Contact Form Drug Charges PC

*First Name

*Last Name

*Email Address

*Phone Number

*Zip

Street Address

Apt/Ste

Incident Street Address

Incident Apt/Ste

*Incident Zip

Business Phone

Cellular or Pager

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?
YesNo

If yes, when?

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

Have you been convicted of other offenses?
YesNo

If yes, what and when?

Have you been through drug treatment in the past?
YesNo

Are you on probation or parole?
YesNo

For what?

Do you have any other cases pending?
YesNo

Was anyone else arrested?
YesNo

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?
YesNo

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

Were there any witnesses to the alleged offense?
YesNo

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?
YesNo

Who?

Special concerns

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