LAWYERS FOR CRIMINAL JUSTICE
- Los Angeles based Criminal Defense and Immigration Law Firm -
California and federal criminal law, California and federal habeas procedings and related immigration matters.

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