- Your name and address
Your Street Address:
City
State
Zip Code
- Telephone number: Residence
Work:
- I have information of possible misconduct or disability on the part of
Circuit #:
State:
- When and where did this happen?
- If your information arises out of a court case, please answer these questions:
(a) What is the name and number of the case?
Case name:
Case no:
(b) What kind of case is it?
criminal
domestic relations
small claims
traffic
probate
civil
juvenile
contempt
other
(c) What is your relationship to this case?
plaintiff/petitioner
defendant/respondent
attorney
witness
other
(d) If you were represented by an attorney at the time of the conduct of the judge or court commissioner, please identify the attorney:
Street Address
City:
State:
Zip Code
Attorney Phone #:
- List documents that help support your information that the judge or court commissioner has engaged in misconduct or has a disability, noting which ones you have attached:
4. Identify, if you can, any other witnesses to the conduct of the judge or court commissioner:
Street Address
City:
State:
Zip Code:
Attorney Phone #:
Street Address
City:
State:
Zip Code:
Attorney Phone #:
- Specify below the details of what the judge or court commissioner did that you think constitutes misconduct or indicates disability. [PLEASE TYPE OR PRINT LEGIBLY; ATTACH ADDITIONAL PAPER IF NECESSARY].
PURSUANT TO SUPREME COURT 12, THE IDENTITY OF INFORMANTS IS KEPT CONFIDENTIAL. YOU MAY CHOOSE TO WAIVE THIS CONFIDENTIALITY.
I choose to waive the confidentiality of Supreme Court Rule 12 and request that a copy of my complaint be sent to the judge or court commissioner.
I do not waive the confidentiality provided by Supreme Court Rule 12 and request that the Commission not disclose my identity to the judge or court commissioner.
Signature: