JUDICIAL COUNCIL OF THE FIFTH CIRCUIT

COMPLAINT OF JUDICIAL CONDUCT OR DISABILITY

1. Complainant’s name:______________________________________

Address: .

.

.

Daytime telephone: ( ) .

2. Judge or Magistrate complained about:

Name: .

Court: .

3. Does this complaint concern the behavior of the judge 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: .

Docket 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 number: ( ) .

Docket number(s) of any appeals of above case(s) to Fifth Circuit

Court of Appeals: .

4. Have you filed any lawsuits against the judge or magistrate (use the reverse

Side if there is more than one):

Court: .

Docket number: .

Present status of suit: .

Your lawyer’s name: .

Address: .

.

.

Telephone number: ( ) .

Court to whom any appeal has been taken:

.

Docket number of the appeal: .

Present status of the appeal: .

.

5. On separate sheets of paper, not large than the paper this form is printed

on, describe the conduct or the evidence of disability that is the subject

of this complaint. See rule 2 (b) and rule 2 (d). Do not use more than 5

pages (5 sides). Most complaints do not require that much.

6. You should either:

(1) check the first line below and sign this form in the presence of a Notary

Public, or:

(2) check the second line and sign the form. You do not need a Notary Public

if you check the second line.

___________ I swear (affirm) that –

____________I declare under penalty of perjury that

(1) I have read rules 1 and 2 of the Rule of the Fifth Circuit Court governing

Complaints of Judicial Misconduct or Disability, and

(2) The statements made in this complaint are true and correct to the best of

My knowledge.

.

(Signature)

Executed on______________________.

(Date)

These forms should be sent to

FIFTH CIRCUIT CLERK’S OFFICE

ATTN; RM 235

600 CAMP STREET

NEW ORLEANS, LOU. 70130

MAIN TELEPHONE # (504) 310-7700