Are you inquiring for yourself or someone else?

Myself Someone Else

Name:*

Address:*

City:*

State:*

Zip Code:*

Main Contact Numbers

Cell*

Home:

Work:

Email Address:*

What are you (or the person you are contacting us on behalf of) charged with: (Please put down all charges)

What Town or Village Court are you charged in?

What County is it in?

Were you (or the person you are contacting us on behalf of) arrested?

Yes No

If arrested, indicate the Date Arrested:

Have you (or the person you are contacting us on behalf of) arrained? (Been brought in front of a judge)

Yes No Don't Know

If so, what is the judge's name?

How long in Jail?

Was bond posted?

Yes No Don't Know

If bond was posted, list $ AMOUNT:

If not arrested, indicate the date ticket was issued:

Are you (or the person you are contacting us on behalf of) employed?

Yes No Don't Know

If employed, list the Occupations(s):

List Salary:

Have you (or the person you are contacting us on behalf of) ever been arrested before?

Yes No Don't Know

If arrested before, when?

Charges:

Any other prior criminal history? (Please list all history, including traffic tickets)

Are you (or the person you are contacting us on behalf of) currently on probation or parole?

Probation Parole No Don't Know

What for?

Are you (or the person you are contacting us on behalf of) a US citizen?

Yes No Don't Know

Do you (or the person you are contacting us on behalf of) have a court date?

Yes No Don't Know

If a court date has been set, indicate the following:

Date:

Time:

What court?

What are your goals? How do you want Sciarrino