The Disciplinary Board
of the
Supreme Court of Rhode Island

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(Date)
Return Form to: Chief Disciplinary Counsel
John E. Fogarty Judicial Annex
24 Weybosset Street, 2nd Floor
Providence, RI 02903
(401) 222-3270
Fax: (401) 222-1191
Please Print or Type:

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(First)
(Middle Initial)
(Last)


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(Mailing Address - Street or Post Office)


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(City/Town)
(County)    (State)
(Zip Code)

Telephone Number(s): Business:_______________ Home Phone:_______________

Attorney against whom you wish to file a complaint:

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(Name)


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(Mailing Address)

Did you employ the attorney: Yes _____ No _____

If yes, give the approximate date of employment:_________________

If no, what is your connection with the attorney? ____________________________________________

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5. Nature of Complaint. (a) Provide a detailed description (dates, names, etc.) of the attorney's conduct. (b) Attach additional pages as necessary. (c) Please provide a copy of any document(s) that you refer to in your complaint. (d) Please sign your complaint.

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6. If your complaint is about a law suit, please furnish the following information, if available:

Title of Suit:_____________________________________________________________________

Suit Number:_________________ Date Suit Filed (approximate):_________________

Name of Court:_________________

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(Signature)