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Judicial Council for the District of Columbia Circuit Complaint of Judicial Misconduct or Disability Mail this form to: Clerk, United States Court of Appeals for the District of Columbia Circuit E. Barrett Prettyman U.S. Courthouse 333 Constitution Avenue, N.W. Washington, D.C. 20001-2866

NOTE: Mark envelope "JUDICIAL MISCONDUCT COMPLAINT" or "JUDICIAL DISABILITY COMPLAINT." Do not put the name of the judge or magistrate on the envelope. 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), where to file a complaint (Rule 7), and other important matters. Your complaint (this form and the statement of facts) should be typewritten and must be legible. Number of copies. If the complaint is about a single judge of the court of appeals, submit three copies of the complaint form, the statement of facts, and any documents. If it is about a single district court judge or magistrate judge, four copies must be filed; if about a single bankruptcy judge, five copies. 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 of the circuit, one for each judge complained about, and one for the Chief Judge of the District Court if the subject judge is a district court judge. 1. Complainant's Name: Address: Daytime telephone:

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2.

Judge or Magistrate complained about: Name: Court:

3.

Does this complaint concern the behavior of the judge(s) or magistrate in a particular lawsuit or lawsuits? [ ] Yes [ ] No

If "yes" give the following information about each lawsuit (use reverse side if there is more than one): Court: Case number: Are (were) you a party or lawyer in the lawsuit? [ ] Party [ ] Lawyer [ ] Neither

If a party, give the following information: Lawyer's Name: Address: Telephone:

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Docket number(s) of any appeals of above case(s) to the Court of Appeals, D.C. Circuit:

4.

Have you filed any lawsuits against the judge or magistrate? [ ] Yes [ ] No If "yes" give the following information about each lawsuit (use the reverse side if there is more than one): Court: Case Number: Present status of lawsuit: Your Lawyer's Name: Address: Telephone:

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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. On separate sheets of paper, not larger than the paper this form is printed on, 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. See Rule 6(a) for further information on what to include in your statement of facts. Do not use more than 5 pages (5 sides). 6. 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)