Theft Contact Form

Name

Email Address

Phone Number

Business Phone

Cellular or Pager

Address

City

State

Zip

Booking #

Driver's License #

Birth Date

Court Date

Time

Court Name

Division/Room

Arresting Officer's Name and Badge

City of Arrest

What offense were you arrested for (include Code section)?

What items did you allegedly take?

What is the asserted value of the items?

Have you previously been convicted of any theft-related crime?
Yes  No 

If yes, when?

Have you been convicted of any other criminal offense?
Yes  No 

If yes, what and when?

Are you on probation or parole?
Yes  No 

If so, for what?

Are there any other pending charges against you?

Does this offense involve your job?
Yes  No 

If so, who is your employer?

Who brought this charge?

Was anyone else arrested (including the person who brought the charge)?
Yes  No 

If so, name all persons arrested?

Was the victim physically injured?
Yes  No 

If so, what were the injuries?

What is your relationship with the alleged victim?

List any witnesses to the alleged act?

What statements do you remember making to the police about the events leading to the charge?

Describe the events leading up to the arrest

Where did the alleged offense occur?

When did the alleged offense occur?

Have you discussed the alleged incident with anybody else?
Yes  No 

If so, with whom did you discuss it and what did you tell him or her?

What is the amount of any bond you posted?

Are there any special bond conditions?

Were you referred to this office by someone?
Yes  No 

If so, who?

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