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INTERVIEW QUESTIONNAIRE

JUDGE: ______________________CASE NUMBER:_______________________

NEXT COURT DATE:__________________________________________________

REFERRED TO OUR OFFICE BY:____________________________________

BIOGRAPHICAL INFORMATION

DATE:___________ TELEPHONE NUMBER:_____________________________

EMAIL ADDRESS: _____________________________________________________

NAME:________________________________________________________________

AKA/NICKNAME: __________________________ CELL/PGR: ______________

ADDRESS:_____________________________________________________________
(STREET) (CITY)
_______________________________________________________________________
_ (STATE) (ZIP)
DATE OF BIRTH:_______________ SOC. SEC. NO:_______________________

WHAT WOULD BE THE BEST TIME TO CALL YOU? ____________________


AT WHAT NUMBER: ___________________________________________________
ARE YOUR FAMILY MEMBERS AWARE OF YOUR ARREST? ____________
IS THERE A NEED TO USE DISCRETION WHEN CALLING YOU? _______
_______________________________________________________________________
_

EMPLOYER:___________________________________________________________
SUPERVISOR’S NAME:_________________________TELE. NO.:_____________
HOW LONG EMPLOYED THERE?:______________SALARY:_______________

MARITAL STATUS:____________ CHILDREN:____________________________


(NAMES) (AGES)
SPOUSE’S NAME:______________________________________________________

PERSONS PRESENT (BESIDES SELF) FOR INTERVIEW: _______________


RELATIONSHIP:____________________ TELEPHONE NO:_________________
ADDRESS:_____________________________________________________________

MILITARY SERVICE:___________________________________________________

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(BRANCH) (DATES) (TYPE OF DISCHARGE)
EVER TREATED FOR A MENTAL OR EMOTIONAL ILLNESS?: _________
IF SO, WHEN AND WHERE?:___________________________________________

BRIEFLY EXPLAIN WHAT YOU MAY NEED ADVICE OR ASSISTANCE WITH


TODAY:_________________________________________________________
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ARREST INFORMATION

ARREST DATE:____________________ TIME: _____________ a.m./p.m.

PLACE:____________________________ AGENCY:____________________

LEO’S NAME:______________________ BOND:______________________


(SURETY) (AMOUNT)

CHARGES: (1): _______________________________________________________

(2): _______________________________________________________

(3): _______________________________________________________

(4): _______________________________________________________

CO-DEFENDANTS (IF ANY):____________________________________________

STATEMENTS BY ARRESTEE OR CO-DEF.?:___________________________


(WRITTEN, ORAL OR RECORDED)
_______________________________________________________________________

MIRANDA?:__________________ IF YES, WHEN:_________________________

WITNESSES: (1): ____________________________________________________


(NAME) (ADDRESS) (TELEPHONE) (NATURE OF TEST.)

(2): __________________________________________________

(3): __________________________________________________

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FACTS:________________________________________________________________

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IDEALLY, THINGS TURN OUT PRECISELY THE WAY YOU WANT, WHAT
WOULD THE OUTCOME BE?____________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_____

KNOWING THAT THERE ARE NO GUARANTEES, WHAT CAN YOU


ACCEPT?_______________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
__

PLEASE CLASSIFY YOUR URGENCY IN CONCLUDING THIS MATTER.


(PLEASE CHECK ONE)

( ) CRITICAL--- PERSONAL SAFETY OR CONTINUATION OF BUSINESS


DEPENDS ON IT.

( ) TIME IS NOT AN ISSUE.

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ANY ACTIVE WARRANTS?: ___________________________________________

HAVE YOU EVER FAILED TO APPEAR ON ANY CHARGES? ____________

CURRENTLY ON PROBATION?: ___________IF YES, WHEN WHERE YOU


PLACED ON PROBATION AND FOR HOW LONG?
_______________________________________________________________________
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COURT: _________________ JUDGE: __________________________________

CRIMINAL HISTORY

ADULT
ARREST:______________________________________________________________
(CHARGE) (DATE) (SENTENCE) (A/G?)

ARREST:______________________________________________________________
(CHARGE) (DATE) (SENTENCE) (A/G?)

JUVENILE
ARREST(S):____________________________________________________________
(CHARGE) (DATE) (SENTENCE) (A/G?)

DL HISTORY: _________________________________________________________

OTHER CHARGES PENDING NOW?:____________________________________

( FOR THE LAW OFFICE OF JAMES CRANER, P.A. TO FILL IN )

FINANCIAL ARRANGEMENTS

NONREFUNDABLE ATTY RETAINER FEE: ___________________________

COSTS AND EXPENSES: _____________________________________________

PAYMENT PLAN:_____________________________________________________

LEGAL FEES:
AMOUNT PD.: ________________ DATE: ______________________
AMOUNT PD.: ________________ DATE: ______________________
AMOUNT PD.: ________________ DATE: ______________________
AMOUNT PD.: ________________ DATE: ______________________

TRUST FEES:

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COSTS PD.: ___________________ DATE: ______________________
COSTS PD.: ___________________ DATE: ______________________
COSTS PD.: ___________________ DATE: ______________________