OFFICE OF THE CHIEF DISCIPLINARY COUNSEL

Complaint Form

Read instructions before filling in this form.

1. Your name and address ___________________________________________________________________ _______________________________________________________________________________________

2. Telephone number: Residence ____________________    Work: ____________________

3. The name, address and telephone number of the attorney being complained about.  (See note below.) ______________________________________________________________________________________ ______________________________________________________________________________________

4. Have you or a member of your family complained about this attorney previously?  Yes ___ No ___   If yes, please state to whom the previous complaint was made, its approximate date and disposition. ____________ _______________________________________________________________________________________

5. Did you employ the attorney?  Answer yes or no and, if “yes,” give the approximate date you employed him/her and the amount, if any, paid to him/her. _______________________________________________ _______________________________________________________________________________________

6. If your answer to 5 above is “no”, what is your connection with the attorney?  Explain briefly. ___________ _______________________________________________________________________________________

7. Write out on a separate piece of paper and send with this form a detailed, factual statement of what the attorney did or did not do that you are complaining about.  Please state the facts as you understand them.  Do not include opinions or arguments.  If you employed the attorney, state what you employed him/her to do.  Sign and date such separate piece of paper.  Further information may be requested.  (Attach copies of pertinent documents. Please be advised we cannot return documents submitted to this office.  You should retain a copy of all materials you submit.)

8. If your complaint is about a law suit, answer the following, if known:

a. Name of court (For example, Circuit Court or Municipal – in what county) ___________________  _________________________________________________________________________________

b. Title of the suit (For example, Smith vs. Jones). _________________________________ _________________________________________________________________________________

c. Case # ___________________________________________________________________________

d. Approximate date the suit was filed ____________________________________________________

e. If you are not a party to this suit, what is your connection with it?  Explain briefly. ______________ _________________________________________________________________________________

Signature ________________________________________________________________________________Date  _______________

NOTE:  If you are complaining about more than one attorney, prepare separate complaint forms for each attorney in answer to questions 3 through 8 above on separate sheets if necessary.

Mail To: OCDC, 3335 American Avenue, Jefferson City, MO 65109