Assault Contact Form

Name

Email Address

Phone Number

Business Phone

Cellular or Pager

Address

City

State

Zip

Booking #

Driver's License #

Court Date

Time

Court Name

Division/Room

Arresting Officer's Name and Badge

City of Arrest

What were you arrested for (include Code section if known)

Have you been convicted of assault before
Yes  No 

If yes, when

Have you been convicted of other offenses
Yes  No 

If yes, what and when

Are you on probation or parole
Yes  No 

For what

Do you have any other cases pending

Who brought the assault charges

Was anyone else arrested (including the person you were alleged to have assaulted)
Yes  No 

If so, name all persons arrested

List all of the witnesses to the alleged assault

What statements do you remember making to the police about the alleged assault

Describe the order of events leading up to the arrest

Was the alleged assault victim a friend or family member
Yes  No 

If so, describe the relationship

Did you experience any injuries as a result of the alleged assault
Yes  No 

If so, what type of injuries

Were you treated by a doctor for your injuries
Yes  No 

Have you discussed the alleged assault with anybody else
Yes  No 

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

What is the amount of the bond you posted

Are there any special bond conditions

Were you referred by somebody else
Yes  No 

Who

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