The Florida Bar Inquiry/complaint Form Page 2
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2The Florida Bar
Inquiry/Complaint Form
PART ONE: (Read instructions on reverse side.)
Your Name: ___________________________________
Attorney’s Name: _____________________________
Address: _______________________________________
Address: ______________________________________
City: ______________________ State: _____________
City: ______________________ State: ____________
Phone: ________________ Zip Code: _____________
Phone: _________________ Zip Code: ____________
ACAP Reference No. ___________________________
PART TWO: (See reverse, part two.) The specific thing or things I am complaining about are:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
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PART THREE: (See reverse, part three.) The witnesses in support of my allegations are: [see attached
sheet].
PART FOUR: (See reverse, part four.)
I did / did not (circle one or the other) attempt to use ACAP to resolve this situation.
To attempt to resolve this matter, I did the following:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
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PART FIVE (See reverse, part five.): Under penalty of perjury, I declare the foregoing facts are true, correct
and complete.
_______________________________________________________
Signature
Date
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