Usca Form - Complaint Of Judicial Misconduct Or Disability - Judicial Council Of The District Of Columbia Circuit Page 2

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4.
Have you filed any lawsuits against the judge?
Yes
No
If "yes" give the following information about each lawsuit (use the reverse side if more than one)
Court:
Case number:
Present status of lawsuit:
Your lawyer's name:
Address:
_
Telephone:
(
)
Court to which any appeal has been taken in the lawsuit against the judge:
Docket number of the appeal:
Present status of the appeal:
Brief Statement of Facts. Attach a brief statement of the specific facts on which the claim of judicial
5.
misconduct or disability is based on up to five double-sided pages (8.5 x 11"). 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.
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: ____________________
USCA Form
June 2016 (REVISED)

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