COMMONWEALTH OF MASSACHUSETTS COMMISSION ON JUDICIAL CONDUCT 11 BEACON STREET, SUITE 525 BOSTON, MASSACHUSETTS 02108-3006 Phone: (617) 725-8050 Fax: (617) 248-9938 COMPLAINT FORM CJC Complaint Number: ________________ This form is designed to provide the Commission with information necessary to determine whether your complaint falls within the Commission's jurisdiction, pursuant to M.G.L. Chapter 211C, and whether an investigation or further action should be taken. Please review the Code of Judicial Conduct (SJC Rule 3:09) and the rules of the Commission, both of which are available on the Commission's website at www.mass.gov/cjc, before filling out this form. ONLY ONE JUDGE MAY BE COMPLAINED OF ON EACH FORM. PLEASE TYPE OR PRINT CLEARLY ALL INFORMATION Your name:_______________________________________________________________________________ Your address:_____________________________________________________________________________ ________________________________________________________________________________________ Daytime telephone number:__________________________________________________________________ Name of judge:____________________________________________________________________________ Court:___________________________________________________________________________________ Case name:_______________________________________________________________________________ Docket number:___________________________________________________________________________ Attorney(s) involved:_______________________________________________________________________ Date(s) of misconduct: ______________________________________________________________________ Has an appeal been filed?____________________________________________________________________ Please summarize the general nature of your complaint: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com Specific Facts: Please describe exactly what the judge did that you believe constitutes judicial misconduct or evidence of disability, and on what date(s). YOUR COMPLAINT WILL BE SCREENED ON THE BASIS OF THIS FORM ONLY. DO NOT RELY UPON ATTACHMENTS TO MAKE YOUR ALLEGATIONS. (You may attach copies of any documents which support your allegations, for the purposes of the investigation. Please delete anyone's personal identifying information, such as social security number, bank account information, or credit card information.) ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ I understand that this complaint and any other communication to or from the Commission on Judicial Conduct must remain confidential to the extent required by M.G.L. Chapter 211C, Section 6, and Commission Rule 5. I also understand that this complaint and any attachments I send to the Commission become the property of the Commission and will not be returned to me. Signed: __________________________________ Date: __________________________________ Please mail completed form to: Executive Director Commission on Judicial Conduct 11 Beacon Street, Suite 525 Boston, MA 02108-3006 American LegalNet, Inc. www.FormsWorkFlow.com