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Mark W. McNeely

McNeely Law Office

30 E Washington St, Suite 100

Shelbyville, IN 46176

Fax:  317-392-4321

Fax:  317-392-9329

 

CRIMINAL FACTUAL QUESTIONNAIRE

 

 

PERSONAL INFORMATION

 

Name: ______________________________________________________________________________

 

Address: ____________________________________________________________________________

 

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Phone: ______________________________________ Birthdate: ________________________________

 

Social Security #: ______________________________

 

Employer: ___________________________________________________________________________

 

Employer Address: _____________________________________________________________________

 

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Employer Phone: ______________________________ Length of Employment: ______________________

 

Marital Status: ________________________________________________________________________

 

Children (Names/Ages): _________________________________________________________________

 

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CURRENT CRIMINAL INFORMATION:

 

Pending Charges: ______________________________________________________________________

 

County/Case Number: __________________________________________________________________

 

Date and Time Present Incident Occurred: ___________________________________________________

 

Where Present Incident Occurred: _________________________________________________________

 

Describe the events leading up to the incident in question: ________________________________________

 

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Were you arrested/ticketed? ___________ If arrested, amount of bond: ____________________________

 

Was anyone with you? If so, give names, relationship, addresses and phone number: ____________________

 

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List any witnesses. Please give name, address, phone number and what they can testify to.

 

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PAST CRIMINAL AND JUVENILE HISTORY

 

Have you ever received a ticket? If so, when, where and for what reason?  Please describe the outcome of such ticket. Was it dismissed, paid, etc.?

 

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Have you ever been arrested as an adult or juvenile? If so, please state when you were arrested, where you were arrested, the charges, the cause number and the circumstances surrounding your arrest. Please describe the outcome of such arrest. Did you enter a guilty plea or go to trial? Describe the outcome of the plea or trial.

 

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Have you ever been convicted? If so, please state when you were convicted, where you were convicted, the charges, the county, the cause number and the circumstances surrounding your conviction.

 

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List any additional information or us as additional writing space if needed;

 

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Please sign and return to Mark W. McNeely, McNeely Law Office.

 

Date: _________________          Signature: _________________________________________________

 

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