Contact Form Sex Offenses 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

City of Arrest

What offense were you arrested for (include Code section)?

Have you previously been convicted of a sex offense?
YesNo

If yes, when?

Have you been convicted of other offenses?
YesNo

If yes, what and when?

Are you on probation or parole?
YesNo

For what?

Do you have any other cases pending?

Are you currently required to register as a sex offender?

Who brought the sex offense charge?

Was anyone else arrested (including the person you were alleged to have assaulted)?
YesNo

If so, name all persons arrested.

List any witnesses to the alleged act.

What statements do you remember making to the police about the event leading to the charge?

Describe the events leading up to the arrest.

Was the alleged victim a friend, acquaintance or family member?
YesNo

If so, describe the relationship.

How old is the alleged victim?

Have you discussed the alleged sex offense or sexual assault with anybody else?
YesNo

If so, with whom did you discuss it and what did you tell him or her?

What is the amount of any bond you posted?

Are there any special bond conditions?

Were you referred by somebody else?
YesNo

Who?

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