Florida Complaint Form in PDF

NOTICE

Mailing Instructions

The Florida Bar converts its disciplinary files to electronic media. All submissions are being scanned into an electronic record and hard copies are discarded. To help ensure the timely processing of your inquiry/complaint, please review the following guidelines prior to submitting it to our office.

1.Please limit your submission to no more than 25 pages including exhibits. If you have additional documents available, please make reference to them in your written submission as available upon request. Should Bar counsel need to obtain copies of any such documents, a subsequent request will be sent to you.

2.Please do not bind, or index your documents. You may underline but do not highlight documents under any circumstances. We scan documents for use in our disciplinary files and when scanned, your document highlighting will either not be picked up or may obscure any underlying text.

3.Please refrain from attaching media such as audio tapes or CDs, oversized documents, or photographs. We cannot process any media that cannot be scanned into the electronic record.

4.Please do not submit your original documents. All documents will be discarded after scanning and we will not be able to return any originals submitted to our office. The only original document that should be provided to our office is the inquiry/complaint form.

5.Please do not submit confidential or privileged information. Documents submitted to our office become public record. Confidential/privileged information should be redacted. Such information includes, but is not limited to, bank account numbers, social security numbers, credit card account numbers, medical records, dependency matters, termination of parental rights, guardian ad litem records, child abuse records, adoption records, documents containing names of minor children, original birth and death certificates, Baker Act records, grand jury records, and juvenile delinquency records. If information of this nature is important to your submission, please describe the nature of the information and indicate that it is available upon request. Bar counsel will contact you to make appropriate arrangements for the protection of any such information that is required as part of the investigation of the complaint.

Please be aware that materials received that do not meet these guidelines may be returned. Thank you for your consideration in this respect.

The Florida Bar

Inquiry/Complaint Form

PART ONE (See Page 1, PART ONE – Complainant Information.):

Your Name: _________________________________________________________________________

Organization: ________________________________________________________________________

Address: ____________________________________________________________________________

City, State, Zip Code: __________________________________________________________________

Telephone: __________________________________________________________________________

E-mail: _____________________________________________________________________________

ACAP Reference No.: _________________________________________________________________

PART TWO (See Page 1, PART TWO – Attorney Information.):

Attorney’s Name: _____________________________________________________________________

Address: ____________________________________________________________________________

City, State, Zip Code: __________________________________________________________________

Telephone: __________________________________________________________________________

PART THREE (See Page 1, PART THREE – Facts/Allegations.): The specific thing or things I

am complaining about are: (attach additional sheets as necessary)

PART FOUR (See Page 1, PART FOUR – Witnesses.): The witnesses in support of my

allegations are: [see attached sheet].

PART FIVE (See Page 1, PART FIVE – Signature.): Under penalties of perjury, I declare that the foregoing facts are true, correct and complete.

_________________________________________________

Print Name

_________________________________________________

Signature

_________________________________________________

Date