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Personal Information
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First Name
Last Name
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Home Phone
Work Phone
Other Phone
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Email Address
How did you find us?
How did you find us (other)?
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| What's the Best Time to Contact You: am pm |
| Where Would You Like to be Contacted: Home Work Other |
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Case Information
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Date of Arrest
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Upcoming Court Dates
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Arresting Officer
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Judge's Name
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| Have you already been arraigned? Yes No |
| If yes, what was the date? |
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Briefly describe the charges against you:
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| Do you have any previous misdemeanor convictions? Yes No |
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If yes, please describe them:
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| Do you have any previous felony convictions? Yes No |
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If yes, please describe them:
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| Is there a bond currently set in your case? Yes No |
| If yes, what is the amount? |
Additional Comments:
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