CRIMINAL INTAKE
CLIENT: _________________________________________________ DATE:__________________
ADDRESS: ___________________________________________ PHONE:____________________
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LICENSE # AND STATE: ________________________________ SS#______________________
AGE______ DOB:_________ COURT AND COURT DATE_______________________________
DATE OF ARREST_________________ POLICE DEPARTMENT___________________________
PRIOR CONVICTIONS______________________________________________________________
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PROBATION OR PAROLE: _________________________________________________________
ANY OTHER CASES PENDING IN ANY OTHER COURT OR STATE:________________________
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IMMIGRATION STATUS: ____________________________________________________________
NOTES:__________________________________________________________________________
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