JUDICIAL COUNCIL OF THE ELEVENTH CIRCUIT COMPLAINT OF JUDICIAL MISCONDUCT OR DISABILITY UNDER 28 U.S. C. § 372(c) To file a complaint of judicial misconduct or disability, please answer all of the questions on this form and send three copies in an envelope to the Clerk, United States Court of Appeals, 56 Forsyth Street, N.W. , Atlanta, Georgia 30303. Please write “ Section 372(c) Complaint” on the envelope. Do not write the name of the complained-of judge on the envelope. This complaint must be legible; if possible, it should be typewritten. For other details, see the Rules of the Judicial Council of the Eleventh Circuit Governing Complaints of Judicial Misconduct or Disability. CONFIDENTIAL IN THE MATTER OF A COMPLAINT FILED BY: ___________________________________________________________________________________ NAME OF COMPLAINANT ___________________________________________________________________________________ ADDRESS ___________________________________________________________________________________ ( ___________ ) _____________________________ DAYTIME TELEPHONE NUMBER AGAINST: ___________________________________________________________________________________ NAME OF COMPL AINED-OF JUDGE ___________________________________________________________________________________ COURT 2002 © American LegalNet, Inc. 1. G Yes G No Does this complaint concern a particular lawsuit? If yes, please pr ovide the follow ing inform ation about the law suit. (If more than one lawsuit is involved, use additional pages, as necessary.) ___________________________________________________________________________________ COURT IN WHICH LAWSUIT WAS FILED ______________________________________ _______________________________________ DOCKET NUMBER DOCKET NUMBER OF APPEAL, IF ANY What is (or was) your role in the law suit? G Party (including pro se) G Attorney G Juror G Witness G None of these Please pr ovide the nam e, a ddress, and telephon e numbe r of your attorney in this lawsuit: 2. G Yes G No Have you filed a lawsuit against the judge? If yes, please pr ovide the follow ing inform ation about the law suit. (If more than one lawsuit is involved, use additional pages, as necessary.) ___________________________________________________________________________________ COURT IN WHICH LAWSUIT WAS FILED ______________________________________ _______________________________________ DOCKET NUMBER DOCKET NUMBER OF APPEAL, IF ANY ___________________________________________________________________________________ PRESENT STATUS OF L AWSUIT OR APPEAL Please provide the name, address, and telephone number of your attorney: 3. On separate sheets of paper, no larger than the paper on which this form is printed, please describe the evidence of misconduct or disability that is the subject of this complaint. Do not use more than five single-sided pages. 4. Sign your name. I declare under pe nalty of per jury that I have re ad Rule 1 of the Rules o f the Judicial C ouncil of the E leventh Circ uit Gover ning Com plaints of Judicial M isconduct and Disability, and that the statem ents made in this complaint are true and correct to the best of my knowledge. _______________________________________________ ________________________________ SIGNATURE OF COMPLAINANT DATE 2002 © American LegalNet, Inc.