引导语：一份好的起诉状，要写明原告和被告人的姓名、性别、年龄、民族、职业、籍贯、工作单位和住址。如果有诉讼代理人，还应当写明诉讼代理人的姓名、职业、住址、工作单位、代理权的范围以及与原告之间的关系等。今天，小编为大家整理了范文，欢迎阅读与参考!
1.管辖权声明。
2.1936年6月1日，被告在马萨诸塞州波士顿市一条名为波依斯顿街的公路上，疏于驾驶而将正步行跨越公路的原告撞倒。
3.于被告撞击造成的腿部骨折及其他伤害，使原告不能工作，并遭受了身体和精神的巨大痛苦原告还为此支出医疗护理费和住院费共1000美元。
据此，原告请求判决被告支付 美元的赔偿金并支付诉讼费用。
(注：因共同过失为积极抗辩，故起诉书无需包含关于原告应有注意的声明。)
COMPLAINT FOR NEGLIGENCE
1.Allegation of jurisdiction.
2.On June 1， 1936， in a public highway called Boylston Street in Boston， Massachusetts， defendant negligently drove a motor vehicle against p0laintiff who was then crossing said highway.
3.As a result plaintiff was thrown down and had his leg broken and was otherwise injured， was prevented from transacting his business， suffered great pain of body and mind ， and incurred expenses for medical attention and hospitalization in the sum of one thousand dollars.
Wherefore plaintiff demands judgment against defendant in the sum of dollars and costs.
(NOTE： Since contributory negligence is an affirmative defense ，the complaint need contain no allegation of due care of plaintiff.)