Criminal Defense Intake Form

*Name:

*Address:

*City:

*State:
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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:

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