Criminal Information Form — Misdemeanors and Felonies

General Contact Information:
First Name:
Last Name:
Street Address:
City:
State:
Zip:
E-mail Address:
Home Phone:
Work Phone:
Pager/Cell Phone:
What method would you prefer we use to contact you?     Phone         E-mail       Fax
What time of day would you like us to call? Morning   Afternoon    Evening    N/A
Marital Status:	Please Choose One Single Married Divorced Separated Widowed
Employer:
Address:
Emergency Contact
Name:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Spouse's Information (Leave as N/A if single)
Full Name:
Date of birth:
Employer:
Employer Address:
Employer's Phone:
Children's Information (Leave as N/A if none)
Name:		Date Of Birth:
Name:		Date Of Birth:
Name:		Date Of Birth:
Name:		Date Of Birth:
Charge Information
What crime(s) are you charged with?
What date did the alleged crime occur?
At what time of day?
Give a brief but thorough description of your version of what allegedly happened (Please be honest, your information is confidential):
Did you make a statement or say anything at all to the police about what happened? Yes    No
Did the police have a search warrant to obtain evidence from you? Yes    No
Are there any co-defendants involved in your case? If so, what are their names? Leave as N/A if none.
Did you submit to any DNA, blood or breathalyzer tests? If so, please describe specifically.
Witness Information
IMPORTANT: If you have no witnesses to subpoena, please indicate: Yes - I have witnesses to subpoena. Please fill out the form below. I UNDERSTAND THAT FOR WITNESSES TO BE SUBPOENAED, I MUST PROVIDE COMPLETE INFORMATION TO MY ATTORNEY, IN WRITING OR BY THIS ONLINE FORM, NO LESS THAN THREE (3) WEEKS PRIOR TO MY COURT DATE! No - I DO NOT have witnesses to subpoena.
Witness #1
Name:
Home Phone:
Address:
City:
State:
Zip:
Witness #2
Name:
Home Phone:
Address:
City:
State:
Zip:
Witness #3
Name:
Home Phone:
Address:
City:
State:
Zip:
Witness #4
Name:
Home Phone:
Address:
City:
State:
Zip:
Retained Clients Only
I understand and agree to the fee of $105.00 for up to one-half hour for a consultation.  If my consultation should exceed one-half hour, I understand that I will be billed at the hourly rate of $210.00 for any and all additional time spent with J.B. Thomas & Associates.  I agree to pay this consultation fee and understand that the fee for this consultation shall be applied toward the total attorney's fee if I retain the services of J.B. Thomas & Associates for this matter. Yes - I agree        No - I disagree