CRIMINAL DEFENSE INTAKE FORM

Name:

Address:

City:

State:
---ALAKAZARCACOCTDEDCFLFAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Zip:

*E-mail address:

Home Phone:

Business Phone:

Cellular or Pager:

Booking #:

Court Date:

Time:

Court Name:

Division/Room:

Arresting Officer's Name and Badge:

City of Arrest:

What were you arrested for (include Code section if known)?

Was the crime for which you were arrested a
---MisdemeanorFelonyUnknown

Have you been convicted of a similar crime before?
Yes No 

If yes, when?

Have you been convicted of other offenses?
Yes No 

If yes, what and when?

Are you on probation or parole?
Yes No 

For what?

Do you have any other cases pending?
Yes No 

Was anyone else arrested?
Yes No 

If so, name(s) of all persons arrested:

What statements do you remember making to the police about the alleged crime?

Describe the order of events leading up to the arrest:

Have you discussed the alleged crime with anybody else?
Yes No 

If so, who did you discuss it with and what did you tell them?

Were there any witnesses to the alleged crime?
Yes No 

If yes, provide names and contact information if known:

What is the amount of the bond you posted?

Are there any special bond conditions?
Yes No 

Were you referred by somebody else?
Yes No 

Who?

Special concerns:

Where did you hear about this website?
---Television AdRadio AdNewspaper AdBillboardsReferred by a FriendSearch Engine

The contents of this contact form are provided by and are the responsibility of the person posting the email communication. Your email will not create an attorney-client relationship and will not necessarily be treated as privileged or confidential. You acknowledge that any reliance on material in email communications is at your own risk.