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b. Title of the suit ________________________________________________________
c. Case number and date suit was filed _______________________________________
d. If you are not a party to this suit, what is your connection with it? Explain briefly.
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If you have copies of court documents, please attach.
3. Explain in detail why you think this attorney has done something improper or has failed to
do something which should have been done. Attach additional sheets of paper if necessary.
Supporting documents, such as copies of a retainer agreement, proof of payment,
correspondence between you and your attorney, the case name and number if
a specific case is involved, and copies of papers filed in connection with the case, may
be useful to our investigation. Do not send originals, as they will not be returned.
Additionally, please do not use staples, post-it notes, or binding. Please limit your
supporting documentation to 25 pages. Information, including audio, video or image
files, submitted on a USB thumb drive or flash drive must not exceed 25MB.
Information received after the 10 day deadline will be returned and not considered,
as well as information submitted on CDs, DVDs, cassette tapes or other unsupported
media.
Include the names, addresses, and telephone number of all persons who
know something about your grievance.
Please be advised that a copy of your grievance will be forwarded to the attorney
named in your grievance. To protect your privacy and the privacy of others, please
redact personal identifying information (i.e., social security number, date of birth)
from any document you provide in support of your grievance and avoid
submitting medical records or protected health information belonging to third-
parties. Please be advised that in the event that you do provide records that contain
your own personal identifying information or protected health information, you
are authorizing us to share this information with the attorney named in your
grievance. Be advised that documents that contain unredacted third party personal
identifying information or that individual’s protected health information will be
returned and not considered. By executing the grievance below, you authorize the
CDC to disclose your personal identifying information and protected health
information as necessary to comply with the law, or as necessary to carry out the
function and duties of the CDC.
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