Criminal Defense Case Evaluation Form

Name: Address: City: State: AL AK AS AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VI VA WA WV WI WY Zip: E-mail Address: Home Phone: Business Phone: Cell Phone: Fax Number: Date of alleged incident: Date of arrest or notice to appear: Location of arrest: Law enforcement agency: Officer's Name: Badge Number: Charge made by law enforcement: Have formal charges (information or indictment) been filed by the state or government? Yes No Did the court set a bond? Yes No If so how much was the bond? Did you post a bond or make bail? Yes No If yes, did you utilize a bondsman? If yes, what is the name and phone number of your bail bondsman? Name: Number: Were there any special conditions of your bond? What hearings have you attended? First Appearance Date: Arraignment Date: Pre-trial conference Date: What hearings are scheduled? If yes, was anyone else arrested or charged? Yes No In as much detail as possible, what statements do you remember making to the police at any time? In as much detail as possible, please provide a chronology of events, beginning one hour before the alleged incident until one hour after your arrest, including direct quotes, as you remember them. Were there any witnesses to the alleged incident? Yes No If yes, state names, addresses, phone numbers, and matter about which they are expected to testify. Did you discuss the alleged incident with any one? Yes No If so, state, in as much detail as possible, the content of those conversations and the name, address, and telephone number of the persons with whom you spoke about the incident. Have you ever been convicted of a crime? Yes No If so, what prior convictions do you have, dates of conviction, county and state of conviction. Are you currently on probation or parole? Yes No If yes, for what conviction, in what county and state, and what is the length and termination date? Do you have any other cases pending? Yes No If yes, what is the nature of the pending case and in what county and state is it pending? How were you referred to Uman Law Firm? Website Friend Family Advertisement How did you hear about this website? Website Friend Family Advertisement

Although initial e-mail evaluation forms do not create an attorney-client relationship, all information contained in your evaluation forms and e-mails is and will be treated as privileged and confidential and will never be disseminated nor disclosed to any person or entity without your express permission.

In most cases, you will receive a response within 48 hours.