INSTRUCTIONS:
A
written and signed statement of the facts must be filed with the Disciplinary Board before your complaint can be
considered. Therefore, under Statement of Complaint, please fully and completely set forth the facts and circumstances of
your complaint, including relevant dates, contacts you made with the attorney, the fee arrangement, dates and amounts paid
to the attorney, services to be performed, the names and addresses of other individuals involved in the legal matter, exactly
what conduct you believe is unethical or illegal, etc.
Pl
ease attach copies of all correspondence and/or documents relating to your case. If you send original documents and
wish them returned to you, check here _______. If you have not attached any documentation, please explain why:
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STATEMENT OF COMPLAINT: (Note: Attach as many additional pages as necessary to fully set forth all of the relevant
facts and circumstances surrounding your complaint.)
CONFIDENTIALITY:
S
taff of the Office of Disciplinary Counsel (ODC) and the Board are required to maintain the confidentiality of complaints
and related investigations and proceedings unless and until one of the exceptions to confidentiality, as set forth in
Enforcement Rule 402, applies. ODC staff may interview the respondent-attorney or other persons who may have
information that is relevant to your complaint, and may disclose information when disclosure is permitted or required by
Court or Board Rules.
IMMUNITY:
E
nforcement Rule 209(a) provides that any person who communicates with Disciplinary Counsel or the Board relating to
misconduct by a respondent-attorney or gives testimony before a hearing committee or special master in a proceeding
conducted pursuant to the Enforcement Rules, shall be immune from civil suit based upon such communication or testimony.
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(Date) (Your Signature)