Name
Email Address
Phone Number
Business Phone
Cellular or Pager
Address
City
State
Zip
Booking #
Driver's License #
Court Date
Time
Court Name
Division/Room
Arresting Officer's Name and Badge
City of Arrest
What were you arrested for (include Code section)?
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?
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?
Were you referred by somebody else? Yes No
Who?
Special concerns
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