Fill and Sign the Complaint for Personal Injury Wrongful Death and Survival Form

IN THE ______________ COURT OF ______________ COUNTY STATE OF ________________       ) )       ) Petitioner/Plaintiff, ) ) ) NO.       Vs. ) )       ) Respondent/Defendant ) ) AMENDED COMPLAINT COMES NOW THE PLAINTIFFS, and files this their complaint and for grounds would show the following: 1. The estate of ______________________ is properly filed in the ___________ Court of ____________ County, _______________. ______________________ is a bona fide adult resident citizen of _____________ County, __________________ and wife of the deceased. ______________________, by and through her best friend, ______________________, is a resident citizen of _________________County, _______________ and the daughter of the deceased. ______________________, by and through his best friend, is a resident citizen of ______________________ County, ______________________ and the son of the deceased. ______________________ is a bona fide, adult resident citizen of ___________________ County, ____________________ and brother of the deceased. ______________________ is a bona fide adult resident citizen of ________________ County, _____________________ and brother to the deceased. - 1 - ______________________ is a bona fide adult resident citizen of the State of _______________________ and sister of the deceased. ______________________ is a bona fide adult resident citizen of _______________________ County, ________________________ and brother of the deceased. ______________________ is a bona fide resident citizen of ___________________ County, ____________________ and sister of the deceased. ______________________________ is a bona fide adult resident citizen of ______________________ County, ______________________ and father of the deceased. ______________________ is a bona fide adult resident citizen of _______________________ County, ______________________ and mother of the deceased. Defendants ______________________, ______________________, ______________________ and ______________________, doing business as the ______________________ and now as the ______________________ and/or ______________________ and/or ______________________ are adult resident citizens of _______________________ County, _______________________ and can be served with process of this court at their business which is located at ______________________, ______________________, _____________________. ______________________ and ______________________, doing business as the ______________________ and now as the ______________________ and/or ______________________ and/or ______________________ are believed to be residents of the State of ___________________ or the State of _____________________________ and can be served at their business address of the ______________________, ______________________, ______________________, ____________________________. The identity of John Doe 1,2,3, and 4 cannot be ascertained at this time and once ascertained will be served with the process of this Court forthwith. - 2 - JURISDICTION 2. Jurisdiction of this Court is raised as this action is in excess of $____________ and several of the Plaintiffs, including decedent's estate, reside in ______________ County, ____________________________. FACTS 3. On or about the _______ day of _______________, 20____, ______________________ and a co - worker registered as guests of the defendant ______________________ by signing the guest register and prepaying the room rent. ______________________ and the co - worker placed their bags in the room and then went to eat. They returned to the room and discovered that the air conditioning did not work. They reported this to the motel management which told them that they would dispatch someone to examine the air conditioning unit. Someone knocked on the door. ______________________, believing it was someone from the motel maintenance answered the door. The person at the door was a prostitute that offered ______________________ a "date". ______________________ refused the proposal and as he was closing the door, three men charged through the door, viciously attacking ______________________. ______________________'s attackers robbed both he and his co - worker and then viciously shot and killed ______________________. 4. On the _______ day of _______________, 20_____, and for a long period of time prior thereto, defendants knew or with the exercise of reasonable care, should have known that: a) By leaving the motor lodge open, unlocked and accessible to anyone who cared to enter onto the premises; b) By falling to have adequate security guard protection at the motor lodge at the time Plaintiff became a guest of the motor lodge; - 3 - c) By failing to have adequate security guard protection at the motor lodge on a regular and continuing basis during the months immediately prior to the ______ day of ________________, 20_____ to deter the commission of crimes which had been regularly occurring on the premises of the motor lodge; d) By failing to install a closed circuit TV monitoring system designed to scan the public areas of the motor lodge complex, including public areas of buildings where guests are lodged; e) By failing to establish and enforce standards for the operation of the lodge which would protect guests from physical attack and their property from theft; f) By failing to take affirmative action to discover a dangerous condition on the premises of the motor lodge, to - wit: the commission of serious crimes on said premises on a regular and continuing basis immediately prior to the _______ day of _______________, 20____; g) By failing to design and construct the motor lodge in a manner that would protect guests of the lodge from physical attack and that would protect the property of guests from loss by theft, specifically, but not limited to not having a peep hole in the door of the room in which the deceased, ______________________ was checked into; h) By failing to warn Plaintiff before he accepted accommodations at the motor lodge that criminal acts had been taking place on the premises of the motor lodge regularly for many months prior to the date Plaintiff was attacked and injured, and that this criminal activity would or might constitute a threat to Plaintiffs safety if he accepted accommodation at the motor lodge. - 4 - 5. Plaintiff alleges that the assault and battery upon his person occurred as the proximate result of Defendants' negligence and breach of their legal duties and obligations to Plaintiff as hereinabove set forth. 6. Plaintiff alleges that prior to the ______ day of _____________, 20_____, Defendants knew that crimes were being committed in and around the motor lodge with great frequency and regularity, and that the guests of the motor lodge were in great jeopardy because of Defendants' conscious failure to provide safeguards that would prevent physical attacks upon their guests. During the period immediately preceding the attack on Plaintiff, serious crimes were committed on the premises of the motor lodge, including armed robbery, numerous burglaries and other serious crimes, the details of which will be offered into evidence at the trial of this action. Defendants were aware of the criminal activity which was taking place in and about the motor lodge, but took no steps to safeguard their guests from violent attack or to warn them that their lives and property would be risked by accepting accommodations at the motor lodge. The failure of defendants to make provision for the safety of their guests and to warn their guests of the danger involved in accepting accommodations at the motor lodge amounted to gross negligence and defendants' omissions in this regard infer a conscious indifference to the welfare of their guests, including plaintiff, which justifies the imposition of punitive damages. WHEREFORE, PREMISES CONSIDERED, the Plaintiffs requests that this Court grant unto the Plaintiff Estate of ______________________ the loss of earnings in the amount $__________; pain and suffering damages in the amount of $__________; the loss of the enjoyment of life damages in the amount of $__________; Plaintiff ______________________, the loss of companionship and society of the deceased in the amount of $__________; Plaintiff ______________________, the loss of society and companionship and guidance from deceased - 5 - in the amount of $__________; Plaintiff ______________________, the loss of society and companionship and guidance from the deceased in the amount of $__________; Plaintiff ______________________, the loss of society and companionship in the amount of $__________; Plaintiff ______________________, the loss of society and companionship in the amount of $__________; Plaintiff ______________________, the loss of society and companionship in the amount of $__________; Plaintiff ______________________. The loss of society and companionship in the amount of $__________; Plaintiff ____________________, the loss of society and companionship in the amount of $__________; Plaintiff __________________, the loss of society and companionship in the amount of $__________; Plaintiff __________________; the loss of society and companionship in the amount of $__________; Plaintiff ___________________, the loss of society and companionship in the amount of $__________; and punitive damages in the amount of $__________. Respectfully submitted, Dated: Name:       Title:       Address:       Address:       City, State, Zip:       Phone:       Fax:       E-Mail:       Attorney No.:       - 6 - CERTIFICATE OF SERVICE I, ______________________________, do hereby certify that I have this day mailed, U.S. Mail, postage prepaid, a true and correct copy of the above and foregoing to __________________________________, at the following address; ___________________________________________________________________ THIS the ____ day of _____________, 20____. _________________________________ - 7 -