Amador — OPREF-036 Court Complaint Form

Source: https://amador.courts.ca.gov/system/files/court-complaint-form.pdf

SUPERIOR COURT OF AMADOR COUNTY 500ARGONAUT LANE, JACKSON,CALIFORNIA 95642 (209) 257-2600

Complaint Form

Last Name First Name/MI

Mailing Address:

Home Phone ( ) Message/Work Phone ( )

Please check the box next to the Department you are complaining about:

Administration Temporary Judge Court appointed Counsel for Child

Courtroom Staff Mediator

Other:

Name of person filing complaint against:

General Nature of Complaint:

Please explain the nature of your complaint in greater detail. Please print or type. Please give detailed information such as dates, times, places, type(s) of complaint(s) and if there were any witnesses. Use the reverse of this form and additional sheets if necessary.

COURT COMPLAINT FORM-(Rev. 09/05/12)-OPREF-036

If you believe that a particular Local Rule of Court or the law has been violated, please list:

Please provide the date upon which the alleged complaint occurred.

Please provide proposed solution or remedy requested.

__________________________________________ ________________________________
Signature of Complainant Date

__________________________________________ ________________________________
Complainant’s Representative (if any) Date

__________________________________________ ________________________________
Received by Date

COURT COMPLAINT FORM-(Rev. 09/05/12)-OPREF-036