Incident Street Address
Cellular or Pager
Driver's License #
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?
If yes, when?
Describe the circumstances of the past drug violation and your sentence, if any
Have you been convicted of other offenses?
If yes, what and when?
Have you been through drug treatment in the past?
Are you on probation or parole?
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 drug offense?
Describe the order of events leading up to the arrest
Have you discussed the alleged drug offense with anybody else?
If so, whom did you discuss it with and what did you tell them?
Were there any witnesses to the alleged offense?
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?
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