Law Office of Sharon Curtis, LLC

ATTORNEY, COUNSELOR & MEDIATOR

BOARD CERTIFIED IN CRIMINAL LAW

TEXAS BOARD OF LEGAL SPECIALIZATION

CLIENT INFORMATION SHEET

None of the information that you provide in this sheet can be used without your consent. Please answer these questions fully and truthfully which will end up saving you time, money, and giving us a better chance of success in your case.

Interview Date: ______

Client's Name: ______

Address:______

City______State______Zip Code______

Phone Number(s): Home: ______Cell:______

Work:______Fax:______

Email address:______

What is the best way to reach you by mail or email?______

Age: ______Date Of Birth: / / TX. Driver’s License #: ______

Are you a U.S. Citizen? ______yes______no If not, what is your status in the U.S.?______

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Social Security #: ______Class of Driver’s License: ______

Physical Characteristics: Race ______Height ______Weight ______

Hair Color ______Eye Color ______Marital Status: ______Spouse's Name______

Your Occupation______Employer______

Employer’s Address: ______

How long have you been Employed? ______Previous Employment______

Emergency Contact Person: ______Relation to you:______

Phone Number(s): Cell______home______office______

Address: ______

Email address:______

Spouse's Occupation______Employer______

Spouse’s Cell Phone: ______Spouse's Work Phone:______

Children and Dependents

Name Age Address (If different)

______

Parents: Mother’s Name______Father's Name:______

Address ______

Cell Phone: ______Home Phone______

Available to testify favorably on your behalf?______

CRIMINAL HISTORY, IF ANY:

PRIOR ARREST(S): Year: County: Result:

______

______

______

______

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CURRENT OFFENSE(S): Date of Offense:

______

______

______

Place of Offense: ______Time of Offense: ______

Date of Arrest: ______Place of Arrest: ______

Arresting Agency: ______Bond Amount: ______

Who or What Agency bonded you out, if any? ______

What happened?: ______

______
______
______
______

______

Confession/Statement? If so, to whom?______

Search? If so, by whom?______

Was a search warrant produced? Please explain the events that transpired:______

Do you feel/believe you are innocent of this charge?______

Please explain?______

Please tell us everything else you believe will help us in the handling of your case: Attach an additional sheet if you need to:______

______

______

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WITNESSES:

Name: Address: Cell/Home Phone:

  1. ______
  2. ______
  3. ______
  4. ______

How did you learn about our services? ______

Thanks for taking the time to provide us this information.

______

Client Signature Date

If mailed, please send to:

Law Offices of Sharon Curtis

1216 N. Central Exp. Ste. 205, McKinney, TX 75070

214-726-1881, 214-269-5942-fax