COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.ATTORNEY ETHICS GRIEVANCE FORMCalendar No.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)Please Type Or Print Legibly All InformationA.GRIEVANT: Mr./Mrs./Miss/Ms. (Circle One)LAST NAMEFIRSTM. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ADDRESSSTREET/P.O. BOXCITYSTATEZIPCOUNTYTHE PEOPLE OF THE STATE OF NEW YORK TOOFFICE () B.TELEPHONE: HOME ()THE SPECIFIC LAWYER YOU ARE COMPLAINING ABOUT IS:LAST NAME (INCLUDE SR., JR., III, ETC.)FIRSTMGREETINGS:() OFFICE ADDRESSSTREET/P.O. BOXPHONEWE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofCITYSTATEZIPCOUNTYo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomNOYES(1)IS THE SPECIFIC LAWYER COMPLAINED OF YOUR LAWYER?(2)IF SO, DOES THIS LAWYER STILL REPRESENT YOU?NO (3)YESIF NOT, DO YOU HAVE A NEW LAWYERNO (4)YESIF SO, WHO IS YOUR NEW LAWYER? Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.C.THE TYPE OF CASE HANDLED BY THE LAWYER WAS: (CHECK ONE)Admiral/Maritime(V)(I) Adoption/Name ChangeInternational Law(A)Juvenile Delinquency (J) Bankruptcy/Insolvency/Foreclosure(B)(L) CollectionLabor, one of the Justices of the(H)(Q) ContractLandlord/Tenant(K)(N) Corporation/Partnership LawNegligence(Personal Injury)Court in Witness, Honorableday of, 20 County,Property Damage Criminal, Quasi-Criminal and(X)(P) Municipal CourtPatent/Trademark/Copyright(C)(R) Domestic Relations (Divorce, Support,Real Estate(S) Custody)Small Claims Court(D)(Attorney must sign above and type name below)(T) Estate/ProbateTax(W) Federal Remedies/Civil RightsWorkers Compensation(E)(Y) Government Agency ProblemsOther Litigation (specify)(F)(G) (Local Thru Federal)(Z) Immigration/NaturalizationOther Non-Litigation (specify)Attorney(s) for(M)IS THE CASE HANDLED BY THE LAWYER STILL PENDING? NO YESOffice and P.O. Address(This Section for Secretary's Use Only)DOCKET NUMBER DATE DOCKETED Telephone No.: Facsimile No.: E-Mail Address:""COMPLETE BOTH SIDE""Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.D.OTHER RELATED COMPLAINTS OR LITIGATION (1)Have you filed a complaint regarding this matter with law enforcement authorities or any other state or federal agency?JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)YES NOIf yes, please state:Name of Agency: Contact Person: Date Filed: Result: (2)Is the matter you are complaining about the subject of a pending civil law suit? YES NO If yes, give name of Court Docket Number: County: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .E.NATURE OF GRIEVANCE:State what the lawyer did or failed to do which may be unethical. State all relevant FACTS including dates, times, places and names and addresses of important witnesses. Attach copies of important letters and documents.THE PEOPLE OF THE STATE OF NEW YORK TO (Use Additional Sheets if Necessary)GREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomYour failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.F.INVESTIGATIVE CONFIDENTIALITY Under Supreme Court Rule 1:20-9(a), once you file this grievance form you are REQUIRED thereafter to keep all communication about this ethical matter CONFIDENTIAL during the investigation until and unless a complaint is issued and served. Only at that time does confidentiality end and the matter becomes public. This investigative confidentiality does not prevent you from discussing the facts underlying your grievance with, or reporting them to, any other person or agency. However, during the investigation you may not disclose the fact that you have filed an ethics grievance to persons other than members of the attorney disciplinary system, except to discuss the case with other witnesses or to consult an attorney., one of the Justices of theCourt in Witness, Honorableday of, 20 County,Date: Signature(Attorney must sign above and type name below)PLEASE REVIEW THE PAMPHLET "INFORMATION ABOUT GRIEVANCE PROCEDURES AND DISCIPLINE OF LAWYERS" PROVIDED BY THE ETHICSAttorney(s) forOffice and P.O. AddressPLEASE NOTIFY DISTRICT SECRETARY OF DISABILITY ACCOMMODATION NEEDSTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com
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