Drug Crimes Contact Form

*First Name

*Last Name

*Email Address

*Phone Number


Street Address


Incident Street Address

Incident Apt/Ste

*Incident Zip

Business Phone

Cellular or Pager

Booking #

Driver’s License #

Court Date


Court Name


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?
Yes No

If yes, when?

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

Have you been convicted of other offenses?
Yes No

If yes, what and when?

Have you been through drug treatment in the past?
Yes No

Are you on probation or parole?
Yes No

For what?

Do you have any other cases pending?
Yes No

Was anyone else arrested?
Yes No

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?
Yes No

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

Were there any witnesses to the alleged offense?
Yes No

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?
Yes No


Special concerns

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