LAWYERS FOR CRIMINAL JUSTICE
- Los Angeles based Criminal Defense and Immigration Law Firm

PLEASE COMPLETE THIS FORM ON BEHALF OF THE DEFENDANT
To ensure your privacy this form is on a secure page and the information will only be used by
Lawyers for Criminal Justice

NON-U.S. CITIZEN CLIENT INTAKE INFORMATION

Name of defendant:

 

Defendant’s prison number:

 
Address:

Telephone:

 

Date of birth:

 

E-mail:

 

Emergency contact:



Country(ies) of nationality:
Date you first entered the United States:

Was this entry with permission?
Yes
Date last entered the United States:

Was this entry with permission?

 
Yes No

What was the last country in which you resided before your last entry into the
United States?


Current immigration status:

Have you ever been placed in removal proceedings before an immigration judge?


Yes

Have you ever been removed from the United States?
Yes No
What other names have you used:

Do you fear you will be harmed if you are returned to your country:




Yes
Explain:

Marrital status:

Spouse immigration status:

Has your spouse ever been placed in removal proceedings before an
immigration judge?


Yes

Has your spouse ever been removed from the United States?

Yes

Number of children:



Children's immigration status:
Have you ever been arrested: when/ for what offense:

Did you see a judge?


Yes
If yes, provide the case number:
 

Contact person for defendant

Name:
Address:
Phone number:

E-mail:

 

What is your relationship to the defendant? 

Do you and/or defendant speak English? 

 
Yes

If not, what language?

 

Did defendant have a jury trial?

 
Yes

Where and when?

 

What was the defendant convicted of?

If there were mutiple counts please list them and the verdict for each:

 

When was defendant sentenced?

 

What was the sentence?

 

Was a notice of appeal filed?

 
Yes

When?

 

Who was defendant’s trial attorney? 

 

Are there any other legal matters currently pending against the defendant?

 

Yes

Please list them:

 

Has defendant ever appealed his/her conviction before?

 

Yes No

What was the last court the case was in? 

 

What legal issues would the defendant, or you, like to see raised in his/her appeal?

 

 

©The Law Office of Tara Selver