2012 annual report - Supreme Court - State of Ohio

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6) Was your agreement for services with the attorney in writing? Yes NoIf yes, attach a copy of the agreement. If not, please explain the terms of your agreement.7) What is your alleged loss amount?If loss was property, give details and value of property on a separate sheet.8) What is the date you became aware or learned of the loss?9) What happened that made you aware of the loss?10) Were you, at the time of the loss, the spouse, close relative, partner, associate, employee oremployer of the attorney, or a business entity controlled by the attorney? YesNoIf yes, give relationship:11) Has any part of the loss been recovered? If so, when?From whom? In what amount? $12) Was the loss covered by any insurance or bond? If so, please give the name and address ofthe insurance or bonding company:13) Describe what steps you have taken to recover the loss directly from the attorney, or any othersource:32• Any recovery made by claimant from other sources prior to a CSF determination of eligibility must bereported to the fund. Recoveries not reported to the fund are grounds to deny a claim. Any recoverymade by claimant after a CSF determination of eligibility will be subrogated back to the fund. The fundwill retain all subrogation rights if compensation is made to the client by the fund. The claimaint mustexecute a CSF release and subrogation agreement before receiving an award.
AFFIRMATIVE ACTION14) Have you reported this loss to any of the following agencies: If you checked any of the itemsbelow, please indicate the date reported, name/address of the agency and contact person, ifknown.Local Prosecutor:Date Reported:Office of Disciplinary:Counsel:Date Reported:Local Police Department:Date Reported:Local Bar:Association:Date Reported:Name of Bar Association:15) If you are currently being represented by an attorney, please provide the followinginformation:Attorney’s Name:Address:City: State: ZIP Code:Telephone: ( )16) How did you learn of the Clients’ Security Fund?Court Rules do not permit attorneys who help clients process claims with the Fund to charge legal feesfor that service. Attorneys may apply to the Fund for reimbursement of fees.Should you receive an award from the Fund, the facts relating to your loss become a public record.I (We) have read this Statement of Complaint and certify that under penalty of perjury the contentsthereof are true of my own knowledge and belief.Witness Signature of Claimant DateWitness Signature of Second Claimant DateNotary Public33
Page 1: 2012 annual reportClients’ Securi
Page 4 and 5: Clients’ Security Fund of OhioJER
Page 7: INTRODUCTIONThe Clients’ Security
Page 10 and 11: BOARD OF COMMISSIONERSMEMBERSCUNIJO
Page 12 and 13: REVENUEATTORNEY REGISTRATION FEESEv
Page 14 and 15: CLAIMS PROCEDUREINTAKE AND EVALUATI
Page 16 and 17: CLAIMS ACTIVITYThe CSF board of com
Page 19 and 20: AWARDS BY DISCIPLINED OR DECEASED A
Page 21: CONCLUSIONThis report confirms that
Page 24 and 25: OHIO LAWYERS INVOLVED IN AWARDS SIN
Page 37: APPENDIX BCLIENTS’ SECURITY FUND
Page 42 and 43: and no-front-end-load money market
Page 44 and 45: is made, the date of the alleged wr
Page 46 and 47: FORMER COMMISSIONERSCLIENTS’ SECU
Page 48: The Supreme Court of OhioClients’

2012 annual report - Supreme Court - State of Ohio

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