Fill and Sign the For the State of Montana Form

OFFICE OF DISCIPLINARY COUNSEL FOR THE STATE OF MONTANA P.O. Box 1099 Helena, Montana 59624-1099 (406) 442-1648 * PLEASE NOTE ODC’S FORMS AND INFORMATION ARE NOW AVAILABLE ONLINE AT www.montanaodc.org COMPLAINT COVER SHEET (Please read attached inform ation before completing.) Date _______________________ Your Name ____________________________________________________________________ Please Print Legibly Mailing Address ________________________________________________________________ Street or Box No. City State Zip Home Phone ________________ Work Phone ________________ May we call you at work? ____ Attorney’s Name ________________________________________________________________ Name of attorney this complaint is directed against Mailing Address ________________________________________________________________ Street or Box No. City State Zip Date you Hired Attorney _________________________________________________________ Amount Initially Paid Attorney ____________________ Total Amount Paid ________________ Do You Presently Owe the Attorney Any Fees? ____________________________________________ Do You Have a Written Fee Agreement? Y / N If Yes, Please Send Us a COPY. Type of Legal Problem Attorney was Hired to Handle? __________________________________ ________________________________________________________________________\ ______ Is This Matter Still Pending in Court? _______________________________________________ If Yes, Provide the Names of the Other Parties Involved and the Court File Number if You Have this Information: ________________________________________________________________ ________________________________________________________________________\ ______ Have You Previously Filed a Discipline Action Against an Attorney? Y /\ N If Yes, Please Provide the Details on a Separate Sheet of Paper. 1. Attach a separate sheet of paper with a deta iled explanation of the reasons you are filing a complaint against the attorney. Please print legibly. 2. Include as much factual data as possible (i.e. dates, names, phone numbers, amounts of money involved, witnesses, etc.). Please put the information in chronological order. 3. If you have any documents that will help to explain your complaint, please attach copies (do not attach original documents ). 4. Keep the following questions and answers for future reference.