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Criminal Intake Form

NOTE: An asterisk (*) indicates REQUIRED information. The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

*Are you calling on behalf of yourself or someone else?:    Myself   Someone else
 
*Name of person in trouble:   
*City:   
*State:   
*Zip:   
*Main Contact Phone Number:   
Cell:   
Home:   
Work:   
*Email Address:   
 
*HOW DID YOU HEAR ABOUT US?
AT&T BellSouth Yellow Pages Phone Book
Yellowpages.com
Referral
FindLaw.com
Attorney Search Network
Google search
Yahoo search
Other:
If you selected other, please indicate the source:   
 
*What are you (or the person you are contacting us on behalf of) charged with?:   
 
*What State has charged you (or the person you are contacting us on behalf of)?:    GEORGIA   ANOTHER STATE

** NOTE: If you selected another state, please stop here. Since the charges involve the laws of another state, Lekan Law Firm cannot assist you with this matter. Please contact an attorney in the state in which you or the other person have been charged.
 
*What county?:   
 
*Were you (or the person you are contacting us on behalf of) arrested?:    Yes   No
If arrested, indicate the Date of Arrest:   
 
How long in jail?:   
 
Was bond posted?:    Yes   No
 
If bond was posted, list the $ AMOUNT:   
 
If not arrested, indicate the date ticket was issued:   
 
Citation Numbers:   
 
*Are you (or the person you are contact us on behalf of) employed?:    Yes   No   Don't Know
 
If employed, list the Occupation(s):   
 
List the Salary:   
 
*Have you (or the person you are contacting us on behalf of) ever been arrested before?:    Yes   No   Don't Know
 
If arrested before, When?:   
 
Charges:

 
Any other prior criminal history? (Please list all history, including traffic tickets):

 
*Are you (or the person you are contacting us on behalf of) currently on probation?:    Yes   No   Don't Know
 
What for?:   
 
*Are you (or the person you are contacting us on behalf of) a US Citizen?:    Yes   No   Don't Know
 
*Do you (or the person you are contacting us on behalf of) have a court date?:    Yes   No   Don't Know
 

If a court date has been set, indicate following:
Date:   
Time:   
What Court?:   
 
*Do you have your case number?:    Yes   No   Don't Know
 
What are your goals? How do you want Lekan Law Firm to assist you (i.e. Go to trial, Plead to charges, Dismissal...)?: