Form 2: Municipal Court Questionnaire

• Library: Criminal Law Forms (ABA) (2013 Ed.)

Form 2: Municipal Court Questionnaire

PLEASE FILL OUT BOTH PAGES OF OUR CONFIDENTIAL INTERVIEW FORM AND RETURN TO FRONT DESK

KENNETH VERCAMMEN & ASSOCIATES, PC ATTORNEY AT LAW 2053 WOODBRIDGE AVENUE EDISON, NJ 08817 732-572-0500

PLEASE PRINT

NAME __________

ADDRESS __________

CITY __________ STATE ___ ZIP __________

CELL #(___)__________ PHONE-DAY(___)__________

NIGHT (___)__________

TODAY'S DATE ___/___/___ E-MAIL __________

Referred By: __________

If referred by a person, is this a client or attorney? If you heard about the law office on the Internet, what search terms did you use?

WHAT ARE YOU CHARGED WITH (Not the Summon(s) #) [provide tickets, hearing notice and other important papers to front desk to be copied]

1. __________

2. __________

3. __________

IMPORTANT INFORMATION

Date of Offense: __________ Time: __________ (A.M./P.M.) Your Age __________

Town: __________ (street/location)? __________

What Happened: __________

Write additional details on the back of this page. YOU MUST FILL OUT BOTH PAGES PRIOR TO SEEING THE ATTORNEY.

Mun Ct Questionnaire rev 9/19/12

Kenneth Vercammen, Esq. Confidential interview form page 2

Other Persons Arrested or Witnesses: [If none write none]

__________
co-defendant/ Witness Name

__________
Their Address

__________
Phone No.

__________
Name

__________
Address

__________
Phone No.

3. Write down everything you said in police presence. What did police say to you...