Drug Crimes Contact Form

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 specific drug offense were you arrested for (include Code/statute section, if known)?

Have you been convicted of a drug violation before?
Yes  No 

If yes, when?

Describe the circumstances of the past drug violation and your sentence, if any

Have you been convicted of other offenses?
Yes  No 

If yes, what and when?

Have you been through drug treatment in the past?
Yes  No 

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 drug offense?

Describe the order of events leading up to the arrest

Have you discussed the alleged drug offense with anybody else?
Yes  No 

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

Were there any witnesses to the alleged offense?
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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