.)	
-v-	
Third–party defendant(s)
(Write the full name of each third–party defendant.  If the names
of all the third–party 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.)	
THIRD – PARTY COMPLAINT 	
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  	
(if known)	
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Pro Se 11 (Rev. 12/16) Third–Party Complaint	
B. The Defendant(s)/Third–Party Plaintiff(s)Provide the information below for each defendant/third–pa rty 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
C. The Third–Party Defendant(s) Provide the information below for each third–party defendan	
t named in the 	complaint, whether the 
third–party defendant is an individual, a go	
vernment 	ag	ency, 	an 	organization, 	or a corporation.  For an 
indiv	
idual th	ird	–party defendant, in	clude the person’s job or title (if 	known).  Attach additional pages if 
needed.	
Third–Party Defendant No. 1 Name
Job or Title 	
(if known)	
Street Address
City and County
State and Zip Code
Telephone Number
E-mail Address 	
(if known)	
Third–Party Defendant No. 2Name
Job or Title 	
(if known)	
Street Address
City and County
State and Zip Code
Telephone Number
E-mail Address 	
(if known)	
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Pro Se 11 (Rev. 12/16) Third–Party Complaint	
Third–Party Defendant No. 3
Name
Job or Title 	
(if known)	
Street Address
City and County
State and Zip Code
Telephone Number
E-mail Address 	
(if known)	
Third–Party Defendant No. 4
Name
Job or Title 	
(if known)	
Street Address
City and County
State and Zip Code
Telephone Number
E-mail Address 	
(if known)	
II. Initial Complaint
A. Identify the initial complaint filed against you and the date it was filed.  Describe the events that gave 
rise to the plaintiff's complaint, the nature of the claims asserted, and the relief sought.  Attach the 
complaint as an exhibit.  
B. State whether you have filed an answer to the complaint and, if so, briefly summarize what admissions 
or denials that answer asserted.  Attach the answer as an exhibit.
III. Third–Party Complaint
A. Describe the nature of the relationship between you and the third–party defendant.  Attach any contracts 
or documents showing the nature of the relationship. 	
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Pro Se 11 (Rev. 12/16) Third–Party Complaint	
B. Explain why, if the plaintiff received any judgment against you, you will be entitled to judgment againstthe third–party defendant for contribution to or indemnification for the amount of damages and costs 
awarded to the plaintiff.  Include the percentage of  the plaintiff's recovery that the third–party defendant 
will be required to contribute.  Describe the facts, or relevant provisions of state law, that demonstrate 
you are entitled to collect from the third–party defendant.
IV. Certification and Closing Under Federal Rule of Civil Procedure 11, by signing belo w, I certify to the best of my knowledge, information,
and belief that this complaint: (1) is not being presen ted 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 revers ing existing law; (3) the factual contentions have
evidentiary support or, if specifically so identified,  will likely have evidentiary support after 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 provid	
e the Clerk’s Office with any chan	ges to my address where case–related	 pap	ers may b	e 
served	
.  I understan	d that my failure to keep a current address o	n file with the Clerk	’s Office may result 
in th	
e dismissal o	f my case.	
Date of signing:
Signature of Defendant/Third–Party Plaintiff
Printed Name of Defendant/Third–Party Plaintiff
B. For Attorneys Date of signing:
Signature of Attorney
Printed Name of Attorney
Bar Number	
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Pro Se 11 (Rev. 12/16) Third–Party Complaint	
Name of Law Firm
Street Address
State and Zip Code
Telephone Number
E-mail Address	
Page 5 of  5