Criminal Defense Intake Form

*Name:

*Address:

*City:

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*ZIP:

*E-mail address:

*Home Phone:

Business Phone:

Cellular or Pager:

Facsimile:

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
Choose One Misdemeanor Felony Unknown

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?
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