NOTE: * indicates a required
field.
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| Personal Information |
| Name* |
|
| Date of Birth (mm/dd/yyyy) |
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| Address |
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| City, state, zip |
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| Country |
|
Phone*:
(At least one phone number is required.
Use the format 555-555-5555.)
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| Fax |
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| E-mail |
|
Case Information |
| Briefly explain what you may need advice about or assistance with.* |
|
Do you have a court date?
Where is it and when?
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Briefly explain any prior criminal record,
arrests, convictions, dates and charges. |
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| Which police department arrived?
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| Do you have any photos, reports, bills, estimates or any other documents? |
Yes
No
If yes, please describe what you have.
|
| Were you arrested?
|
Yes
No
If yes, please provide your booking number and name of the jail.
|
| Were any recorded or written statements given or signed during this incident? |
Yes
No
If yes, when and to whom?
|
Other Details |
| Are you completing this form
on behalf of someone else? |
Yes
No
If yes, please provide your contact information.
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| |
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How would you pay for
fees in this matter? |
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| |
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Please tell us how you
found our web site. |
West / FindLaw Legal
Directory (Lawoffice.com)
Martindale-Hubble Legal
Directory (Lawyers.com)
Verizon Superpages
Directory (SuperPages.com)
SBC Smartpages
Directory (Smartpages.com)
Google Search Engine
(Google.com)
AOL Search (AOL.com)
Yahoo! Search (Yahoo.com)
Other (please
indicate):
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