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Attachment C
Attachment C
Attachment C
Record of Criminal Cases/Traffic Violations
Name
First
Middle Initial
Last
Email
*
Please indicate whether the matter described below involves a criminal matter, or a minor traffic violation not involving drugs/or alcohol.
Criminal Matter
Moving Traffic Violation
Date of Incident ( or time period involved):
MM
DD
YYYY
Age at time of incident:
Location of Incident:
City / County
State / Province / Region
Title of complaint or indictment:
Court File Number
Date(s) the complaint or indictment was filed:
Name and complete address of court or entity with possession of documents:
Name of Court
Address
City, State, ZIP Code
Telephone Number
Name and complete address of law enforcement agency involved:
Name
Address
City, State, ZIP Code
Telephone Number
Name and complete address of entity bringing charges:
Name
Address
City, State, ZIP Code
Telephone Number
Name and complete address of attorney retained in defense of this matter:
Name of Attorney
Address
City, State, ZIP Code
Telephone Number
Date first heard:
MM
DD
YYYY
Charge(s) at time of arrest/citation:
Charge(s) at time of trial:
Date Format: MM slash DD slash YYYY
Final Disposition:
Brief description of incident as well as circumstances leading up to and surrounding the same:
***Attach, where applicable, certified copies of docket sheet(s), the charging documents, police records, etc., as well as the judgment of convictions, the presentence investigation (if applicable) and any other relevant pleadings.
Drop files here or
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