 |
|
|
|
|
|
|
|
|
||
|
|
You may download and print this form by clicking here.
Mark W. McNeely McNeely Law Office 30 E Washington St, Suite 100 Shelbyville, IN 46176 Fax: 317-392-4321 Fax: 317-392-9329
CRIMINAL FACTUAL QUESTIONNAIRE
PERSONAL INFORMATION
Name: ______________________________________________________________________________
Address: ____________________________________________________________________________
____________________________________________________________________________________
Phone: ______________________________________ Birthdate: ________________________________
Social Security #: ______________________________
Employer: ___________________________________________________________________________
Employer Address: _____________________________________________________________________
____________________________________________________________________________________
Employer Phone: ______________________________ Length of Employment: ______________________
Marital Status: ________________________________________________________________________
Children (Names/Ages): _________________________________________________________________
____________________________________________________________________________________
CURRENT CRIMINAL INFORMATION:
Pending Charges: ______________________________________________________________________
County/Case Number: __________________________________________________________________
Date and Time Present Incident Occurred: ___________________________________________________
Where Present Incident Occurred: _________________________________________________________
Describe the events leading up to the incident in question: ________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Were you arrested/ticketed? ___________ If arrested, amount of bond: ____________________________
Was anyone with you? If so, give names, relationship, addresses and phone number: ____________________
____________________________________________________________________________________
____________________________________________________________________________________
List any witnesses. Please give name, address, phone number and what they can testify to.
____________________________________________________________________________________
____________________________________________________________________________________
PAST CRIMINAL AND JUVENILE HISTORY
Have you ever received a ticket? If so, when, where and for what reason? Please describe the outcome of such ticket. Was it dismissed, paid, etc.?
____________________________________________________________________________________
____________________________________________________________________________________
Have you ever been arrested as an adult or juvenile? If so, please state when you were arrested, where you were arrested, the charges, the cause number and the circumstances surrounding your arrest. Please describe the outcome of such arrest. Did you enter a guilty plea or go to trial? Describe the outcome of the plea or trial.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Have you ever been convicted? If so, please state when you were convicted, where you were convicted, the charges, the county, the cause number and the circumstances surrounding your conviction.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
List any additional information or us as additional writing space if needed;
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Please sign and return to Mark W. McNeely, McNeely Law Office.
Date: _________________ Signature: _________________________________________________
|
|
|
|
Home Page | Make A Payment | About The Staff | Mediation| Estates | Wills | Contact Us Copyright © 2009 McNeely Law Office, Mark W. McNeely. All Right Reserved.
|
|
