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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