Fillable COMPLAINT FORM CIRCUIT CLERK AOC-CCCF-1 Rev. 1-13 AP (Administrative Office of the Courts)

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COMPLAINT FORM CIRCUIT CLERK AOC-CCCF-1 Rev. 1-13 AP (Administrative Office of the Courts)

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Please type or print legibly. NOTE: This form can be lled in online then printed OR printed and then lled out.

I. COMPLAINANT INFORMATION:

Mr. q Mrs. q Ms. q

Name: _________________________________________________________________________________________

(Last) (First) (Middle)

Address: ______________________________________________ ____________________________ ________

(Street, No., Route) (City, State) (Zip)

Home Phone: ___________________________________ Cell Phone: __________________________________

II. COMPLAINT AGAINST:

Please identify the county of the Circuit Court Clerk: ________________________

Name: _________________________________________________________________________________________

(Last) (First) (Middle)

Address: ______________________________________________ ____________________________ ________

(Street, No., Route) (City, State) (Zip)

III. ADDITIONAL INFORMATION:

a) If your complaint arises out of a court case, please answer the following:

1. Case Name: _________________________________________________________________________________

Case County: ________________________________ Case No. ____________________________________

2. What kind of case is it?

Criminal _____ Civil _____ Family _____ Juvenile _____ Other __________________________

3. What is your relationship to the case?

Plaintiff/Petitioner _____ Defendant/Respondent _____ Attorney _____ Witness _____

Other _________________________________________________________________________________

FOR INTERNAL USE ONLY

CCCCC Case Number: __________

Meeting Date(s): _______________

_____________________________

AOC-CCCF-1

Rev. 1-13

Page 1 of 3

Commonwealth of Kentucky

Court of Justice www.courts.ky.gov

AP Part XVI

CIRCUIT CLERK

COMPLAINT FORM

lex

justitia

( ) ( )

Please be advised that the Commission only has authority over Commonwealth of Kentucky Circuit Court Clerks,

and such authority does not extend to deputy clerks. Complaints about deputy clerks should be reported to the

respective county’s Ofce of the Circuit Court Clerk and addressed pursuant to the Court of Justice Personnel Policy.

Personal dissatisfaction alone cannot be grounds for an investigation.

The Commission’s investigation shall be condential under Part XVI of Rules of Administrative Procedure, Section 7.

AOC-CCCF-1

Rev. 1-13

Page 2 of 2

IV. ALLEGATIONS AND STATEMENT OF FACTS:

Please state the facts and circumstances you believe constitute ofcial misconduct or improper conduct. Include

any details, names, dates, places, addresses, and telephone numbers to assist the Committee in its evaluation and

investigation of this complaint. Attach any documents pertaining to this complaint.

_______________________________________________________________________________________________

b) When and where did the alleged clerk misconduct occur?

________________ Time: _______ Location: ___________________________________________Date:

Date: ________________ _______ Location: ___________________________________________

Time:

c) If you are represented by an attorney, please identify the attorney:

Name: _________________________________________________________________________________________

(Last) (First) (Middle)

Address: ______________________________________________ ____________________________ ________

(City, State)(Street, No., Route) (Zip)

Home Phone: ___________________________________

( )

IV. ALLEGATIONS AND STATEMENT OF FACTS (continued):

_______________________________________________________________________________________________

If additional space is required, please attach and number additional one-sided 81/2" X 11" pages as needed.

V. I certify that the allegations and statements of facts set forth above are true and correct to the best of my

knowledge, and belief and are made of my own free will.

______________________________________, 2_____ ____________________________________________

(Date) (Complainant's Signature)

AOC-CCCF-1

Rev. 1-13

Page 2 of 3

Mail Complaint To: Circuit Court Clerks Conduct Commission

Supreme Court of Kentucky

Attention: Chief of Staff and Counsel

State Capitol, Room 235

700 Capitol Avenue

Frankfort, Kentucky 40601

Phone (502) 564-4162

Fax (502) 564-1933

www.courts.ky.gov

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COMPLAINT FORM CIRCUIT CLERK AOC-CCCF-1 Rev. 1-13 AP (Administrative Office of the Courts)

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Completed 14 August 2020

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