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STATE OF NEW YORK
SUPREME COURT, APPELLATE DIVISION
ATTORNEY GRIEVANCE COMMITTEE
THIRD JUDICIAL DEPARTMENT
COMPLAINT FORM
Questions marked with a
*
are required
Date:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2022
2023
2024
2025
COMPLAINANT INFORMATION:
Your Name:
Last Name
First Name
(Initial)
Address:
Street
(Apt. #)
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
District of Columbia
County
Zip
Telephone:
Cell/Home
Business
Email Address:
ATTORNEY COMPLAINED OF:
Attorney Name:
Last Name
First Name
(Initial)
Address:
Street
(Apt. #)
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
District of Columbia
County
Zip
Telephone:
Cell/Home
Business
Email Address:
DATE YOU HIRED/RETAINED ATTORNEY (If Applicable):
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
CONTACT WITH OTHER AGENCIES
Have you contacted any other agency, such as a Bar Association, another Grievance Committee, Attorney General's Office, or any other State Agency concerning this matter?
Yes
No
If so, state the name of the agency:
What action was taken by the agency?
COURT ACTION TAKEN BY YOU AGAINST THE ATTORNEY
Have you taken any civil or criminal action against the attorney?
Yes
No
If so, please name the court and provide the index number:
What is the status of the matter and/or what action was taken by the Court?
ALLEGATIONS:
Explain your complaint against the attorney in as much detail as possible. Please be sure to include the following information: Was the attorney paid any money, and if so, how much? What legal services did the attorney agree to perform? What work did the attorney do? What conduct did the attorney engage in that you believe was improper? Please provide a digital copy of all relevant documents, including the retainer agreement, written communications (letters and emails) to and from the attorney, and the names of any witnesses and their contact information (address, telephone number, and email).
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