APPENDIX A (COMPLAINT FORM) Nebraska Commission on Unauthorized Practice of Law 380 8 Normal Blvd. Lincoln, NE 68506 - 5420 Date 1. Please give us information so we can contact you. 2. Who do you believe has engaged in the Unauthorized Practice of Law? Name Name Address Address City, State Zip City, State Zip Home Phone Home Phone Cell Phone Cell Phone Other Phone Other Phone Email Email 3. What did they do? What is your specific complaint? Be specific. Give actual dates and full addresses of all places that are important to your complaint. Tell what kind of contact you had with the person, whether it was a phone call, personal meeting, emails, letters, or something else. Attach copies of any papers, letters, receipts, checks, contracts, advertisements, or anything else that applies to this complaint. Supporting documents may be scanned and emailed to nsc.cfdcomplaints@nebraska.gov or mailed to the address above. If you need additional space, please use the supplement pages at the end of this form. American LegalNet, Inc. www.FormsWorkFlow.com 4. Are they still doing the same thing that you are complaining about? Yes If you answered Yes , please tell us how you know? Tell us about other people or other things that have happened that show the person is still doing the same things you are complaining about. If you need additional space, please use the supplement pages at the end of this form. No I don't know 5. Did you pay money to this person for some services? Yes No How much money did you pay? $ How did you pay the money? Cash Check Credit Card Other 6. What kind of services did you receive? Tell us everything you can about what things they did for you, and maybe what they didn't do for you. What did you really want them to do? Did you get what you wanted? Did you have any problems with the services at any time? Do you still have problems because of the services? If you need additional space, please use the supplement pages at the end of this form. American LegalNet, Inc. www.FormsWorkFlow.com 7.Have you filed complaints, or a lawsuit, about this person and this matter with anyone else? Yes If you answered Yes , tell us who you contacted. If you hired a lawyer about this matter, please give us the name, address, phone, and email of your lawyer. Tell us about what they have told you and what they have done. If you need additional space, please use the supplement pages at the end of this form. No 8.Do you know of anyone else who knows about this situation? Name Address Phone IMPORTANT: PLEASE READ CAREFULLY BEFORE SIGNING The information given in this complaint form is true and correct to the best of my knowledge and belief. I understand it may be used in legal proceedings. Date Signatur e Do not write in this area. Appendix A amended March 18, 2015, amended March 14, 2018 American LegalNet, Inc. www.FormsWorkFlow.com American LegalNet, Inc. www.FormsWorkFlow.com American LegalNet, Inc. www.FormsWorkFlow.com