*Name:

*Address:

*City:

*State:

*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

Have you been convicted of a similar crime before?

If yes, when?

Have you been convicted of other offenses?

If yes, what and when?

Are you on probation or parole?

For what?

Do you have any other cases pending?

Was anyone else arrested?

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?

If so, who did you discuss it with and what did you tell them?

Were there any witnesses to the alleged crime?

If yes, provide names and contact information if known:

What is the amount of the bond you posted?

Are there any special bond conditions?

Were you referred by somebody else?

Who?

Special Concerns:

Where did you hear about this website?