COMPLAINT FORM COMPLAINT OF JUDICIAL MISCONDUCT OR DISABILITY To begin the complaint process, complete this form and prepare the brief statement of facts described in item 5 (below). The Rules for Judicial-Conduct and Judicial-Disability Proceedings, adopted by the Judicial Conference of the United States, contain information on what to include in a complaint (Rule 6) as well as information on other important matters. The rules are available in the clerk's office or on the court's website at www.uscfc.uscourts.gov. Your complaint (this form and the statement of facts) should be typewritten if possible. If not typewritten, it must be legible. If the complaint is about a single judge of the court, three copies of the complaint form, the statement of facts, and any attachments must be filed. If the complaint is about more than one judge, enough copies must be filed to provide one for the clerk of the court, one for the chief judge, and one for each judge complained about. Enclose each copy of the complaint in an envelope marked "COMPLAINT OF MISCONDUCT" or "COMPLAINT OF DISABILITY" and submit it to: Clerk of Court, United States Court of Federal Claims, 717 Madison Place, NW, Washington, DC 20005. DO NOT PUT THE NAME OF ANY JUDGE ON THE ENVELOPE. ______________________________________________________________________________ 1. Name of Complainant: Contact Address: ________________________________________ ________________________________________ ________________________________________ Daytime Telephone: 2. Name(s) of Judge(s): ________________________________________ ________________________________________ ________________________________________ 3. Does this complaint concern the behavior of the judge(s) in a particular lawsuit or lawsuits? [ ] Yes [ ] No If yes, give the following information about each lawsuit: Case Number: _______________________ Docket number of any appeal to the Federal Circuit: ______________________ Are (were) you a party or lawyer in the lawsuit? [ ] Party [ ] Lawyer [ ] Neither If you are (were) a party and have (had) a lawyer, give the lawyer's name, address, and telephone number: American LegalNet, Inc. www.FormsWorkFlow.com __________________________________________________ __________________________________________________ __________________________________________________ 4. Have you filed any lawsuits against the judge? [ ] Yes [ ] No If yes, give the following information about each such lawsuit: Court: ______________________________________________ Case Number: ______________________________________________ Present status of lawsuit: __________________________________ Name, address, and telephone number of your lawyer for the lawsuit against the judge: __________________________________________________________ __________________________________________________________ __________________________________________________________ Court to which any appeal has been taken in the lawsuit against the judge: __________________________________________________________ Docket number of the appeal: _________________________________ Present status of the appeal: 5. _________________________________ Brief Statement of Facts. Attach a brief statement of the specific facts on which the claim of judicial misconduct or disability is based. Include what happened, when and where it happened, and any information that would help an investigator check the facts. If the complaint alleges judicial disability, also include any additional facts that form the basis of that allegation. Declaration and Signature: I declare under penalty of perjury that the statements made in this complaint are true and correct to the best of my knowledge. (Signature)_____________________________ (Date)_______________________ 6. American LegalNet, Inc. www.FormsWorkFlow.com