Online Contact Form

Name:

Email Address:

Daytime Phone:

Date of Arrest:

Arrest Location (include county if other than Leon):

Do you have any prior criminal convictions in any state? Yes No

If so, please list (include month, year and result):

Are you on probation or parole? Yes No

Did this charge involve an accident? Yes No

Were there any injuries? Yes No

If so, please explain:

Were you given field sobriety exercises? Yes No

Did you take the breath test? Yes No

If so, what were the results of samples 1 and 2?

Were you advised of your Miranda Rights? Yes No